Posted at 10.05.2018
A 60 years old female XYZ patient was admitted in medical center with organic and natural brain syndrome two years ago. She actually is still hospitalized. My first discussion with patient was after i inserted her room, she explained to get out. In second conversation as I tried out to talk to her, she paid attention to me only for two minutes but didn't answer me and instructed her care-taker to inform me to leave the area.
My further attempts at interaction with the patient would cause conversations not prolonged 2-4 minutes and then she would remove herself to a place where no-one would bother her. More often than not, she held herself in her room and become hostile when someone tried out to take her outside the house. She couldn't concentrate on a very important factor more than 2 minutes. Her major symptoms were brief attention period, impaired recent ram and poor judgment.
In three weeks rotation I've found she was reluctant to talk with others. She experienced convenient when no person disturbed her. Initially she was very highly guarded but very steadily as I caused her, things commenced to boost. I made small interventions to make her socialize, such as, every day I got her outdoors and asked her to greet medical care pros etc. The end result of the little attempts was very positive. The health care professionals seen a discernable change in her action. Now this patient greets others and responds more positively. THE PHYSICIAN said she confirmed very positive advancements and advised these interventions should be persisted.
The strategy which came in my mind and very perceptibly I've found in my own patient was cultural isolation. Matching to Nicholas R, Nicholson Jr. (2009) "Social isolation is advised, state in which the individual lacks a feeling of owed socially, lacks proposal with others, has a minor number of cultural contacts and they're deficient in fulfilling and quality relationships"(p. 1346).
Social isolation is a public condition that leaves significant effects on subconscious well-being and physical health, with the expenses of these conditions particularly higher among old and psychologically ill patients. Matching to Havens et al. cited by Nicholas R & Nicholson Jr. (2009) "Psychological barriers such as drop in cognition, poor or transformed mental health factor that lead to sociable isolation" (p. 1346). EASILY relate the idea with my patient she loves to live alone, unable to talk about her life experiences, insufficient belongingness with others, unable to do her activity everyday living and all of these were because of her cognitive impairment and low focus level which leads her towards interpersonal isolation in her.
Many factors which brings about public isolation. In Pakistan, steadily our company is loosing our traditional worth, social bonds like family and neighborhood. With changing socio-economic and ethnic conditions, we witness the introduction of nuclear families living separately rather than the traditional extended families living together. Books on interpersonal isolation is not available about our country but I've found the Southern Asian Article (New Delhi India). Indian culture is similar to ours and we can easily relate their findings to our context. Age Well Basis (2010) stated that "Ever-changing socio-economic scenario of the united states has led to emergence & attractiveness of nuclear family they felt themselves completely isolated and by itself" (p. 21). Regarding to Age group Well Foundation (2010) "In urban areas 39. 1% older persons were reported isolated socially as well as emotionally" (p. 09).
In late age certain individuals faculties become enfeebled. For example cognitive impairment, physical frailty, limited ability for cultural connections. If this is followed with social isolation, the chances of depression developing are much increased. If the situation continues, the individual is found in a downward spiral where public isolation and depression prey on one another, and the individual becomes deprived of the capability to conduct social conversation. According to Draper cited by Heather L. Menne et al. (2009) "left untreated depression and depressive symptoms intensified issues with cognitive processing" (p. 554).
According to Amin A. & Gadit M. (2010) "One of the mental diseases, depression. . . 22. 9%prevalence of depression among older" (p. 03). Chronic diseases, the death of friends and family members and emotions of sociable isolation can truly add up to communal isolation in aged adults. Regarding to Ather M Taqui &et al. "The prevalence of depression in older people in our study was 19. 5%" (p. 04). They also mentioned the cause of depression was nuclear family and credited to less public conversation with family, older have problems with depression.
Stigmatization towards mental health problems is very common, which make emotionally ill patients socially isolated more. Zahid, J. et al. (2006) explained "The younger respondents felt that folks with schizophrenia, depression and substance abuse are dangerous more likely to blame people with substance abuse problems for their medication use" (p. 57).
Care-taker perceptions towards later years people and then for mentally unwell patients are also contributing factor towards public isolation. Matching to Baltes and Smith quoted by Graeme Hawthorne (2006) "It really is a stereotype of later life that there is a network of loneliness, cultural isolation and neglect" (p. 522). During my mental health specialized medical, I detected that care-takers feel that if they fulfill the patient's physical needs, provide them with medicine on time, this is more than sufficient. Their behaviour toward old age was as they are extremely old, there is absolutely no hope for them to remedy from mental disorder. A similar thing was happened with my own patient. Her care-taker's perceptions were "now my patient is very old and you don't have to make any attempts because since 2 yrs I am with her but there are no positive improvements".
Roy's Adaption Model (Roy & Andrews 1999) is one conceptual and theoretical model in medical with which public isolation matches well. With this model she focused on four modes of adaptation, physiologic-physical, Self-concept, Role function and Interdependence Method. If individuals declines in a single mode they have specific affects on physical and mental health. Corresponding to Nicholas R, Nicholson Jr. (2008) "Being socially isolated can be conceptualized as having inadequate self-concept or Interdependence function responses the individual has failed to adapt and this is manifested when you are socially isolated" (p. 1349). Through this model a nurse can take notice of the behavior of the individual is adaptive or maladaptive.
Self-concept mode centered on psychological and religious sense of integrity and reason for living in the universe. When someone looses sense of internal well being, has no reason for life, unconcerned with others, this makes a person socially isolated. Cognitive impairment is the major cause which interferes in this mode and the individual seems helpless to adjust this method effectively and switches into cultural isolation. Interdependence method deals with individuals relationships with others, their goal, structures and how it grows singularly and in an organization. When a person fails to adapt this mode appropriately and shows less concern towards close relations, or someone's adored one's show less concern toward the individual it makes the person socially isolated.
