Social isolation and loneliness might initially appear as minor concerns. However, they can significantly weaken patients and severely impact their quality of life. While any patient can experience isolation, older adults are particularly vulnerable due to factors like the loss of loved ones, living alone, and chronic illnesses. Although social isolation may not be immediately critical, research indicates it increases the risk of dementia, heart disease, and stroke, along with depression and suicide.
For socially isolated patients, nurses and other healthcare professionals can become crucial points of contact and social interaction. Nurses must be sensitive to the obstacles these patients face and approach the topic delicately, as patients may hesitate to express feelings of loneliness openly. Nurses can offer supportive, non-judgmental advice, advocate for their patients, or simply provide a listening ear to those feeling alone.
Attention: This nursing diagnosis has been renamed.
Nursing diagnoses are periodically updated, added, or removed by the NANDA International Diagnosis Development Committee (DDC) to reflect changes in standardized language. “Social Isolation” has been replaced by “Inadequate Social Connectedness.” While this shift is important for standardization, both students and experienced nurses may not be fully familiar with this change. Therefore, this article will continue to use the diagnostic label “Social Isolation” to ensure clarity and familiarity until the newer term gains wider acceptance.
In this article, we will explore the nursing diagnosis of loneliness, encompassing its causes, signs and symptoms, expected outcomes, nursing assessments, interventions, and care plans.
Causes (Related to)
The following are frequently observed causes of social isolation, which can contribute to feelings of loneliness:
- Developmental delays that hinder social skills and interaction.
- Impaired cognitive functioning affecting social judgment and communication.
- Abnormalities in physical appearance leading to self-consciousness and avoidance of social situations.
- Inappropriate social behavior causing rejection or exclusion by peers.
- Inability to engage in or maintain meaningful relationships due to various personal or interpersonal factors.
- Traumatic experiences causing psychological or emotional pain, leading to withdrawal from social contact.
- Disabilities (motor, speech, cognition) limiting participation in social activities.
- Frequent illnesses, hospitalizations, or complex treatments disrupting social routines and connections.
- Living alone, lacking regular social interaction in the home environment.
- Lack of a support system, absence of family, friends, or community ties for emotional and social sustenance.
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of social isolation and loneliness. These are categorized into subjective and objective data, based on patient reports and nursing assessments.
Subjective: (Patient reports)
- Feelings of loneliness and rejection, expressing emotional distress due to perceived lack of social connection.
- Insecurity in relationships, displaying anxiety and uncertainty in social interactions.
- Fear and anxiety related to social situations and interactions with others.
- Belief that interests, values, or behavior are viewed as socially or culturally different or unacceptable, leading to self-isolation.
- Preference to be alone, actively avoiding social contact and seeking solitude.
Objective: (Nurse assesses)
- Absence of support from family or friends, lack of identified social support network.
- Diagnosis of a mental disorder that can negatively impact relationships (e.g., PTSD, schizophrenia), clinical evidence of conditions affecting social functioning.
- Flat or dull affect, displaying limited emotional expression in social contexts.
- Irritable or hostile demeanor, exhibiting negative or aggressive behavior towards others.
- Physical limitation that prevents social interaction (bedridden, paralysis), objective barriers to social engagement due to physical health.
- Nonverbal or poor ability to communicate; speech impediment, observable difficulties in verbal and nonverbal communication.
- Inappropriate social cues or behavior, demonstrating actions or responses that are not socially fitting or understood.
Expected Outcomes
The following are typical nursing care planning goals and desired outcomes for addressing social isolation and loneliness:
- Patient will verbalize a desire to interact with others and actively seek social engagement opportunities.
- Patient will acquire and improve social and communication skills to foster healthier relationships.
- Patient will express enhanced feelings of self-worth and increased confidence in social situations.
- Patient will participate in social activities with others that are aligned with their personal interests and mental/physical capabilities.
Nursing Assessment
The initial step in nursing care is a comprehensive nursing assessment, where the nurse gathers physical, psychosocial, emotional, and diagnostic information. Specifically related to loneliness and social isolation, the assessment should include subjective and objective data collection:
1. Determine barriers to socialization. Identify and evaluate any obstacles preventing the patient from engaging in social activities. This could include lack of adaptive equipment, transportation issues, or physical limitations. The nurse should explore potential solutions to mitigate these barriers and facilitate greater social participation.
2. Assess the patient’s feelings and perceptions of loneliness. Recognize that patients may feel embarrassed or ashamed to admit to feeling lonely. Create a safe and empathetic environment to explore their emotions. Inquire about the patient’s hobbies, interests, and current social connections. The nurse can also suggest relevant community groups or programs that align with the patient’s interests to foster new social opportunities.
