Feeling of not belonging, being cared for, or empowered within a given context

• Confusion
• Difficulty establishing social interaction
• Difficulty independently performing activities of daily living
• Difficulty sharing personal life expectations
• Impaired memory
• Impaired physical mobility
• Inadequate self-esteem
• Inadequate social skills
• Inadequate social support
• Inadequate transportation
• Negative opinion of support system
• Paralyzing fear of crime
• Paralyzing fear of traffic
• Values incongruent with cultural norms

• Chronic disease
• Cognitive disorders

• Age
• Gender
• Developmental stage
• Level of education
• Reason for hospitalization (physiologic or psychiatric)
• Attitudes of family, friends, teachers, and other important individuals toward adolescent
• Available support systems
• Factors contributing to social isolation, including delayed physical development, immaturity, altered mental status, changes in behavior or cognition, illness, and history of trauma
• Self-esteem
• Coping and problem-solving ability
• Evidence of substance abuse
• Current and past stressors
• Health status, including vision or hearing deficits, chronic illness, incontinence, and pain
• Self-care abilities, including knowledge and use of adaptive equipment and supplies, and technical and mechanical skills
• Living conditions, including home environment, site of activities and resources, and transportation
• Mental status, including behavior, mood, and affect
• Musculoskeletal status, including coordination, functional ability, gait, range of motion, presence of tremor or paralysis, and muscle tone, size, and strength
• Sociocultural factors, including ethnic and religious background

• Alienation
• Decreased eye contact
• Dissatisfaction with respect from others
• Dissatisfaction with social connection
• Dissatisfaction with social support
• Feeling insecure in public
• Feels different from others
• Flat affect
• Hostile
• Impaired ability to meet expectations of others
• Inadequate levels of social activities
• Loneliness
• Minimal interaction with others
• Preoccupation with own thoughts
• Purposelessness
• Self-neglect
• Social behavior incongruent with cultural norms

• Patient will express feelings associated with social isolation.
• Patient will identify causes of social isolation.
• Patient will participate in planning social activities.
• Patient will identify personal behaviors that are considered socially unacceptable and will acknowledge the need for change.
• Patient will demonstrate more socially acceptable behaviors.
• Patient will make use of community resources.
• Patient will describe increased number of social contacts.
• Patient will express satisfaction with level of social contacts.
• Patient will exhibit effective interpersonal communication skills.
• Patient will report feeling less isolated as social interaction improves and will report improved sense of self-esteem.

Suggested NOC Outcomes

• Assign a primary nurse to patient to enhance continuity of care, establish a trusting relationship, and provide an opportunity to practice developing a one-on-one relationship.
• Arrange uninterrupted time to talk with patient during each visit. Listen to patient's concerns and feelings. Provide honest feedback (positive and negative) about patient's behavior to encourage appropriate behaviors and reinforce awareness of inappropriate ones. Feedback is essential to behavior modification.
• Provide guidance as patient explores possible causes for feelings of social isolation. Help patient identify inappropriate behaviors and provide education about ways to improve communication and interpersonal skills to foster socially acceptable behavior. Patient may be more willing to learn new skills and behaviors after becoming aware of the connection between unacceptable behavior patterns and feelings of isolation.
• Discuss with patient causes and contributing factors of social isolation. Find out what factors patient believes interfere most with the ability to develop relationships with others to determine patient's wants and needs.
• Make a contract with patient that requires demonstration of one new behavior within a specific period. Reward successful changes in behavior. Contracts can enhance self-esteem by giving patient responsibility for making constructive changes and allowing enough time to practice new behavior and communication skills without fear of criticism. Successful completion of the contract provides positive reinforcement.
• Demonstrate appropriate communication skills and behaviors in all interactions with patient to provide an example of appropriate behavior and reinforce teaching concepts.
• If appropriate, address physical limitations that interfere with patient's ability to form social relationships. For example, if patient has a hearing deficit, make a referral to an audiologist for a hearing aid; if patient has a mobility impairment, make a referral to a physical therapist for an exercise program or for recommendations for assistive devices. Patient may need physical limitations addressed before patient can overcome social isolation.
• Assess the influence of the home environment on patient's social life. For example, is patient afraid to go outside because of a high crime rate in the neighborhood? If so, consider investigating options, such as a retirement community or residential care facility, which might offer better social opportunities. Patient may not be aware of alternative living options.
• Engage patient in role-playing activities that simulate social situations. Provide encouragement and positive reinforcement, and avoid criticism to provide an opportunity to rehearse new skills in a safe environment, which reduces anxiety and boosts self-confidence.
• Encourage patient to participate in group activities and one-on-one interactions with staff members. Gradual increases in social interaction help reduce patient's feelings of social isolation and instill confidence in newly developed communication and interpersonal skills.
• Encourage patient to increase level of social contact gradually to avoid becoming overwhelmed.
• Refer patient to social services for follow-up, if necessary, to ensure a comprehensive approach to care.
• Talk to patient about community resources, such as social services or support groups that can provide ongoing support. Provide names, addresses, and phone numbers whenever possible. This provides patient with ongoing opportunities for social interaction in a supportive environment.

Suggested NIC Interventions

• Patient expresses feelings of social isolation and desire for help.
• Patient identifies causes of social isolation.
• Patient takes part in planning social activities.
• Patient identifies socially unacceptable personal behaviors and acknowledges the need for change.
• Patient demonstrates more socially appropriate behaviors.
• Patient exhibits effective communication skills.
• Patient reports increased social interaction, decreased feelings of isolation, and improved self-esteem.

• Observations of patient's behavior and communication skills
• Patient's description of causes for impaired social interaction
• Nursing interventions to promote behavior modification and improved socialization
• Patient's response to interventions
• Resources and referrals provided to patient or family members
• Evaluations for expected outcomes

• Bower, M., Conroy, E., & Perz, J. (2018). Australian homeless persons' experiences of social connectedness, isolation and loneliness. Health & Social Care in the Community, 26(2), e241-e248. doi:10.1111/hsc.12505
• Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: An integrative review. Health & Social Care in the Community, 26(2), 147-157. doi:10.1111/hsc.12367
• Moola, F. (2018). The complexities of contagion: The experience of social isolation among children and youth living with cystic fibrosis in Canada. Journal of Child Health Care, 22(4), 631-645. doi:10.1177/1367493518767784