A phenomenological study exploring the experiences of protective isolation in patients undergoing allogenic Haematopoietic Stem cell Tranplantation
Patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) become pancytopenic after myelosuppressive chemotherapy. To lower the infection risk, they usually receive hospital care in protective isolation until full neutrophil recovery. Protective isolation may cause psychological distress, as the level of depression was found to double after a short time in isolation. Therefore, this study aimed to explore the lived experiences of protective isolation in adult patients who had been cared for allogeneic HSCT.
Material and methods
Following the Giorgi's approach, a descriptive phenomenological study was conducted during October 2015 in a university hospital in Rome. After gaining written consent, two nurses interviewed 10 patients (7 female, age ranging 28–66), who had undergone allogeneic HSCT 30-2190 days previously. They were diagnosed with leukemia (n = 7) or lymphoma (n = 3). Participants were asked about their hospital stay in isolation using open-ended and un-structured questions, such as ‘What did it mean for you being isolated?’.
An overarching theme emerged as being in isolation to achieve transformation. The inductive content analysis yielded 3 themes and 11 subthemes. The theme ‘the special place for transformation’ included: (1a) feeling (un)safe in a limited setting, (1b) waiting time alone, and (1c) living the transformation of the relationship with loved ones. The theme ‘the experience of embodied transformation’ included: (2a) recognising the sources of problems, (2b) interpreting the signs of transformation, (2c) losing control on body and mind, and (2d) finding the inner strength. The theme ‘light and shade from in and out’ included: (3a) receiving gifts from others, (3b) being informed and motivated, (3c) being grateful for the care, and (3d) recognising that the darkness may prevail.
Patients may live the experience of being cared for allogeneic HSCT in protective isolation as a transformation process. This transformation requires a special place to occur, involves inner changes of body and mind, and is influenced by light and shade from inside and outside. Since patients in isolation may suffer because of loneliness, lack of freedom, and total distress, healthcare providers should monitor the impact of protective measures on the patients' overall quality of life.