The Effects Of Social Isolation

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The Effects Of Social Isolation Essay

A 60 years old female XYZ patient was admitted in hospital with organic brain syndrome two years ago. She is still hospitalized. My first interaction with patient was when I entered her room, she told me to get out. In second interaction as I tried to talk to her, she listened to me only for two minutes but didn’t answer me and instructed her care-taker to tell me to leave the room.

My further attempts at interaction with the patient would result in conversations not lasting 2-4 minutes and then she would remove herself to a place where no one would bother her. Most of the time, she kept herself in her room and become aggressive when someone tried to take her outside. She couldn’t concentrate on one thing more than 2 minutes. Her major symptoms were short attention span, impaired recent memory and poor judgment.

In three weeks rotation I have found she was reluctant to talk with others. She felt more comfortable when no one disturbed her. Initially she was very strongly guarded but very gradually as I worked with her, things began to improve.The Effects Of Social Isolation Essay. I made small interventions to make her socialize, such as, every day I took her outside and asked her to greet the health care professionals etc. The end result of these little efforts was very positive. The health care professionals noticed a discernable change in her behavior. Now this patient greets others and responds more positively. The Doctor said she showed very positive improvements and recommended these interventions should be continued.

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The concept which came in my mind and very perceptibly I have found in my patient was social isolation. According to Nicholas R, Nicholson Jr. (2009) “Social isolation is suggested, state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts and they are deficient in fulfilling and quality relationships”(p.1346).

Social isolation is a social condition that leaves significant effects on psychological well-being and physical health, with the costs of these conditions particularly higher among old and mentally ill patients. According to Havens et al. cited by Nicholas R & Nicholson Jr. (2009) “Psychological barriers such as decline in cognition, poor or altered mental health… factor that lead to social isolation” (p.1346). If I relate the concept with my patient she likes to live alone, unable to share her life experiences, lack of belongingness with others, unable to do her activity daily living and these all were because of her cognitive impairment and low concentrate level which leads her towards social isolation in her.

Many factors which leads to social isolation. In Pakistan, gradually we are loosing our traditional values, social bonds like family and neighborhood. With changing socio-economic and cultural conditions, we witness the emergence of nuclear families living separately rather than the traditional extended families living together. Literature on social isolation is not available about our country but I have found the South Asian Article (New Delhi India). Indian culture is similar to ours and we can easily relate their findings to our context. Age Well Foundation (2010) stated that “Ever-changing socio-economic scenario of the country has resulted in emergence & popularity of nuclear family …they felt themselves completely isolated and alone” (p.21). According to Age Well Foundation (2010) “In urban areas 39.1% older persons were reported isolated socially as well as emotionally” (p.09).

In late age certain human faculties become enfeebled. For instance cognitive impairment, physical frailty, restricted ability for social interaction. If this is accompanied with social isolation, the chances of depression occurring are much increased. The Effects Of Social Isolation Essay. If the situation continues, the person is caught in a downward spiral where social isolation and depression feed on each other, and the person becomes deprived of the ability to conduct social interaction. According to Draper cited by Heather L. Menne et al. (2009) “left untreated depression and depressive symptoms … intensified problems with cognitive processing” (p.554).

According to Amin A. & Gadit M. (2010) “Among the mental illnesses, depression … 22.9%prevalence of depression among elderly” (p.03). Chronic illnesses, the death of friends and loved ones and feelings of social isolation can add up to social isolation in older adults. According to Ather M Taqui &et al. “The prevalence of depression in the elderly in our study was 19.5%” (p.04). They also mentioned the cause of depression was nuclear family and due to less social interaction with family, elderly suffer from depression.

Stigmatization towards mental illness is very common, which make mentally ill patients socially isolated more. Zahid, J. et al. (2006) stated “The younger respondents felt that people with schizophrenia, depression and drug abuse are dangerous… more likely to blame people with drug abuse problems for their drug use” (p.57).

Care-taker perceptions towards old age people and for mentally ill patients are also contributing factor towards social isolation. According to Baltes and Smith quoted by Graeme Hawthorne (2006) “It is a stereotype of later life that there is a network of loneliness, social isolation and neglect” (p.522). During my mental health clinical, I observed that care-takers think that if they fulfill the patient’s physical needs, give them medicine on time, this is more than sufficient. Their attitudes toward old age was as they are very old, there is no hope for them to cure from mental illness. The same thing was happened with my own patient. Her care-taker’s perceptions were “now my patient is very old and you don’t need to make any efforts because since two years I am with her but there are no positive improvements”.

