Social isolation and loneliness may not at first seem like a significant problem. However, it has the potential to be debilitating to patients and has major impacts on their quality of life. While all patients may be at risk for isolation, older adults have the highest risk due to the loss of spouses and friends, living alone, and chronic illnesses. While social isolation may not be an acute concern, research shows that isolation increases the risk of dementia, heart disease, and stroke, as well as depression and suicide.
For patients who are socially isolated, nurses and other healthcare professionals may be some of the main contacts and social interactions for these patients. Nurses must be attuned to the barriers these patients face and may have to tread lightly as patients may not be forthcoming with their feelings of loneliness. Nurses can offer nonjudgmental suggestions, be supportive advocates, or simply be a listening friend to patients feeling alone.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of social isolation:
- Developmental delays
- Impaired cognitive functioning
- Abnormalities in physical appearance
- Inappropriate social behavior
- Inability to engage in or maintain relationships
- Traumatic experiences causing psychological or emotional pain
- Disabilities (motor, speech, cognition)
- Frequent illnesses, hospitalizations, or complex treatments
- Living alone
- Lack of a support system
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of social isolation. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
Subjective: (Patient reports)
- Feelings of loneliness and rejection
- Insecurity in relationships
- Fear and anxiety
- Interests, values, or behavior are viewed as socially or culturally different or unacceptable
- Prefers to be alone
Objective: (Nurse assesses)
- Absence of support through family or friends
- Diagnosis of mental disorder that has the potential to affect relationships (for example: PTSD, schizophrenia)
- Flat or dull affect
- Irritable or hostile demeanor
- Physical limitation that prevents social interaction (bedridden, paralysis)
- Nonverbal or poor ability to communicate; speech impediment
- Inappropriate social cues or behavior
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for social isolation:
- Patient will express a desire to interact with others and will seek social engagement.
- Patient will learn social and communication skills to improve relationships.
- Patient will express a feeling of improved self-worth and confidence.
- Patient will participate in activities with others that align with their interests and mental/physical capabilities.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to social isolation.
1. Determine barriers to socialization.
If there are barriers to socialization such as a patient not having access to adaptive equipment, the nurse should explore potential solutions to help the patient overcome these barriers.
2. Assess the patient’s feelings and perceptions.
It can be embarrassing to admit to feeling lonely. The nurse can assess if the patient has hobbies or interests and if they have friends to enjoy them with. The nurse may also be able to suggest public groups or programs for the patient to take part in.
3. Recognize signs of isolation due to low self-esteem.
Patients who struggle with low self-esteem may feel uncomfortable in new situations. The nurse may be able to explore techniques to improve self-esteem or recommend counseling.
4. Note unusual social behaviors or missing social cues.
The nurse can observe for inconsistent communication, lack of understanding of humor or sarcasm, or a dislike of being touched as barriers to adequate socialization. Some patient populations may benefit from coaching on communication strategies.
5. Identify strained relationships or missing support systems.
Patients often divulge information about an estranged spouse or children, living far away from family, or difficulties in personal relationships. Listen closely for these statements as they may be a way of the patient wanting to discuss feelings of loneliness or abandonment.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with social isolation.
1. Offer yourself as a nonjudgmental listener.
Patients who may feel isolated due to rejection or a feeling of not belonging may not feel safe to open up. They may respond with hostility or short answers as a defense mechanism. Establishing a therapeutic relationship promotes trust and a safe space for the patient to discuss sensitive matters.
2. Utilize multidisciplinary support for assistance with social skills.
Some patients that struggle with communication may benefit from behavioral therapists to assist with teaching social and communication skills. Those with a stutter can work with a speech therapist. Physical and motor impairments can benefit from physical therapy and occupational therapy.
3. Encourage support groups.
Patients may feel isolated due to a chronic health condition such as a colostomy, pain, or autoimmune disease. Speaking with others who are enduring the same challenges can make the patient feel less alone.
4. Use technology.
Socialization isn’t strictly for face-to-face interaction. All patients can benefit from online forums, chat groups, and communication apps, and phone calls to foster relationships.
5. Refer to therapy for deeper issues.
Patients who have experienced deep losses, such as an older adult who lost their spouse or other situations where grief is apparent, may need counseling to work through their loss and prevent further isolation. Social anxiety and traumatic experiences may need deeper investigation by a trained mental health professional.