3. Recognize signs of isolation linked to low self-esteem. Patients with low self-esteem may feel inadequate or uncomfortable in social settings, leading to avoidance and isolation. Assess for self-deprecating thoughts or negative self-perceptions. The nurse can explore techniques to build self-esteem, such as positive self-talk and focusing on strengths, or recommend counseling services to address underlying self-esteem issues.
4. Note any unusual social behaviors or difficulties interpreting social cues. Observe for inconsistencies in communication, misunderstanding of humor or sarcasm, or aversion to physical touch, as these can be barriers to effective socialization. Some patients may benefit from targeted coaching on social communication strategies to improve their interactions.
5. Identify strained relationships or the absence of support systems. Actively listen for cues indicating strained relationships with family or friends, geographical distance from loved ones, or difficulties in maintaining personal relationships. Patients may subtly reveal these issues as a way of expressing underlying feelings of loneliness or abandonment. Paying close attention to these statements provides opportunities for further exploration and support.
Nursing Interventions
Nursing interventions and care are crucial for the patient’s well-being and recovery from social isolation and loneliness. The following are effective nursing interventions to address these concerns:
1. Offer yourself as a nonjudgmental listener to build trust. Patients experiencing isolation due to rejection or feelings of inadequacy may be hesitant to open up. They might present with defensive behaviors like hostility or curt responses. Establishing a strong therapeutic relationship based on trust is essential to create a safe space where the patient feels comfortable discussing sensitive emotions and experiences.
2. Utilize multidisciplinary support to enhance social skills. For patients struggling with communication and social interaction, collaboration with a multidisciplinary team is beneficial. Behavioral therapists can provide targeted training in social and communication skills. Speech therapists can assist those with speech impediments, while physical and occupational therapists can address physical or motor impairments that hinder social engagement.
3. Encourage participation in support groups to foster connection. Patients feeling isolated due to chronic health conditions such as a colostomy, chronic pain, or autoimmune diseases can greatly benefit from support groups. Connecting with others facing similar challenges can reduce feelings of loneliness and provide mutual understanding and encouragement.
4. Leverage technology to expand social opportunities. Socialization is not limited to face-to-face interactions. Technology provides numerous avenues for connection. Online forums, chat groups, communication apps, and even regular phone calls can help patients maintain and build relationships, regardless of physical limitations or geographical barriers.
5. Refer to therapy for deeper emotional and psychological issues. Patients who have experienced significant losses, such as the death of a spouse, or those with apparent grief or trauma, may require professional counseling. Therapy can help them process their loss, manage grief, and prevent further social withdrawal. For patients with social anxiety or traumatic experiences, referral to a trained mental health professional is crucial for in-depth assessment and intervention.
6. Offer resources and equipment to mitigate isolation. Address practical barriers to social engagement. If lack of transportation is a factor, provide information on free or low-cost transportation options. For homebound patients, connect them with agencies that offer volunteer companion services. If physical impairments like incontinence contribute to isolation, provide necessary supplies or equipment, such as wheelchairs, to enhance confidence and mobility.
7. Recommend adult daycare centers or similar facilities to increase social interaction. Research and suggest local adult daycare centers or community facilities that offer structured activities and social engagement opportunities for older adults. This could also include local gyms with group exercise classes or libraries with crafting or book clubs, providing diverse options for social participation.
8. Encourage volunteering as a way to combat loneliness and build social connections. Helping others is a powerful way to reduce loneliness and foster a sense of purpose. Volunteering offers a low-pressure environment for social interaction, particularly for those who are socially anxious. Suggest volunteering at animal shelters, participating in community clean-up days, or assisting with local events to create meaningful social engagement.
9. Offer constructive feedback and an outside perspective on social behaviors. Patients may be unaware of negative or inappropriate social behaviors they exhibit that contribute to isolation. Provide gentle and constructive suggestions, such as advising against using offensive language or encouraging them to focus on positive conversation topics rather than controversial subjects, to improve their social interactions.
10. Suggest strategies for introverted patients to increase social proximity without pressure. Even individuals who prefer solitude can experience negative effects of isolation. For introverted patients, suggest low-pressure ways to be around others, such as walking in the neighborhood or a park, or having lunch at a café. These activities allow them to be in social proximity without the direct pressure to engage, offering a comfortable level of social stimulation and potential for interaction.
Nursing Care Plans
Nursing care plans are essential tools to prioritize assessments and interventions for both short-term and long-term care goals. Here are examples of nursing care plans tailored to address social isolation and loneliness:
Care Plan #1
Diagnostic statement:
Social isolation related to alteration in mental status as evidenced by repetitive actions and desire to be alone.
Expected outcomes:
- Patient will report an increased willingness to socialize with others.
- Patient will actively participate in activities and programs to their ability and preference.
Assessment:
1. Review patient history and note any traumatic events. Traumatic experiences can trigger anxiety and lead to withdrawal from social situations. Understanding the patient’s history helps identify potential root causes of isolation.