Roy’s Adaption Model (Roy & Andrews 1999) is one conceptual and theoretical model in nursing with which social isolation fits well. In this model she focused on four modes of adaptation, physiologic-physical, Self-concept, Role function and Interdependence Mode. If human declines in one mode it has specific affects on physical and mental health.The Effects Of Social Isolation Essay. According to Nicholas R, Nicholson Jr. (2008) “Being socially isolated can be conceptualized as having ineffective self-concept or Interdependence mode responses … the person has failed to adapt and this is manifested by being socially isolated” (p.1349). Through this model a nurse can observe the behavior of the person is adaptive or maladaptive.

Self-concept mode focused on psychological and spiritual sense of integrity and purpose of living in the universe. When someone looses sense of psychological well being, has no purpose of life, unconcerned with others, this makes a person socially isolated. Cognitive impairment is the major cause which interferes in this mode and the person feels helpless to adapt this mode effectively and goes into social isolation. Interdependence mode deals with human relationships with others, their purpose, structures and how it grows individually and in a group. When a person fails to adapt this mode appropriately and shows less concern towards close relations, or a person’s loved one’s show less concern toward the person it makes the person socially isolated.

Social isolation has strong connection with mental illness. Social isolation and cognitive impairment go side by side. According to Ellis and Hickie cited by Graeme Hawthorne (2006) “In addition there are associations between social isolation and mental illness… premature death” (p.522).

My patient was socially isolated due to impaired cognitive abilities, short attention span and impaired recent and immediate memory. Older people need more concentration and care as I relate the above with my patient, she was 60 years old and struggling to remember recent events and concentrate on one point. When she failed to do these tasks which hinder her communication and daily activities, this made her more agitated and led to social isolation.

In old age cognitive impairment decline daily activities, loss of interest in social interaction, face difficulties to express their own feelings and to understand other’s ideas. All these things also play a significant role in social isolation. According Van Oostrom cited by Graeme Hawthorne (2006) “Related to difficulties with mild cognitive impairment…partner loss and institutionalization” (p.522).

Research conducted on social isolation has identified many different factors that might contribute to social isolation in older adults, Physical environment factors such as place of residence, geographic distance from family or friends. According to Kaneda cited by Barratt J. (2007) “In developing countries growing numbers of older …isolation bereft of the traditional environment of an extended family” (p.02). In the light of literature, my patient was dependent on the care-taker in hospital although she fulfills her physical needs but I never observed her encourage the patient to mingle with others. In my view this was also one of the causes for her social isolation.

Maintaining relationships and participating in social activities have been associated with improved memory and intelligence in the elderly. There are many strategies which as a nurse we can develop to take out a person from isolation. Studies found that educational and social activity, group interventions that target specific groups of people can alleviate social isolation among older people. The Effects Of Social Isolation Essay.

Patient assessment I have covered in the scenario. I had planned strategies at the individual, family, group and institutional level. But I just got a chance to implement on the individual and institutional level.

Strategies for individual: I worked on her short attention span and on social isolation. Initially I asked her to come out from the room, we would take a round in corridor. She refused but gradually she accepted. I made her friend of the other staff, explored her life achievements and acknowledged it in front of other staff; made her sit in the garden and in the television room, Every day I took her outside and encouraged her greet the health care professionals.

I involved her in occupational therapy although out of eight days occupational therapy sessions she only attended three sessions and only in the last session she sat for as long as ten minutes and talked with doctor and answered the questions appropriately. I asked her the old admitted patient’s names and she could recall most of their names. I encouraged her to sit and talk to them. I tried to involve her in a daily routine, like, to decide what she would like to wear next day and to ensure to brush her teeth and wash her face herself. I think to involve the socially isolated patient in her daily routine is the best technique to take them out from their condition. I gave her the opportunity for decision making, such as I wanted to talk to her and where would she want to sit and for how long could we sit together. As a result, it made her talk and use her cognitive ability.

I asked her about her interests. She told me, she liked to recite her religious verses and “Nat” I asked her to recite in the occupational therapy session. There everybody acknowledged her and she was encouraged to talk about herself. She said she had performed “Hajj” with her husband and now my husband is not alive. I tried to involve her in drawing but for this she strictly refused me, but asked me to write down the name of “Allah”. She promises to color it but later on she refused.

