This phenomenological study explored the perceptions nursing essay

This study looked at patients’ perceptions of reverse isolation while undergoing autologous bone marrow transplant (ABMT). Persons in reverse isolation experience both obvious and less evident stressors. To understand patients’ perceptions of these stressors, semi-structured audiotaped interviews were held periodically during isolation (21-25 days) with six subjects receiving ABMT. This identified recurrent themes, which were then validated in a final interview. Most subjects understood the rationale of reverse isolation, and many prepared by bringing objects of personal value with them. Few mentioned feeling restricted by the room after the initial days. Some patients used the TV, VCR, radio, and telephone as ” extensions to the world,” as well as for entertainment. Subjects found visits from their main supports very important in coping with feelings of isolation. The patients’ emphasis on a variety of ways to pass time was particularly interesting. The overall finding, however, was that the physical side effects of the treatment brought more distress than the isolationThe authors questioned the directors of 13 protected-environment installations on the psychological effects of protected environment treatment. Psychological problems reported included anxiety, depression, sleep disturbance, withdrawal, regression, and hallucinations. Children seemed to adapt better than adults to protected environments. Respondents recommended the use of preentry orientation, structured recreation programs, steps to prevent time disorientation, and psychological support for both patients and staff to minimize the psychological effects of treatment in protected environmentsA variety of infection prevention and control precautions are used to minimise the risk of infection spread from person to person, both patients and staff. Standard Precautions (SPs), including hand hygiene and use of personal protective equipment (PPE), are applied routinely to all patients, whereas transmission-based precautions (TBPs) are used when a patient is known or suspected to have an epidemiologically important infectious disease or condition, in order to further reduce the risk of spread of infection. The use of single room isolation is part of TBPs and is a cornerstone of hospital infection prevention and control practice. However, successfully implementing TBPs, including single room isolation, continues to be a challenge in the UK for a number of reasons. Effective approaches to increasing the quality and safety of patient care are increasingly based on utilising simple tools that increase the likelihood that care will be provided in a reliable way. The tool presented is intended to facilitate both learning and practice in relation to TBPs and to promote the delivery of safe patient care in relation to single room isolation. It is designed for use in those situations when a single room is available for patient isolation. It also highlights the other important TBPs to be taken to prevent the spread of infection, whether or not a single room is available. It can be adapted for use with any organism or disease for which TBPs are recommended. At a time when healthcare associated infections (HCAI) such as Clostridium difficile and meticillin resistant Staphylococcus aureus (MRSA) continue to have an impact on both acute and community care settings, and their reduction is embedded within national targets for NHS healthcare providers, tools that make it easy for healthcare workers to apply safe practices within their daily routines are essential. Initial testing suggests that this tool is acceptable to healthcare workers and further study will identify its potential contribution to healthcare workers’ knowledge and practice in this area. Bone marrow transplantation (BMT) is being increasingly used to treat children and adults with a variety of life-threatening diseases. Although BMT is a life-saving intervention in many instances, it is a high-technology procedure–both aggressive and life-threatening–associated with an array of physical and psychological stressors. Therefore, psychiatric and psychosocial research and intervention can greatly contribute to the understanding and management of BMT recipients, donors, and their families. Seven major areas of psychiatric and psychosocial concern in BMT are identified and the literature relevant to each area is reviewed. Since October 1988 there has been an isolation ward at Basle Cantonal Hospital. Its purpose is to treat patients with high dose chemotherapy and bone marrow transplantation under protective isolation and by standardized criteria. The isolation ward has two sub-units, viz. the reverse isolation for neutropenic patients (8 single room units) and the LAF unit (5 laminar airflow units) for allogeneic bone marrow transplantation (BMT). Up to July 1992, 287 patients (152 males and 133 females) required 527 hospitalizations. The median age was 41 (5-82) years in the reverse isolation unit and 28 (4-61) years in the LAF unit. Bed occupation was 90% and 82% throughout the period. 71% of patients were from the Basle area and the rest from elsewhere in Switzerland or from other countries. Diagnosis: acute leukemias (112); myelodysplastic or myeloproliferative syndromes (52); severe aplastic anemia or agranulocytosis (46); lymphoproliferative syndromes (50); solid tumors (28). Indications for hospitalisation: BMT (107); complications after BMT (infections, GvHD) (63); chemotherapy on protocols of SAKK (105); other chemotherapies (64); antilymphocyte globulin or growth factor treatment (27); splenectomies (18); neutropenic fever (62); patient work-up (59); terminal care (20). Patients in reverse isolation were hospitalized for a median 17 (1-142) days; in the LAF unit for 52 (1-121) days.(ABSTRACT TRUNCATED AT 250 WORDS)There has been a remarkable growth in the use of bone marrow transplantation (BMT) in the past 30 years. The rapid expansion of BMT reflects its increasingly important role in the treatment of several life-threatening diseases of the hemopoietic system. The first BMT in human patients was performed after conditioning with total body irradiation (TBI). As an important part of BMT protocols, TBI has an established role in many preparative regimens used before BMT in the treatment of hematological diseases. Historically, TBI schedules varied during the last 30-year period with regard to different radiation source used, treatment technique, beam modifiers, actually delivered total dose, dose rate, and fractionation schedule. The aim of this review article is to discuss the 50- year experience in the field of TBI, as well as radiobiological, technical and dosimetric requirements and especially effects of total dose, dose rate and fractionation schedules on the prognosis of transplanted patients. The radiobiological and radio-oncological requirements demand special TBI treatment techniques quite different from usual radiotherapy. The technique needed depends extremely on the prescribed values of treatment parameters and on the local technical possibilities. TBI dosimetry has to account for the physical situation of treatment with very large field sizes at extended distances and should be performed under TBI conditions close to the real treatment situation. The effects of total dose, dose rate, fractionation schedule on the leukemia cell killing, immunosuppression, and sparing of normal tissues are considered in detail. Their effects on overall survival, leukemia recurrence, acute and chronic graft versus host disease (GvHD), late radiation-induced injuries to normal tissues or organs as well as incidence of interstitial pneumonitis, renal dysfunction and cataract development are analyzed. The definition of currently used TBI procedures is so different in different centers that retrospective analyses remain futile, under better definition and normalization of dose, fraction size, and endpoints occur. There are a lot of difficulties to evaluate, compare or understand clinical RESULTS from so different treatment regimens, often with an irregular set of parameters. In order to establish clinical trials and to evaluate clinical RESULTS, we need comparable schedules, uniform specification, and complete reporting of all relevant parameters. After 50-year experience in the field of TBI, we are beginning to understand the relationship of TBI dose, dose rate and fractionation. However, 20 years after Glasgow we will repeat his persuasion that, however, many questions remain unanswered.