Careplan

Social Isolation CPG (Adult)

Oct.01.2020

Social Isolation (Adult Inpatient)

Clinical Description

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

Key Information

Socially isolated people are more likely to develop physical and mental health issues.

Isolation from support system can cause significant distress and increased risk for suicidal thoughts.

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.

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
- 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
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care

Social Isolation

Signs/Symptoms/Presentation

anxiety
depressed affect
developmentally inappropriate behavior
hopelessness
irritability
lack of social support/resources
reports social insecurity
sadness
social withdrawal

Problem Intervention

Promote Feelings of Connectedness

Promote environment conducive to social interaction (e.g., window to outside, open curtains, telephone, Internet, television, social media access).
Evaluate need for language resources (e.g., interpreter, radio, television programs).
Prioritize activities and offer choices that allow control and meet personal goals for socialization.
Encourage family/support system to actively participate in care; adjust care schedule to maximize family or visitor time.
Offer diversional activity, such as pet therapy, art therapy, group activities, volunteer visits, online group games or 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., meditation, belief system, self-reflection).
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 frequent interaction.
Assess and monitor for signs and symptoms of anxiety and depression.

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

Population-Specific Considerations

Older adults are more likely to experience social isolation.

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]
Gardiner, C.; Geldenhuys, G.; Gott, M. Interventions to reduce social isolation and loneliness among older people: an integrative review. Health and Social Care in the Community. 2018;26(2), 147-157. doi:0.1111/hsc.12367 Source[Review Articles]
Holt-Lunstad, J.; Smith, T. B.; Baker, M.; Harris, T.; Stephenson, D. Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science. 2015;10(2), 227. [Metasynthesis,Meta-analysis,Systematic Review]
Ignatavicius, D. D.; Workman, M. L. (2016). Medical-surgical nursing: Patient-centered collaborative care. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Mikkelsen, A. S. B.; Petersen, S.; Dragsted, A. C.; Kristiansen, M. Social Interventions Targeting Social Relations Among Older People at Nursing Homes: A Qualitative Synthesized Systematic Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2019;56 doi:10.1177/0046958018823929 Source[Systematic Review]
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.