On a group level, I tried to engage her in group activities but due to time constraint, I was not able to implement. I was planned to involve her in psycho education and in cognitive behavioral therapy, group discussions with set agendas, exercises group to promote physical activity. It was also difficult for my patient to cope at that time, but I believe if I could stay longer with her or at least go every week on clinical rather than alternate weeks, I could achieve this task as well. We can involve them in occupational therapy sessions and make a play group where they can play small native games. According to Dana A Glie, et al. (2005) “elderly non demented subjects found that participating in cognitively stimulating leisure activities (e.g. playing board games) protected against development of dementia” (p.865).

My patient was interested in reciting the Quran and if she recites in a group it make her socialize with others and women who are gathered there can share their interests as well. According to Andersson cited by Cattan M. (2005) (1) “found that among small groups of older women who lived alone and who discussed health-related topics, significantly reduced loneliness and increased social contact, self-esteem and participation in organized activities was found. (p.05)”

Family can also follow the above individual level strategies which I had done with my, if person lives at home. They can give appropriate time to them, involve them in their discussion. As a nurse I could conduct teaching on patient disease process and on social isolation with family and teach them how to deal with the isolated patients.

At institutional level we can conduct the workshops, seminars, can make nurses group who entirely deal with isolated patient, provide more information on social isolation in different disease. Attendant nurse teaching should be conducted because they should also know the reasons; consequences of social isolation. I have conducted the teaching on social isolation and on major symptoms of my patient disease which leads to social isolation with two attendant nurses (N/A). At community level we can make community support group for old people, plan activities which they can do easily.

Initially when I start reading this topic my understanding about it, was very limited. I thought loneliness and isolation are the same topic but as I read more about it I have found loneliness is purely a person’s own feeling and even though a person who involves in a group or sits in a group can go through the loneliness feelings. The Effects Of Social Isolation Essay.Whereas social isolation is with-drawl from surrounding, a person has no concern with others. Before dealing with this patient I felt that to approach this patient was very difficult because this patient was not only mentally ill but also isolated and would not let others interact with her. Gradually I started and noticed the difference.

Social isolation in older people is very common and it leaves its great impact on mental health. It does not only impair the cognitive ability, it also declines the daily activities. As a nurse it is our responsibility to deal these patients with endurance, educate the family and care takers to overcome the physical and mental health problems. I also learnt that there is a great contribution of care-takers to make patient socially isolated and if we as a care-taker take a responsibility to give them psychological support and treat them according to their capacity they can also spend a normal life or even we can prevent them from deteriorating.

Does social isolation adversely affect health? Social is the term which is best suited for human being. Because they want companionship or like to stay together for may reason such as company, help, recreation, behavioral development etc. Social isolation is the physical separation of a human from a society of a group of people. Jacqueline old outlined the reason for social isolation in modern and developed countries as people want to be independent and do not want to bother friends, family members or neighbors which make them alone. From ancient time human are social and dependent on others who are relative or neighbor for interaction and helping the counterpart. Due to this social behavior of human they develop different relationships
The impact of loneliness on physical health can also be better understood by the study conducted by Uchino and colleagues (1996). They found that social individuals have lower blood pressure, better immunity and lower levels of stress hormones than the socially isolated people. In contrast another study described by Arthur 2006 demonstrated that it is not yet clear that group therapy or socialization can improve the secondary prevention of Coronary heart Disease. After considering all the studies and arguments by different authors it can be conclude that it is necessary to do more research on the impact of socialization on physical health of individuals. Second impact of social isolation starts to begin from mental health. On the other way mentally ill members sometimes be socially isolated by the other members of the family which adversely impact the mental condition. Mental illness starts first with anxiety which deteriorates to depression and finally psychological disorder. Mentally ill patients do not want to mention their loneliness rather they express their problem in terms of anxiety and depression. It has been reported by Twenge, 2000 that social isolation from others can give rise to anxiety and stress which if persistent for long time can cause serious morbidity or mortality. In contrast it has also been evident that social affiliation or being with others can reduce or
Social isolation is an issue that many individuals face throughout their lives. According to Gottman, social isolation can be defined as “low relative frequencies of peer interactions” (Gottman, 1977, p. 513). The Effects Of Social Isolation Essay. Having friendships is an important aspect of our lives because it contributes to the quality of our lives, life satisfaction and our social welfare (Victor et al, 2000, p. 407). Social isolation can happen throughout the lifespan. It can happen during childhood through not being able to make friends at school or even during old age where having social networks and friendships are harder to attain and maintain with the lack of ability to resources (i.e. car, old age etc). Being socially isolated across the lifespan can lead to depression and loneliness (Victor et al, 2000, p. 407). In children specifically, being socially isolated from others can also lead to depression and loneliness, but also can effect a child’s adjustment and contribute to internalizing and externalizing problems (Lande et al, 2007, p. 267). The problems that are associated with social isolation in children can be predictive of how they may be in the future as well (Qualter et al, 2002, p. 242).

