Nursing diagnosis: Social Isolation related to altered state of wellness, changes in physical appearance, alterations in mental status; perceptions of unacceptable social or sexual behavior or values; inadequate personal resources or support systems; physical isolation
Possibly evidenced by
Expressed feeling of aloneness imposed by others, feelings of rejection
Absence of supportive SO—partners, family, acquaintances or friends
Desired Outcomes/Evaluation Criteria—Client Will
Identify supportive individual(s).
Use resources for assistance.
Participate in activities and programs at level of ability and desire.
Nursing intervention with rationale:
1. Ascertain client’s perception of situation.
Rationale: Isolation may be partly self-imposed because client fears rejection or reaction of others.
2. Spend time talking with client during and between care activities. Be supportive, allowing for verbalization. Treat with dignity and regard for client’s feelings.
Rationale: Client may experience physical isolation as a result of current medical status and some degree of social isolation secondary to diagnosis of AIDS.
3. Limit or avoid use of mask, gown, and gloves when possible, such as when talking to client.
Rationale: Reduces client’s sense of physical isolation and provides positive social contact, which may enhance self-esteem and decrease negative behaviors.
4. Identify support systems available to client, including presence of, relationship with, immediate and extended family.
Rationale: When client has assistance from SO, feelings of loneliness and rejection are diminished. However, for some homosexual clients this may be the first time that the family has been made aware that client lives an alternative lifestyle. Note: Client may not receive needed support for coping with life-threatening illness and associated grief because of discrimination, fear, and lack of understanding—AIDS hysteria.
5. Explain isolation precautions and procedures to client and SO.
Rationale: Gloves, gowns, and mask are not routinely required with a diagnosis of AIDS, except when contact with secretions or excretions is expected. Misuse of these barriers enhances feelings of emotional and physical isolation. When precautions are necessary, explanations help client understand reasons for procedure and provide feeling of inclusion in what is happening.
6. Encourage open visitation, as appropriate, telephone contacts, and social activities within level of tolerance.
Rationale: Participation with others can foster a feeling of belonging.
7. Develop a plan of action with client that looks at available resources and supports healthy behaviors. Help client problem-solve solution to short-term or imposed isolation.
Rationale: Having a plan promotes a sense of control over own life and gives client something to look forward to and actions to accomplish.
8. Be alert to verbal and nonverbal cues including withdrawal, statements of despair, and sense of aloneness. Ask client if thoughts of suicide are being entertained.
Rationale: Indicators of despair and suicidal ideation are often present. When these cues are acknowledged by the caregiver, client is usually willing to talk about thoughts of suicide and sense of isolation and hopelessness.
9. Refer to resources, such as social services counselors and local and national AIDS organizations.
Rationale: Establishes support systems; may reduce feelings of isolation.
10. Provide for placement in sheltered community when necessary.
Rationale: May need more specific care when unable to be maintained at home or when SO cannot manage care.