SOCIAL ISOLATION/IMPAIRED SOCIAL INTERACTION

Definition: Social isolation is the condition of aloneness experienced by the individual and perceived as imposed by others and as a negative or threatened state; impaired social interaction is an insufficient or excessive quantity or ineffective quality of social exchange.

Copyright © 2008 by F.A. Davis Company

Possible Etiologies ("related to")

[Developmental regression]
[Egocentric behaviors (which offend others and discourage relationships)]
Altered thought processes [delusional thinking]
[Fear of rejection or failure of the interaction]
[Impaired cognition fostering negative view of self]
[Unresolved grief]
Absence of available significant others or peers

Defining Characteristics ("evidenced by")

Sad, dull affect
Being uncommunicative, withdrawn; lacking eye contact
Preoccupation with own thoughts; performance of repetitive, meaningless actions
Seeking to be alone
[Assuming fetal position]
Expression of feelings of aloneness or rejection
Verbalization or observation of discomfort in social situations
Dysfunctional interaction with peers, family, and others

Goals/Objectives

Short-Term Goals

Client will develop trusting relationship with nurse or counselor within reasonable time period.

Long-Term Goals

  1. Client will voluntarily spend time with other clients and nurse or therapist in group activities by time of discharge from treatment.
  2. Client will refrain from using egocentric behaviors that offend others and discourage relationships by time of discharge from treatment.

Interventions with Selected Rationales

  1. Spend time with client. This may mean just sitting in silence for a while. Your presence may help improve client's perception of self as a worthwhile person.
  2. Develop a therapeutic nurse.client relationship through frequent, brief contacts and an accepting attitude. Show unconditional positive regard. Your presence, acceptance, and conveyance of positive regard enhance the client's feelings of self-worth.
  3. After client feels comfortable in a one-to-one relationship, encourage attendance in group activities. May need to attend with client the first few times to offer support. Accept client's decision to remove self from group situation if anxiety becomes too great. The presence of a trusted individual provides emotional security for the client.
  4. Verbally acknowledge client's absence from any group activities. Knowledge that his or her absence was noticed may reinforce the client's feelings of self-worth.
  5. Teach assertiveness techniques. Interactions with others may be discouraged by client's use of passive or aggressive behaviors. Knowledge of the use of assertive techniques could improve client's relationships with others.
  6. Provide direct feedback about client's interactions with others. Do this in a nonjudgmental manner.Help client learn how to respond more appropriately in interactions with others. Teach client skills which may be used to approach others in a more socially acceptable manner. Practice these skills through role-play. Client may not realize how he or she is being perceived by others. Direct feedback from a trusted individual may help to alter these behaviors in a positive manner. Having practiced these skills in role-play facilitates their use in real situations.
  7. The depressed client must have lots of structure in his or her life because of the impairment in decision-making and problemsolving ability. Devise a plan of therapeutic activities and provide client with a written time schedule. Remember: The client who is moderately depressed feels best early in the day, whereas later in the day is a better time for the severely depressed individual to participate in activities. It is important to plan activities at a time when the client has more energy and is more likely to gain from the experience.
  8. Provide positive reinforcement for client's voluntary interactions with others. Positive reinforcement enhances self-esteem and encourages repetition of desirable behaviors.

Outcome Criteria

  1. Client demonstrates willingness and desire to socialize with others.
  2. Client voluntarily attends group activities.
  3. Client approaches others in appropriate manner for one-to-one interaction.