hmmm 1st care plan, Loneliness, but now not sure

[vivasmom]

I'm writing a care plan: assessment of a healthy adult.

My nursing diagnosis is Risk for loneliness, as pt. is a SAHM of 22month old, preggo with #2, husband works long hours and her family (with whom she is very close) lives both hundreds and 1000's of miles away. She is also desperate for some non-mommy talk. All of her social interactions revolve around being a mom. she really really wants to talk about something else with grown-ups. when baby 2 comes along, all of the above will feel even more pronounced to her.

goals I've thought of: Pt. will have one adult only evening out per month.

Pt. will list 3 adult only activities that sound interesting to her and fit into her limited spare time by the end of the week.

sooooo. does the above subjective/objective information support risk for loneliness?

[casi, ASN, RN]

I'm another 1st semester student, but the information seems to support it. The only thing that I noticed is your goals are actually outcomes...

[vivasmom]

I thought goals and outcomes are the same, like intervention and implementation are the same. Thanks for looking at my little post!

[ChristineN, BSN, RN]

Perhaps for interventions you could provide her with info about local new mom/mom of little ones groups, play groups, etc. something so she can get out of the house and interact with other adults.

[NoviceRN10]

Is loneliness an actual nursing diagnosis? I would think risk for depression would be easier to "work" with.

[EricJRN, MSN, RN]

I haven't encountered Risk for Loneliness before either. I wonder if Risk for Infection or Risk for Injury would be worth considering. I don't have my NANDA reference with me right now.

Would help us to include some more assessment data, even if it's just ht/wt, vitals, etc.

[vivasmom]

risk for loneliness is a NANDA diagnosis. Re: referral to playgroups etc. she already does that. that is the complete opposite of what social interaction she seeks. i would suggest a book club, but she is too tired and busy to read for leisure. this woman was a very high powered and successful film producer who is very well educated and is having trouble finding people to talk to about stuff other than kids.

i know how it is, i have a 5 year old and although i love to hang out with my friends who are also moms, we end up talking about the kids the majority of the time.

[Daytonite, BSN, RN]

i can't help but wonder what your nursing interventions (none of which you mention, by the way) are. this is a psychosocial diagnosis that is primarily concerned with one's self-perception. the definition of this nursing problem is at risk for experiencing discomfort associated with a desire or need for more contact with others. if there really is a problem, you need to be using the diagnosis of social isolation which is a self-worth problem. this is why initial assessment and looking at the abnormal data symptoms is such an important step in diagnosing. [you must follow the steps of the nursing process in the sequence they occur when you are planning care--no exceptions.] if this patient has symptoms of social isolation, then she has an actual problem here and not a potential problem which is what a "risk for" diagnosis is. for a risk of loneliness you need to be focusing on the patient's feelings to head off the potential problem. that means nursing interventions that involve a lot of therapeutic communication to explore those feelings of deprivation and isolation to assist her in understanding them. that's what these psychosocial problems involve. did you do any reading and investigation of this subject of loneliness? did you find an assessment tool to use to measure her feelings against? the nature of this diagnosis is that the problem does not yet exist, but is only a possibility. i think it is your job to merely facilitate the client's learning, but not to do the work for her. this has to be a discovery process for her.

just a word abut goals/outcomes. they are intimately linked to your nursing interventions. they are what you expect to occur as a result of the performance of the nursing interventions.

you asked, does the above subjective/objective information support risk for loneliness?

can't tell. what's the risk factor on your diagnosis? all you've given is the goals/outcomes. you didn't list any of your nursing interventions. i think you might have a case for

social isolation

based on the information you posted

.

when you use a diagnosis like

risk for loneliness

, you must have the specific problem you expect might happen clearly outlined, at least in your mind. your nursing interventions will be to

• monitor for the signs and symptoms of the problem
  
  
• include nursing interventions designed to prevent that specific problem (signs and symptoms) from occurring
  
  
• a way to report the signs and symptoms if they do occur

you don't get into specific treatment of the problem because the symptoms are not present. if the symptoms are already present, you've diagnosed wrong.

[Daytonite, BSN, RN]

risk for loneliness is a nanda diagnosis. re: referral to playgroups etc. she already does that. that is the complete opposite of what social interaction she seeks. i would suggest a book club, but she is too tired and busy to read for leisure. this woman was a very high powered and successful film producer who is very well educated and is having trouble finding people to talk to about stuff other than kids.

i know how it is, i have a 5 year old and although i love to hang out with my friends who are also moms, we end up talking about the kids the majority of the time.

all right, i'm not belittling your own experiences, but you need to start thinking rationally like a nurse. you have to follow the nursing process when you are writing care plans or working on problems. it is a problem solving process. learn to work it. it will not fail you. you already know how to use it, just not expressed in this language. it is the process behind the illusive phrase you will hear thrown about: critical thinking.

1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
   
3. planning (write measurable goals/outcomes and nursing interventions)
   
4. implementation (initiate the care plan)
   
5. evaluation (determine if goals/outcomes have been met)

[vivasmom]

As this is a care plan for a healthy, well adjusted adult with no social adjustment issues I found social isolation diagnosis to be lacking, esp. defining characteristics like, expressed feelings of rejection, expresses interests inappropriate to age or stage, projected hostility, etc etc. Those are just not there. However, The risk for loneliness diagnosis characteristics: cathectic deprivation, physical isolation and socail isolation are all potentially at play here.

here is what I actually have written for the paper:

Her NANDA nursing diagnosis is risk for loneliness related to decreased adult interaction and long distance familial relationships as manifested by statements such as, “I need to be around some other people and talk about anything other than C. (her son) or Mommyland,” and “I’m so sad my family is so far away, especially my sister.” The objective data to support this diagnosis includes her husband’s work schedule, up to 14 hours a day, and the vast geographic distances between J.P. and her family. The impending birth of her second child and the rigors of having a newborn and a toddler are likely to exacerbate her feelings of isolation and loneliness.

The first goal identified for this patient is: the patient will have at least one adult only evening per month, to start within the next four week period. The second goal for the patient is: the patient will list three non-parenting related activities that interest her and accommodate her limited free time, by the end of this week. To facilitate these goals the nurse will devise several interventions. The nurse will encourage the patient to discuss the activities she enjoyed prior to motherhood. She will assist the patient in identifying inexpensive local activities that can be accomplished within a three-hour timeframe. The nurse will validate the patient’s feelings regarding needing non-motherhood focused activities. Finally the nurse will encourage the patient to identify nearby friends whose friendships she may potentially want to strengthen or deepen.

[Daytonite, BSN, RN]

you've got a big problem with the construction of your nursing diagnosis.

• risk for loneliness related to decreased adult interaction and long distance familial relationships as manifested by statements such as, "i need to be around some other people and talk about anything other than c. (her son) or mommyland," and "i'm so sad my family is so far away, especially my sister."
  • "because the patient is just at risk for the problem, no signs and symptoms of the diagnosis are present (and therefore, you can't include an 'as evidenced by' statement); you're simply developing a plan to prevent the problem from occurring." [page 65, nursing care planning made incredibly easy]

your nursing interventions must prevent the exacerbation of her feelings of isolation and loneliness since that is the focus of this problem you are trying to prevent. your long term goal(s) should reflect and state this. let your short term goals echo the results of your nursing interventions. keep in mind that this is a psychosocial diagnosis. i would concentrate the long term goal around the patient's feelings being averted or their desires or needs satisfied (re-read the definition of this diagnosis).