2. Assess factors contributing to feelings of helplessness (e.g., loss of spouse/parent). Feelings of helplessness can lead to social withdrawal and failure to seek out supportive relationships. Assessing these feelings helps understand the depth of the patient’s isolation.
3. Assess patient’s feelings about self, sense of control over their situation, and level of hope. Evaluating the patient’s level of hopelessness and powerlessness provides insights into the severity of their situation and guides appropriate interventions.
Interventions:
1. Establish a therapeutic nurse-client relationship based on trust and empathy. A strong therapeutic relationship encourages open communication, allowing patients to discuss sensitive issues and feel understood.
2. Assist the patient in identifying and participating in activities that promote socialization. Early encouragement and support for social participation can improve well-being and reduce feelings of isolation. Regular social connections are linked to better mental health and reduced cognitive decline.
3. Coordinate with available resources and support systems to encourage social engagement and self-care. Connecting patients with community resources and support networks enhances their ability to manage daily living activities, increasing self-confidence and comfort in social settings.
4. Promote participation in recreational or special interest activities in a safe and comfortable setting. Safe and supportive environments can reduce anxiety and make patients feel more secure in social situations, encouraging participation and interaction.
Care Plan #2
Diagnostic statement:
Social isolation related to the inability to engage in personal relationships, as evidenced by flat affect and poor eye contact.
Expected outcomes:
- Patient will verbalize a willingness to engage in personal relationships.
- Patient will identify the causes of their social isolation and actions to address it.
Assessment:
1. Assess patient’s feelings towards their social isolation. Social isolation can contribute to or exacerbate depression and anxiety, creating a cycle of withdrawal. Understanding the patient’s emotional state is crucial.
2. Identify barriers to social contact (e.g., physical immobility, sensory deficits, being housebound, incontinence). Physical and sensory limitations, as well as conditions like incontinence, can create significant barriers to social participation due to embarrassment or practical difficulties.
3. Note any history of psychological trauma. Past traumatic events can lead to psychological distress and subsequent social isolation as a coping mechanism.
Interventions:
1. Develop a one-to-one intervention plan tailored to the patient’s specific needs. An individualized care plan, addressing the unique factors contributing to social isolation and leveraging community resources, is essential for effective intervention.
2. Promote positive social interactions and opportunities for engagement. Positive social interactions help patients build new relationships and strengthen existing ones. Social engagement has a significant positive impact on both physical and psychological well-being.
3. Encourage interactions with others who share similar interests. Connecting patients with individuals who have similar interests improves connectedness, facilitates social engagement, and effectively reduces feelings of isolation by fostering common ground and shared experiences.
4. Provide positive reinforcement when the patient initiates social interaction. Positive reinforcement encourages the continuation of efforts to socialize, building confidence and promoting ongoing engagement.
Care Plan #3
Diagnostic statement:
Social isolation related to alteration in wellness as evidenced by a disabling condition and absence of a support system.
Expected outcomes:
- Patient will express an increased sense of self-worth and value.
- Patient will identify and acknowledge their feelings of isolation.
Assessment:
1. Perform a physical examination and note any signs of illnesses. Isolated individuals are at a higher risk of illness, and worsening health conditions can further restrict social activities. Monitoring physical health is important.
2. Assess the patient’s ability to perform self-care and their sense of hope. This assessment helps understand the patient’s coping mechanisms and resilience in stressful situations. Social isolation can be a maladaptive coping strategy, and assessing self-care abilities and hope provides insight into the patient’s overall well-being.
3. Identify available support systems for the patient. Support systems are vital for a positive outlook, mental well-being, and recovery. Identifying existing supports and potential gaps allows the nurse to recommend appropriate support groups or social networks to enhance the patient’s social environment.
Interventions:
1. Establish a professional, trusting relationship to facilitate open communication. Trust is foundational for patients to express themselves honestly and engage in social interactions. A trusting relationship with the nurse can be a crucial first step in breaking down isolation.
2. Refer patients to community support groups and resources as needed. When family support is limited, community-based interventions become essential. Effective external support can address the challenges faced by isolated individuals and families.
3. Assist the client in contacting self-help groups, counselors, and therapists for specialized support. Appropriate referrals are necessary to connect patients with mental health care, chronic disease self-management resources, and interventions designed to enhance social networking and support.
4. Encourage behaviors that promote social engagement, self-management, and appropriate medical or self-care. Managing daily living effectively boosts self-confidence and promotes comfort in social settings. Effective disease management also improves overall well-being, making patients more likely to engage socially.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- CDC. (2021, April 29). Loneliness and Social Isolation Linked to Serious Health Conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Henderson, R. (2016, December 28). Social Isolation – How to Help Patients be Less Lonely. Patient. https://patient.info/doctor/social-isolation-how-to-help-patients-be-less-lonel
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b-000000928
