Angelite Nurses: Social Isolation

Social Isolation

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Death of s/o (_) Divorce (_) Substance abuse (_) Illness:____________________________ ____________________________________ (_) Other:_____________________________ ____________________________________ ____________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Expressed feelings of unexplained dread or abandonment (_) Desire for more contact with people
Minor: (May be present)	(_) Time passing slowly (_) Inability to concentrate and make decisions (_) Feelings of uselessness (_) Doubts about ability to survive

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Identify the reasons for his/her feelings of isolation.

(_) Identify ways of increasing meaningful relationships.

(_) Identify appropriate diversional activities.

(_) Other:

(_) Encourage patient to verbalize feelings.

(_) Assist to identify causative and contributing factors.

(_) Assist to reduce or eliminate causative and contributing factors:
________________________
________________________
________________________

(_) Assist to identify diversional activities. (See Diversional Activity Deficit)

(_) Initiate referrals as needed or increase social relationships:
________________________
________________________
________________________

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

Angelite Nurses