Adolescent is a time where meaningful relationships with peers are very important and inability to achieve and sustain these relationships can lead to psychological health problems (Lande et al, 2007, p. 265). With this being said, adolescents are specifically targets for social isolation (Lande et al, 2007, p. 265). It is evident through past literature that the inability for adolescents to successfully maintain peer relationships is positively correlated with issues of self-esteem, self worth and even suicidal thoughts in adolescents (Lande et al, 2007, p. 267). On the other hand those adolescents who do have meaningful peer relationships showcase high levels of self worth and esteem and aren’t faced with the same problems associated with those who are socially isolated (Lande et al, 2007, p. 266). It is evident that peer relationships are predictive of social isolation in adolescents. In a study done by Lande et al (2007), they looked at the effects of psychological health and the relationship it has with social isolation and how protective factors may also play a factor in mediating the effects of social isolation on psychological health. The study explicitly looked at how social isolation in adolescents is related to psychological health problems, self-esteem, and suicidal thoughts and how protective factors such as family and school connectedness and academic achievement may also be related to degree of social isolation (Lande et al, 2007, p. 272). The results of the study indicate that those adolescents who were considered to be socially isolated were more likely to try and commit suicide, had depressive tendencies and were also more likely to have issues with self-esteem and self worth (Lande et al, 2002, p. 277). Even though the protective factors were reflective of how socially isolated an individual was, it was still important for them to have meaningful peer relationships in order to not be socially isolated (Lande et al, 2002, p. 272).The Effects Of Social Isolation Essay. However, family connectedness did play an important role in determining whether those adolescents who felt socially isolated were likely to attempt suicide as a result (Lande et al, 2002, p. 278). Those adolescents who felt a close family connectedness were less likely to take it the next level and attempt to commit suicide (Lande et al, 2002, p. 278). Therefore, the results of the study indicate that those adolescents who were not able to maintain a close relationship with peers and were socially isolated were more likely to be at risk for depression, self-esteem and self worth issues and were more likely to consider committing suicide. Being unable to have a close relationship with other peers can have damaging effects on adolescents. Even though this study has many strengths and gives evidence for the relationship between social isolation and psychological health in children, there are limitations of the study that also need to be accounted for. One limitation of this study may have been the context of social isolation being asked, it was asked with only a single response of how many close friends did they have which they could talk to about their problems and didn’t account for other factors that could affect social isolation (Lande et al, 2002, p. 280).

Social isolation has also been linked to adjustment problems in children (Laursen et al, 2007). Those children who are incapable of making close friendships during childhood are at increased risk of having internalizing and externalizing problems than those children who are able to maintain close friendships (Laursen et al, 2007). In the study done by Laursen et al (2007), they looked at the correlation between social isolation in children grades one and the likeliness of them having adjustment problems in grade two. The results of the study signify that those children who had a harder time maintaining close peer friendships during the first grade were more prone to maladjustment during the second grade (Laursen et al, 2007, p. 1401). Through these results it can be seen that early friendships in childhood are predictive of proper adjustment in children later and those children who are deemed as socially isolated and can not sustain close friendships early on are more likely to have adjustment problems in the future such as acting out, aggression and depression (Laursen et al, 2007, p. 1401). In addition to shedding more light on the issues of social isolation and adjustment problems in children, there are limitations of this study that should be looked at in more depth in future studies. One of the limitations of this study is the fact that it was carried out in Finland, and the children were Finnish and one has to take into account the fact that maybe the results may have been different if the sample was from other countries including Canada (Laursen et al, 2007, p. 1402).The Effects Of Social Isolation Essay.

Also, in another study done by Rubin et al (1988), they looked at the influence of early social isolation on children and problems that they may face in the future as a result. The results of the study found two types of social isolation that were evident in the children, passive anxious and active immature isolation (Rubin et al, 1988, p. 917). Passive isolation was considered to be evident through the early school years; these children who were considered under this subtype often played by themselves and didn’t make attempt to play with other children (Rubin et al, 1988, p. 917). This was predictive of loneliness, depression, internalizing behaviors and lower levels of self-perception in middle childhood (Rubin et al, 1988, p. 921). Active immature isolation was when the child would showcase more externalizing problems as a result of social isolation, including immature and disobedient behavior, which also occurred during the early school years (Rubin et al, 1988, p. 921). As a result, this was predictive of aggressiveness in middle childhood (Rubin et al, 1988, p. 921). These results display that social isolation in early childhood can be predictive of negative future behavior and these children who are considered to be socially isolated are more likely have issues associated with depression, loneliness, and are more likely to have adjustment problems as well (Rubin et al, 1988). With this being said, one still needs to consider the limitations of the study and what can be done in future research in relation to social isolation and the impact it may have in the future for children. One limitation of this study was the sample who were being studied were considered normal so the relationship between passive isolation and depression only accounts for non clinical depression and not clinical depression which could be an area that could be studied in the future to see if the results yield the same outcome (Rubin et al, 1988, p. 922).

