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Oct.01.2020

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:
      • 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
  • 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.

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