Mental health considerations for patients in isolation
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Mental Health Considerations for Patients in Isolation. Robin Zagurski, LCSW. Bulling, D., Zagurski, R., & Hoffman, S. (2007). Behavioral Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center.

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Bulling, D., Zagurski, R., & Hoffman, S. (2007). Behavioral Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center


Nebraska behavioral health guidelines for medical isolation l.jpg
Nebraska Behavioral Health Guidelines for Medical Isolation Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Assist Nebraska hospitals in meeting the behavioral health needs of patients

  • Background information related to stress

  • Guidelines for services to patients, families, staff, and the community

  • Appendices include an adaptable template policy and other resources


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Patients Admitted to Isolation Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Higher rates:

    • anxiety

    • depression

  • Lower ratings:

    • self-esteem

    • sense of control

      (Gammon, 1998; Davies & Rees, 2000).


Patients l.jpg
Patients Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • May regress to lower levels of functioning

  • May become “annoyingly assertive”, demanding, or fussy with outbursts of temper (Denton, 1986)

  • Can feel out of control

    • Control number of visitors

    • Reassess over time


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Communication Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • People under stress often do not completely understand directions or information

  • Statement of empathy within the first 30 seconds (B. Reynolds, Centers for Disease Control and Prevention, personal communication, January 23, 2007)

  • Directions and information may need to be repeated

    • Present directions in more than one form

      • verbal and written


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Non-native speakers Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Language skills decrease under stress

    • Utilize a professional interpreter

    • Provide information in a culturally and developmentally appropriate manner

  • Use listening skills


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Gowning and Gloving Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Decreases time available for patient interaction

  • Cuts down on impromptu visits

    • Perceived as "a reluctance of some staff members to enter the room" (Kelly-Rossini, Perlman, & Mason, 1996)

  • “Isolate the organism, not the patient” (Denton 1986)


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Patients Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

Families

Hospital Staff/Volunteers

Community

Triage

Inform

Support

Treat

Guidelines Format


Patient triage l.jpg
Patient - Triage Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Assess mental status

    • Admission

    • Periodically throughout isolation


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Patients - Inform Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Common responses to isolation

  • Native language

    • Professional interpreter

  • Multiple modes of communication


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Patients - Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Immediately (30 seconds) use pleasantries; make eye contact

  • Build a relationship with the patient

  • Psychological first aid

    • SOLER

  • Periodically assess visitor restrictions


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Patient Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Allow and encourage reminders of home

  • Provide access to communication means

  • Respond promptly to call lights

  • Encourage exercise; visits; favorite foods


Patient treat l.jpg
Patient - Treat Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Refer to psychiatrist or licensed mental health practitioner for further assessment or treatment

  • Employ suicide precautions as applicable


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Families Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Have their own “particular isolation and experience feelings of guilt, pity and role strain” (Wu, Mu, Tsay, & Chiou, 2005).

  • May avoid typical social interactions with friends and family

  • Unique stressors include:

    • concern about transmissibility

    • restrictions on contact

    • possible use of personal protective equipment by family members

    • potential stigmatization by community members


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Families - Triage Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

Monitor:

  • Stress

  • Expressions of distress


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Families - Inform Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Obtain release of information from patient

  • Provide information:

    • Isolation precautions

    • Illness

    • Risks to patient and others

    • Common responses to isolation


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Families - Inform Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Inform family prior to releasing information to media

  • Suggest internet pages as a way to keep friends and others informed of patient progress

  • Keep family informed while they are away from the hospital

    • Pagers

    • Cell phones


Families support l.jpg
Families - Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Inquire about spiritual needs

  • Encourage frequent breaks from hospital setting

  • Encourage accepting help from others

  • Create a space to gather away from media

  • Encourage adequate sleep and nutrition


Families treat l.jpg
Families - Treat Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Provide referral information (for community or hospital resources prn)


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“Non-essential Staff” Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

“Nonessential staff reported feeling isolated and ineffective in contributing meaningfully to the crisis. The term nonessential may have contributed to this sense. Some were called back to work in re-deployed roles and indicated that it was psychologically more satisfying to work than to stay home.” (Maunder et al, 2003)


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“Non-essential Staff” Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

Pre-identify roles for staff in this category:

  • Allow them to contribute to the resolution of the emergency

  • Stay connected to the hospital

  • Provide support for co-workers who remain in service

    • Child care

    • Shopping services

    • Transportation

    • Lodging

    • Possible economic support

      • Centers for Disease Control (2004)


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Hospital Staff/Volunteers - Triage Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

Supervisors regularly assess staff:

  • Stress levels

  • Coping

  • Fitness for duty


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Hospital Staff/Volunteers - Inform Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Provide information about risks of working with patients

  • Frequent updates to staff on upcoming media reports or press releases

  • Praise and thank workers

  • Hold daily multidisciplinary staff meetings

  • Control rumors by dispensing regular, accurate information to all staff


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Hospital Staff/Volunteers - Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Provide break area away from isolation unit for respite

    • Include trained peers or BH staff

    • Food and drink in a peaceful setting

    • Massage

    • Private space for confidential phone conversations

    • Space to rest comfortably

  • Consider mandatory breaks


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Hospital Staff/Volunteers - Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Maunder and associates (2003) noted that senior staff “acted as role models” by appropriately taking breaks in the designated break areas during the SARS outbreak in Canada


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Hospital Staff/Volunteers - Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Hold regular staff meetings

    • Include mental health support

  • Access Nebraska’s CISM resources

    • http://www.cism.nebraska.edu/

  • Encourage contact with own family via phone

  • Consider enlisting confidential phone support from in-house or community mental health professionals


Hospital staff volunteers treat l.jpg
Hospital Staff/Volunteers - Treat Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Provide referral information for in-house or community resources (e.g., Employee Assistance Program)


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Community Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • In large-scale infections (such as SARS) or a bioterrorism event, it is likely that the community will be interested and affected indirectly by hospital isolation precautions

  • Psychological Casualties


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Community Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

High stress/low trust conditions:

  • Easing the community’s fears of contagion decreases stigma to staff and their families and may lessen psychological casualties in the community


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Community Members - Triage Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Utilize outreach to the community

  • Consider providing intervention/referral training to community members in a position to detect stress/distress in others (e.g., teachers, clinic nurses, faith leaders


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Community Members - Inform Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Provide frequent updates to media

  • Follow good risk communication practices

  • Release:

    • Technical information to community health professionals and hotlines

    • Translations of media information to non-English speaking populations

    • Information to public on how they can be most helpful to those affected by isolation precautions


Community members support l.jpg
Community Members - Support Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

  • Arrange for location outside of hospital for community members to gather if needed or desired

    • Arrange for behavioral health support on site


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Community Members - Treat Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

Provide to media:

  • List of potential referral sources

  • Information on when to seek help


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Psychological First Aid Health Guidelines for Medical Isolation, Lincoln, NE: University of Nebraska Public Policy Center and the University of Nebraska Medical Center

The Nebraska Psychological First Aid curriculum (2004)

In-person training:

Nebraska Regional Behavioral Health Authorities (http://www.disastermh.nebraska.edu/regional.html)

on-line:(http://www.bordersalertandready.com/catalog/module.php?subjectid=11)


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