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NSE 21A/B Study Guide - Midterm Guide: Social Isolation, Nanda, Social Cognitive Theory


Department
Nursing
Course Code
NSE 21A/B
Professor
Patricia Mc Graw
Study Guide
Midterm

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NSE 21: Week 10/ 11
Week 10: Social Isolation
Introduction: Nicholson
-Social isolation is more prevalent in older adults bc of their diminished vitality
and health (bondevik + Skogstad)
-Older adults who live alone or have difficulty leaving home = increased risk SI
-Older adults with small social networks = increased risk for all causes of mortality
History:
1. Irreversible loss of social attacments and community ties (Berkman) = used
number of ties to describe the concept (counting approach)
2. State which an individual experiences a need or desire for contact with others but
is unable fro some reason to make contact (lien-Gieschen) = based on
characteristics of social isolation identified in NANDA (She was a nurse) = first
to take into account the feelings and perspective of OA vs. number of social ties.
3. An objective measure of contacts with other people (havens) = from medicine and
emphasizes the counting approach or the objective nature of social isolation
4. Aloneness experienced by the individual and perceived as imposed by others as
negative or threatened state (Ackley and Ladwig) = Contrasts Haven = this
definition is taken from NANDA book = emphasizes the subjective aspect of
social isolation + weights the feelings experienced by the individual more heavily
than anything else.
-Social isolation = first used to describe groups of people with few social networks
or low levels of social support
-Evolved = true concept embedded in certain nursing theories = allowed for
research
-Social isolation = now includes objective and subjective components = increase in
scope and breadth
-Specific subjective feeling = lack of belongingness
Attributes of Social Isolation (Nicholson)
1. Decreased number of contacts
-Contacts = number of individuals available with whom to interact via phone, visit
etc. OA = socially isolated = small or non existent contact with people or
maintain infrequent contact with those they do have
2. Lack/decrease in the feeling of belonging
-Belonging = experience of personal involvement in a system or environment so
that person feels themselves to be an integral part of that system or environment)

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-Lack of belonging = internal feeling (could be surrounded by others and still not
feel a part of the environment)
-Takes into account the perspective of the OA (as opposed to simply examining
their social isolation status based on numbers alone)
3. Inadequate or non fulfilling relationships (isolation) or being unsatisfied with the
relationship they have
-Feeling that ones needs are not being met or the relationship is inadequate overall
4. Lack of engagement with others
-Actual act of calling someone on the phone or interacting with thme in person
-OA = can have many contacts but not engage with them
-Example = have several friends but they are not called or visited
5. Lack/decrease in the quality of social network members
-OA = may know individuals who are unreliable, uncaring or even abusive = low
quality network members
-OA = may not have strong bonds with others or may have superficial relationships
= low quality
Definitions of social isolation
-State in which the individual lacks a sense of belonging socially, lacks
engagement with others, has minimal number of social contacts and they are
deficient in fulfilling and quality relationships (Nicholson)
Antecedents to social Isolation
1. Lack of relationships
-Includes both type of relationship and frequency of contacts within the
relationship
-Lack of relationship with friends, family, church = lead to social isolation
-Being unmarried = negative outcomes
-Frequency of contacts made among relationships = lead to social isolation
-Being alone = lead to social isolation + sense of alienation
2. Psychological barriers
-Decline in cognition/ altered mental health + satisfaction with other people =
psychological component factors that lead to social isolation
-Dementia + depression = lead to social isolation
-Fewer sources of psychological support + emotional expression + longing for this
support = social isolation
-Loneliness + low morale = present in the literature
3. Physical barriers
-Factors as general as health problems

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-Decline in functional health, functional impairment, reduced mobility physical
disability = SI
-Relationship between age and its phsycial consequences = social isolation
4. Low financial and resource exchange
-Resource exchange = anything that constitutes a trade of personal resources =
money, transportation or assistance
-Economic restraints, low income = SI
-Inadequate personal resources, amount of help given and received and exchange
of support = low resource exchange antecedents = SI
5. Prohibitive environment
-Environmental factors = make social interaction difficult or impossible
-Type of housing, geographical location and relocation to new housing are specific
prohibitive environment antecedents
Consequences of social isolation
1. Decreased networks
2. Increased alcohol intake
3. Increased depression
4. Increased fall
5. Cognitive decline
6. Increased nutritional risk
7. Increased re-hospitalization
8. Increased loneliness
9. Alteration in family process
Isolation in Roys Adaptation model
-Humans = system that give + receive input + adapt effectively or ineffectively to
stimuli
-Environment = situation + circumstances surrounding the person
Health = defined in terms of becoming an integrated being
-Stimulus = received = processed = and exhibited in four adaptive modes:
1. What are the 4 Adaptive Modes?
-Phsyiological
-Self concept
-Role function
-Interdependence
2. What are the two types of behavioral responses?
-Adaptive
-Ineffective
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