6. Offer equipment and resources to improve isolation.
If isolation is related to a lack of transportation, offer free or low-cost transportation options. If a patient is homebound, contact agencies that can provide volunteers for companionship. If a patient feels isolated due to incontinence or another physical impairment, offer supplies or equipment such as a wheelchair to improve confidence.
7. Recommend adult daycare centers or facilities.
The nurse can research centers in the patient’s area that offer activities for older adults. This can also include a local gym that offers exercise classes or a library that offers crafting or book clubs.
8. Encourage volunteering.
A great way to curb loneliness is to help others. This can also be a low-pressure way for someone who is feeling nervous to interact with others. Some examples include volunteering at an animal shelter, assisting with a “clean-up” day at a local park or beach, or helping set up a local event.
9. Offer an outside perspective.
The patient may not be aware of the negativity or inappropriate behaviors they display. The nurse can offer suggestions without sounding rude such as requesting the patient not to use foul language or speaking about more cheerful topics and less about controversial issues.
10. Ideas for the introverted patient.
Even patients who prefer to be alone are at risk for isolation. Simply walking around the neighborhood or a nearby park or enjoying lunch in a cafe allows them to be near others without the pressure to interact. This can be the perfect amount of socialization for an introvert but also offers the opportunity to meet others.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for social isolation.
Care Plan #1
Diagnostic statement:
Social isolation related to alteration in mental status as evidenced by repetitive actions and desire to be alone.
Expected outcomes:
- Patient will report a willingness to socialize with others.
- Patient will participate in activities and programs at the level of ability and desire.
Assessment:
1. Review history and note traumatic events that may have occurred.
Traumatic events can cause anxiety and lead to isolation from social situations.
2. Assess factors contributing to a sense of helplessness (e.g., loss of spouse/parent).
Patients who feel helpless may withdraw and fail to seek out significant people in their lives.
3. Assess feelings about self, ability to control the situation, and sense of hope.
Gauging the level of hopelessness and powerlessness may help the nurse understand the severity of the situation.
Interventions:
1. Establish a therapeutic nurse-client relationship.
When patients feel they are talking to someone they trust, they will feel free to discuss sensitive matters.
2. Assist the patient in identifying activities that encourage socialization.
Early support in mobility and social participation will give a sense of well-being and relief of feelings of social isolation. People with regular social connections present with lesser mental decline than those who are lonely and isolated.
3. Coordinate with available resources, support behaviors to engage in social interactions, and manage personal resources and self care.
Managing activities of daily living can increase self-confidence and promote comfort in social settings.
4. Promote participation in recreational or special interest activities in a setting that the patient views as safe.
Safe environments can make patients feel secure to socialize.
Care Plan #2
Diagnostic statement:
Social isolation related to the inability to engage in personal relationships, as evidenced by flat affect and poor eye contact.
Expected outcomes:
- Patient will verbalize willingness to engage in personal relationships.
- Patient will identify causes and actions to correct social isolation.
Assessment:
1. Assess feelings towards social isolation.
Patients may develop depression and anxiety due to social isolation or vice versa.
2. Identify blocks to social contacts (e.g., physical immobility, sensory deficits, housebound, incontinence).
The patient may be unable to go out, embarrassed to be with others, and reluctant to put themselves in new situations.
3. Note history of psychological trauma.
Traumatic events can cause psychological breakdown and social isolation.
Interventions:
1. Develop a one-to-one intervention with the patient.
An individualized care plan targeting the factors contributing to social isolation and with the help of community resources can help prevent social isolation.
2. Promote social interactions.
Positive social interactions help the patient to establish new social group relationships. Social interactions have a significant impact on physical health and well-being.
3. Encourage interactions with others with similar interests.
Allowing the patient to interact with people with whom they have similar interests will improve connectedness, facilitate social engagement, and alleviate isolation.
4. Provide positive reinforcement when a patient initiates interaction with others.
Positive reinforcement encourages the continuation of efforts.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- CDC. (2021, April 29). Loneliness and Social Isolation Linked to Serious Health Conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Henderson, R. (2016, December 28). Social Isolation – How to Help Patients be Less Lonely. Patient. https://patient.info/doctor/social-isolation-how-to-help-patients-be-less-lonel