In addition to those studies, another study done by Hymel et al (1990), looked at the association between social isolation and internalizing and externalizing behavior over time in children. They looked at whether those children who were considered to be socially isolated in grade five would have maladjustment problems 3 years later in grade five. The results of the study indicate that those children in grade two who were thought of as socially isolated did have problems related to internalizing and externalizing behaviors in grade five (Hymel et al, 1990, p.2017).The Effects Of Social Isolation Essay. The children who were socially isolated were more likely to experience externalizing behavior in the future such as acting out in class and were more likely to be aggressive (Hymel et al, 1990, p. 2016). They were also more likely to experience internalizing behavior such as loneliness (Hymel et al, 1990, p. 2017) The results of this study confirm that social isolation in early childhood is predictive of later behavior in children in relation to adjustment. There are some limitations of the study that should be accounted for. One of the limitations of this study is that causation cannot be inferred between social isolation and internalizing and externalizing behavior but rather that an individual is more likely to experience adjustment problems as a result of social isolation (Hymel et al, 1990. P. 2019).

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There are many negative affects associated with social isolation including emotional loneliness and depression. Social isolation can have many consequences on a child especially during childhood and can also be carried through to the future. Emotional loneliness experienced as a result of social isolation can lead to greater depressive symptoms in children as they grow up (Qualter et al, 2002). In a study done by Qualter et al (2002), they looked at the whether there was relationship between social isolation and emotional loneliness and the predictive behavior of children in the future that is associated with social isolation. They defined emotional loneliness as “a lack of satisfactory attachment” (Qualter et al, 2002, p. 233). They wanted to see whether social isolation was predictive of emotional loneliness in children (Qualter et al, 2002, p. 233). The results of the study indicate social isolation and emotional loneliness are positively correlated (Qualter et al, 2002). Those children who were regarded as socially isolated were also considered to be emotionally lonely because of their inability to make close peer friendships (Qualter et al, 2002, p. 241). As a result, the emotionally lonely children were more likely to have aggressive tendencies as they developed and are more likely to have internalizing and externalizing problems as well (Qualter et al, 2002, p. 241). Furthermore, increased loneliness as a result of social isolation leads to low self-perception in children that can have damaging affects in the future (Qualter et al, 2002, p. 241). As well, the children who were considered to be socially isolated lack sufficient peer relationships they often spend more time alone and are at a greater risk for depression in the future (Qualter et al, 2002, p. 242). The results of this study show that social isolation and emotional loneliness are correlated and those children who are considered to emotionally lonely as a result of social isolation are at increased risk of depression, adjustment problems and low self worth and self esteem (Qualter et al, 2002). However, there are limitations of this study that also need to be taken into consideration. A limitation of this study is that they did not take factors like family relationships into account, which could have had an affect on social isolation in children (Qualter et al, 2002, p. 243). The Effects Of Social Isolation Essay.

In another study done by Asher et al (1985), they looked at whether or not socially isolated children are in fact more likely to experience loneliness that can later cause other psychological health problems such as depression. The results of the study showcase that those children who are considered to be socially isolated are more prone to loneliness as a result of not having a solid network of peer relationships, which can later lead to depression in the future (Asher et al, 1985). In spite of these findings, one also has to account for limitations in this study as well. One limitation of this study was that they specifically looked at low-status children and the results may have been different if the sample was inclusive of children from other status backgrounds (Asher et al, 1985, p. 505).

In conclusion it is evident to see that social isolation can affect anyone throughout the lifespan from young age to old age. Social isolation can have many negative affects on ones life, including depression, loneliness and adjustment problems (Lande et al, 2007, p. 267). This is why social isolation is especially important in the case of children because having a solid network of friends during childhood can help account for all the problems that are associated with social isolation. When a child lack’s a close peer friendships and are socially isolated they are at increased risk for depression, adjustment problems and loneliness that can be an indication of how they will be in the future (Qualter et al, 2002, p. 242). The Effects Of Social Isolation Essay.