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A small but growing body of literature has indicated that contact precautions may be used unnecessarily at times and may contribute unnecessarily to patient loneliness, stigmatization, boredom, anxiety, depression, and decreased patient satisfaction. The time consuming and costly action of donning personal protective equipment (PPE) before having a conversation with the patient creates a barrier to communication and can negatively affect the patient experience.
Description of Methods
This IRB-approved nursing research project was a time series, multiple pre-test; multiple control quasi-experimental study in which the units of analysis are groups of patients cared for in geographically distinct medical-surgical nursing units. A single treatment unit carried out the research intervention and outcomes were compared to outcomes on four control units.
This study created a Safe Zone in contact isolation rooms on the treatment unit. A Safe Zone is a 3-foot square floor space outlined with duct tape extending from the threshold of the door into the patient room. Inside this space, any healthcare worker could stand and carry on a conversation with the patient without donning PPE.
The Caring Assessment Tool (CAT-V) and the Patient Evaluation of Emotional Care During Hospitalization (PEECH) were administered to all patients in the study. Random observations of patient-personnel interaction on all units were recorded on an observation checklist. Infection rates were monitored for all units involved in the study.
Summary of Outcomes/Data
Observations of 897 encounters among 146 random patients on contact isolation precautions revealed that control units used a de facto Safe Zone procedure when staff members stood in patient room doorways to communicate with patients without donning PPE. Over the entire sample of observations, only 10% of patient encounters took place in the doorway (in the Safe Zone). There was an expected significant relationship (X2 = 128.7; p = .0001) between donning PPE and entering the patient’s room.
On both PEECH and CAT-V tools, higher scores corresponded to perception of greater nurse or staff emotional caring. The mean PEECH score on the treatment unit was 53, while the mean PEECH score on control units was 36. The mean CAT-V score for treatment unit patients was 118, while the mean CAT-V for patients on the control units was 93. The differences in scores between units for both tools were statistically significant. Scores on the CAT-V were highly correlated with scores on the PEECH. Rates of targeted infections remained low and were not significantly different between units, indicating the Safe Zone procedure is safe.
Recommendations
This research project found that infection rates remained low when the Safe Zone procedure was observed to be used informally across all units. However, scores on emotional caring was significantly higher on the treatment unit. There was a stronger Clinical Nurse Leaders (CNL) presence on the treatment unit compared to the control units during the study period, thus CNL presence may have confounded the effects of the Safe Zone procedure. Further research on the effect of Clinical Nurse Leaders presence on patient perception of emotional caring is recommended.