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RISK FOR LONELINESS Nursing Care Plan

Risk for Loneliness
At risk for experiencing discomfort associated with a desire or
need for more contact with others

Risk Factors
Pathophysiologic
Related to fear of rejection secondary to:
Obesity
Cancer (disfiguring surgery of head or neck, superstition from
others)
Physical handicaps (paraplegia, amputation, arthritis, hemiplegia)
Emotional handicaps (extreme anxiety, depression, paranoia,
phobias)
Incontinence (embarrassment, odor)
Communicable diseases (acquired immunodeficiency syndrome
[AIDS], hepatitis)
Psychiatric illness (schizophrenia, bipolar affective disorder,
personality disorders)
Related to difficulty accessing social events secondary to:
Debilitating diseases
Physical disabilities
Treatment Related
Related to therapeutic isolation
Situational (Personal, Environmental)
Related to affectional or cathectic deprivation*
Related to physical or social isolation*
Related to insufficient planning for retirement
Related to death of a significant other
Related to divorce
Related to visible physical disabilities
Related to fear of rejection secondary to:
Obesity
Hospitalization or terminal
illness (dying process)
Extreme poverty
Unemployment
Related to moving to another culture (e.g., unfamiliar language)
Related to history of unsatisfactory social experiences secondary to:
Drug abuse
Unacceptable social behavior
Alcohol abuse
Delusional thinking
Immature behavior
Related to loss of usual means of transportation
Related to change in usual residence secondary to:
Long-term care Relocation
Maturational
Child
Related to protective isolation or a communicable disease
Related to autism
Older Adult
Related to loss of usual social contacts secondary to:
Retirement
Death of (specify)
Relocation
Loss of driving ability

Author's Notes
Risk for Loneliness was added to the NANDA list in 1994. Currently,
Social Isolation is also on the NANDA list. Social Isolation is a conceptually
incorrect diagnosis because it does not represent a response, rather
a cause. ElSadr, Noureddine, & Kelley (2009), in a concept analysis of
loneliness, found the literature that supports social isolation as a possible
cause of loneliness. Loneliness and Risk for Loneliness better describe the
negative state of aloneness.
Loneliness is a subjective state that exists whenever a client says it
does and perceives it as imposed by others. Social isolation is not the
voluntary solitude necessary for personal renewal, nor is it the creative
aloneness of the artist or the aloneness—and possible suffering—
a client may experience from seeking individualism and independence
(e.g., moving to a new city, going away to college).

Goal
The client will report decreased feelings of loneliness, as evidenced
by the following indicators:
• Identify the reasons for his or her feelings of isolation.
• Discuss ways to increase meaningful relationships.

Interventions
The nursing interventions for various contributing factors that
might be associated with Risk for Loneliness are similar.
Identify Causative and Contributing Factors (Refer to Related
Factors)
Reduce or Eliminate Causative and Contributing Factors
• Promote social interaction.
• Support the client who has experienced a loss as he or she
works through grief (refer to Grieving).
• Encourage client to talk about feelings of loneliness and their
causes.
• Encourage development of a support system or mobilize
client’s existing family, friends, and neighbors to form one.
• Discuss the importance of high-quality, rather than highquantity,
socialization.
• Refer to social skills teaching (see Impaired Social Interaction).
• Offer feedback on how the client presents himself or herself
to others (refer to Impaired Social Interaction).
Decrease Barriers to Social Contact
• Help identify transportation options.
• Determine available transportation in the community (public,
church-related, volunteer).
• Determine if client must learn how to use alternative transportation.
Help desensitize client to fear/stigma of using public
transportation.
• Assist with the development of alternative means of communication
for people with compromised sensory ability
(e.g., amplifier on phone, taped instead of written letters; refer
to Impaired Communication).
• Assist with management of aesthetic problems (e.g., consult
enterostomal therapist if ostomy odor is a problem; teach
client with cancer to control odor of tumors by packing area
with yogurt or pouring in buttermilk, then rinsing well with
saline solution).
• Refer to Impaired Urinary Elimination for specific interventions
to control incontinence.
Identify Strategies to Expand the World of the Isolated
• Senior centers and church groups
• Volunteer assignments (e.g., hospital, church)
• Foster grandparent programs
• Adult day-care centers
• Retirement communities
• House sharing, group homes, community kitchens
• Adult education classes, special interest courses
• Pets
• Regular contact to diminish the need to obtain attention
through a crisis (e.g., suicidal gesture)
• Psychiatric day hospital or activity program
Implement the Following for People With Poor or Offensive Social
Skills
• Refer to Impaired Social Interactions.
Discuss the Anticipatory Effects of Retirement; Assist With
Planning
• Prepare for ambivalent feelings and short-term negative effects
on self-esteem.
Discuss Those Factors That Contribute to Successful Retirement
(Santrock, 2004; Murray, Zentner, & Yakimo, 2009)
• Stable health status
• Adequate income and health benefits
• Active in community, church, or professional organizations
• Higher education level and ability to pursue new goals/activities
• Extended social network, family friends, colleagues
• Satisfied with life before retirement
• Satisfied with living arrangements
• Plan to ensure adequate income
• Decreased time at work the last 2 to 3 years (e.g., shorter days,
longer vacations)
• Cultivate friends outside work.
• Develop routines at home to replace work structure.
• Rely on others rather than spouse for leisure activities.
• Cultivate realistic leisure activities (energy, cost).
• Engage in community or church programs or professional
organizations.
Initiate Referrals, as Indicated
• Community-based groups that contact the socially isolated
• Self-help groups for clients isolated because of specific medical
problems (e.g., Reach to Recovery, United Ostomy Association)
• Wheelchair groups
• Psychiatric consumer rights associations

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