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May.10.2021

Social Isolation (Pediatric Inpatient)

Clinical Description

Care of the hospitalized child experiencing inability to interact with others either through individual reluctance or because of medical necessity.

Key Information

Children placed in medically required isolation often feel they are being punished.

Research has shown that time spent by healthcare professionals in direct patient care is either less frequent or shorter with patients in isolation, which may perpetuate or augment an existing social isolation problem.

Medically required isolation is an artificial environment which imposes a loss of or limited autonomy, in addition to limited contact with others.

Isolation fromsupportsystem can cause significant distress and increased risk for suicidal thoughts.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

Social Connection Supported

B. Patient, family or significant other will teach back or demonstrate education topics and points:

Education: Overview
Education: Self Management
Education: When to Seek Medical Attention

Correlate Health Status

Correlate health status to:
- history, comorbidity, congenital anomaly
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- child and family/caregiver:
- safety risks
- family interaction
- plan for transition of care

Social Isolation

Signs/Symptoms/Presentation

anxiety
depressed affect
developmentally inappropriate behavior
feels different from others
hopelessness
irritability
reluctance to participate in activity
reports social insecurity
sadness
social withdrawal

Problem Intervention

Promote Feelings of Connectedness

Promote environment conducive to social interaction when possible (e.g., window to outside, open curtains, telephone, television, Internet, radio, familiar toys).
Evaluate need for language resources (e.g., interpreter, radio, television programs).
Prioritize activities and offer choices that allow control and meet individual needs of patient and family/support system connectedness
Encourage family/support system to actively participate in care; adjust care schedule to maximize family or visitor time.
Offer diversional activity, such as play, pet therapy, art therapy, peer group activities, volunteer visits or online activities.
Provide opportunities for expression of feelings, thoughts and stressors to assist with coping.
Identify and encourage use of coping strategies for managing illness-associated isolation (e.g., familiar rituals, personal routines, spiritual activity).
Encourage development of new active interests such as keeping a journal, and coping skills such as reframing, focus on time-limited nature of situation and future plans.
Promote consistent caregivers; provide meaningful stimulation and interaction.
Model appropriate social interaction; provide positive reinforcement and coaching.

Associated Documentation

Complementary Therapy
Supportive Measures

Education

CPG-Specific Education Topics

Overview

risk factors
signs/symptoms

Self Management

resources for support
social interaction

When to Seek Medical Attention

unresolved/worsening symptoms

General Education Topics

General Education

admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan

Safety Education

call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support

References

Biagioli, V.; Piredda, M.; Alvaro, R.; de Marinis, M. The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: Systematic review and metasynthesis. European Journal of Cancer Care. 2016; doi:10.1111/ecc.12461 [Metasynthesis,Meta-analysis,Systematic Review]
Cacioppo, S.; Grippo, A. J.; London, S.; Goossens, L.; Cacioppo, J. T. Loneliness: Clinical import and interventions. Perspectives on Psychological Science. 2015;10(2), 238-249. doi:10.1177/1745691615570616 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Calati, R.; Ferrari, C.; Brittner, M.; Oasi, O.; Olié, E.; Carvalho, A. F.; Courtet, P.. Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. Journal of Affective Disorders. 2019;245, 653-667. doi:10.1016/j.jad.2018.11.022 Source[Review Articles]
Doenges, M. E.; Moorhouse, M. F.; Murr, A. C. (2016). Nurse's pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F. A. Davis. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Hazinski, M. F. (2013). Nursing care of the critically ill child. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Newman, K.; Wang, A. H.; Wang, A. Z. Y.; Hanna, D. The role of internet-based digital tools in reducing social isolation and addressing support needs among informal caregivers: a scoping review. BMC Public Health. 2019;19 doi:10.1186/s12889-019-7837-3 Source[Review Articles]
Purssell, E.; Gould, D.; Chudleigh, J. Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis. BMJ Open. 2020; doi:10.1136/ bmjopen-2019-030371 Source[Meta-analysis]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.