Social isolation has strong reference to mental illness. Public isolation and cognitive impairment go side by side. Regarding to Ellis and Hickie cited by Graeme Hawthorne (2006) "In addition there are associations between communal isolation and mental disorder premature death" (p. 522).
My patient was socially isolated anticipated to impaired cognitive talents, short attention course and impaired recent and immediate memory. Older people need more concentration and care when i relate the aforementioned with my patient, she was 60 years old and struggling to remember recent situations and focus on one point. When she failed to do these tasks which impede her communication and day to day activities, this made her more agitated and led to interpersonal isolation.
In later years cognitive impairment decrease daily activities, lack of interest in cultural interaction, face issues expressing their own feelings and understand other's ideas. All these things also play a substantial role in social isolation. According Van Oostrom cited by Graeme Hawthorne (2006) "Linked to difficulties with minor cognitive impairmentspouse reduction and institutionalization" (p. 522).
Research conducted on sociable isolation has discovered many different factors that might contribute to public isolation in aged parents, Physical environment factors such as host to property, geographic distance from family or friends. Matching to Kaneda cited by Barratt J. (2007) "In growing countries growing numbers of old isolation bereft of the traditional environment of an extended family" (p. 02). Inside the light of literature, my patient was dependent on the care-taker in medical center although she fulfills her physical needs but I never noticed her encourage the patient to mingle with others. In my view this was also one of the complexities for her social isolation.
Maintaining human relationships and participating in communal activities have been associated with much better memory and intellect in the elderly. There are numerous strategies which as a nurse we can form to obtain a person from isolation. Studies discovered that educational and communal activity, group interventions that target specific groups of individuals can alleviate sociable isolation among older people.
Patient assessment I have protected in the situation. I had planned strategies at the average person, family, group and institutional level. But I simply got an opportunity to implement on the individual and institutional level.
Strategies for individual: I done her short attention period and on social isolation. In the beginning I asked her to come out from the room, we would take a round in corridor. She refused but steadily she accepted. I made her friend of the other personnel, explored her life accomplishments and acknowledged it in front of other staff; made her sit down in your garden and in the tv set room, Every day I needed her external and motivated her greet medical care experts.
I involved her in occupational therapy although out of eight days occupational therapy trainings she only attended three sessions in support of within the last program she sat for so long as 10 minutes and spoken with doctor and replied the questions appropriately. I asked her the old admitted patient's names and she could recall almost all of their names. I prompted her to stay and talk to them. I tried out to involve her in a day to day routine, like, to decide what she'd prefer to wear next day and also to ensure to brush her tooth and wash her face herself. I think to require the socially isolated patient in her daily routine is a good technique to take them out of their condition. I gave her the chance for decision making, such as I wanted to talk to her and where would she want to take a seat and for how long could we take a seat together. As a result, it made her converse and use her cognitive capability.
I asked her about her hobbies. She explained, she liked to recite her religious verses and "Nat" I asked her to recite in the occupational remedy session. There every person recognized her and she was motivated to discuss herself. She said she experienced performed "Hajj" with her partner and now my husband is not alive. I attempted to involve her in sketching but also for this she totally refused me, but asked me to write down the name of "Allah". She assures to color it but later on she refused.
On a group level, I attempted to engage her in group activities but scheduled to time constraint, I had not been able to apply. I was prepared to involve her in psycho education and in cognitive behavioral remedy, group conversations with set agendas, exercises group to promote physical activity. It had been also difficult for my patient to deal at that time, but I believe if I could stay longer with her or at least go every week on medical rather than alternate weeks, I possibly could achieve this activity as well. We are able to entail them in occupational remedy sessions and make a play group where they can play small local games. Corresponding to Dana A Glie, et al. (2005) "elderly non demented themes found that taking part in cognitively stimulating leisure activities (e. g. playing board games) shielded against development of dementia" (p. 865).
My patient was interested in reciting the Quran of course, if she recites in a group it make her socialize with others and women who are compiled there can reveal their hobbies as well. Relating to Andersson cited by Cattan M. (2005) (1) "found that among small groups of elderly women who lived together and who discussed health-related topics, significantly reduced loneliness and increased interpersonal contact, self-esteem and contribution in sorted out activities was found. (p. 05)"
Family can also follow the above specific level strategies that i had done with my, if person lives at home. They can give appropriate time for you to them, require them in their dialogue. As a nurse I could conduct teaching on patient disease process and on sociable isolation with family and educate them how to deal with the isolated patients.
At institutional level we can conduct the workshops, seminars, can make nurses group who completely offer with isolated patient, provide more information on interpersonal isolation in various disease. Attendant nurse coaching should be conducted because they should also know the reason why; consequences of social isolation. I've conducted the teaching on public isolation and on major symptoms of my patient disease which contributes to cultural 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 scanning this theme my understanding about it, was very limited. I thought loneliness and isolation are the same theme but as I reading more about it I've found loneliness is solely someone's own feeling and even though someone who involves in a group or sits in an organization can feel the loneliness feelings. Whereas sociable isolation is with-drawl from adjoining, one has no nervous about others. Before interacting with this patient I noticed that to approach this patient was very difficult because this patient had not been only mentally sick but also isolated and would not let others interact with her. Little by little I started out and recognized 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 potential, it also declines the day to day activities. To be a nurse it is our responsibility to offer these patients with endurance, instruct the family and care and attention takers to get over the physical and mental health issues. 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 provide them mental health support and treat them regarding to their capacity they can also spend a standard life or even we can prevent them from deteriorating.