Social Isolation

Published on Saturday March 10th , 2007

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:________________
________________________
________________________
________________________

  

 

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Patient/Significant other signature

 

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RN signature