THEORITICAL BACKGROUND OF

SOCIAL ISOLATION

A. Definition of Social Isolation

Social isolation is an attempt to avoid a relationship of communication with others
because they feel the loss of intimate relationships and do not have the opportunity to share
feelings, thoughts, and failures. Clients have difficulty in spontaneously relating to others who
are manifested by isolating themselves, being ignorant, and unable to share experiences
(Balitbang, 2007).
Social isolation is a condition in which an individual experiences a decline or even
inability to interact with others around him (Damaiyanti, 2008).
Social isolation is also the loneliness experienced by individuals and is felt when driven
by the presence of others and as negative or threatening statements (Nanda-1, 2012).

B. Response Range
Response Range of Social Isolation

Adaptive Response Maladaptive response

Alone Feeling alone Withdraw

Autonomy Dependencies Dependency
Cooperate Suspicious Manipulation
Interdependent Suspicious

Figure 1
Source: Townsend in Fitria (2009, pp. 126)

The following will be explained about the responses occurring to social isolation:
a. Adaptive Response
The range of adaptive responses is a response that is still acceptable to the prevailing
social and cultural norms. In other words the individual is still within normal limits
when solving the problem. Here is an attitude that includes an adaptive response.
1) Alone: the response a person needs to reflect on what has happened in his or
her social environment.
2) Autonomy: an individual's ability to determine and convey ideas, thoughts,
and feelings in social relationships.
3) Cooperate: the ability of individuals who need each other.

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 4) Interdependent: interdependence between individuals and others in fostering
interpersonal relationships.
b. Maladaptive Response
Maladaptive response is a response that deviates from social norms and life
somewhere. The following are behaviors that include maladaptive responses:
1) Withdraw: someone who has difficulty in open relationship with others.
2) Dependence: a person fails in developing self-confidence so that it depends on
others.
3) Manipulation: someone who interferes with others as an individual object so
can not foster deep social relationships.
4) Suspicious: a person fails to develop trust in others.

C. Etiology
According Direja (2011), the occurrence of this disorder is influenced by predisposing
factors such as development and socio-cultural. Failure can lead to an individual not believing
in himself, not believing in others, hesitating, fearing wrong, pessimistic, despairing of others,
unable to formulate desires, and feeling depressed. This situation can lead to behavior does
not want to communicate with others, prefer silence, avoid others, and neglected everyday
activities.
a. Predisposing Factors
1) The growth factor
At each stage of individual growth there is a developmental task that must be met
in order to avoid disruption in social relationships.
If the tasks in these developments are not met then it will hamper the phase of
social development that will eventually cause problems.
Developmental Stage Task
Infancy Establish a sense of trust
Play period Develop autonomy and early independent
behavior
Pre-school period Learn to show initiative, sense of
responsibility, and conscience
School period Learn to compete, cooperate, and
compromise
Pre-teen period Consider intimate relationship with same
sex
Adolescence Be intimate with friends of the opposite
sex or dependent

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 Young adulthood Being interdependent between old and
friend, looking for a partner, getting
married and having children.
Middle-aged Learn to accept the results of life that has
been passed
Old adult age Open to loss and develop a sense of
attachment to culture.
Table 1
Source: Stuart and Sundeen (1995), p.346 quoted in fitria (2009)

2) Communication factors in the family

Disruption of communication in the family is a factor supporting the occurrence
of interference in social relationships. In this theory which involves a problem in
communicating so as to cause a double bind is a state in which a family member
receives conflicting messages at the same time or high emotional expression in
the family that hinders to connect with the environment outside the family.
3) Socio-cultural factors
Social isolation or alienation from the social environment is a factor supporting
the occurrence of interference in social relationships. This is due to the false
norms adopted by the family, where every unproductive family member such as
the elderly, the chronically ill, and the disabled are alienated from their social
environment.
4) Biological factors
Biological factors are also one of the factors supporting the occurrence of
disorders in social relationships. Organs that can affect the occurrence of social
relationships are the brain, for example in schizophrenic clients who have
problems in social relationships have abnormal structures in the brain such as
brain atrophy, as well as changes in the size and shape of cells in the limbic and
cortical regions.
b. Precipitation Factor
The occurrence of social relations disorders can also be caused by internal and external
factors of a person. The precipitation stressor factor can be grouped as follows:
1) External factors
An example is the social-cultural stressor, the stress caused by social-cultural
factors such as family.
2) Internal factors
An example is the psychological stressor, that is, stress is caused by anxiety or
anxiety that is prolonged and occurs simultaneously with the limited ability of the

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 individual to overcome it. This anxiety can occur due to demands to part with the
nearest person or not to meet individual needs.

D. Problem Tree

Social Isolation Problem tree - Pull Away

E. Signs and Symptoms

Here are the signs and symptoms of clients with social isolation, (Direja, 2011):
a. Less spontaneous
b. Apathy (indifferent to the environment)
c. Facial expression is less radiant
d. Not taking care of themselves and not paying attention to personal hygiene
e. There is no or less verbal communication
f. isolate themselves
g. No or less aware of the surrounding environment
h. Food and beverage intake is disrupted
i. Retention of urine and feces
j. Decrease activity
k. Less energy (energy)
l. Inferiority
m. Posture changes, for example the attitude of the fetus / fetus (especially in the
sleeping position)

F. The Process Occurred

This behavior is usually caused by someone's self-judgment, so there is a feeling of shame to
interact with others. If no further intervention is done, it will cause a change in sensory

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 perception, hallucinations and risk of self-harm, others, even the environment. Closed
behavior with others can also lead to activity intolerance that may ultimately affect the
inability to perform self-care.
A person who has low self-esteem is initially caused by an inability to solve problems in his
life, so that the person behaves abnormally (individual coping is not effective). Family role is
big enough in encouraging clients to be able to solve the problem. Therefore, if the support
system is not good (family coping is not effective) it will support a person has low self-
esteem.

G. The process of nursing

1. Assessment
Each individual has the potential to engage in social relationships as the level of
relationship that is the relationship and the relationship of interdependence in the face
and overcome the various needs every day. On the assessment of clients difficult to
talk, quiet, daydreaming and aloof in the corners.
Termination of the relationship process is closely related to individual dissatisfaction
of the patient's relationship caused by the lack of negative environmental participant
role participants, this condition may develop a sense of distrust in others. To assess
social isolation patients, we may use interviews and observations to patients and
families (Generous, Deden 2013).
a. Predisposing Factors
1) Growth Factor
At each stage of individual growth there is a developmental task that must
be met in order to avoid disruption in social relationships.
2) Biological Factors
Biological factors are also one of the factors supporting the occurrence of
disorders in social relationships. Organs that can affect the occurrence of
social relations disorders is the brain, for example in schizophrenic clients
who have problems in social relationships have abnormal structures in the
brain such as brain atrophy, as well as changes in the size and shape of
cells in the limbic and cortical regions.
3) Socio-Cultural Factors
Social isolation or alienation from the social environment is a factor
supporting the occurrence of interference in social relationships. This is
due to the false norms adopted by the family, where every unproductive
family member such as the elderly, the chronically ill, and the disabled are
alienated from their social environment.

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 4) Family Communication Factor
Disruption of communication in the family is a factor supporting the
occurrence of interference in social relationships. In this theory which
involves a problem in communicating so as to cause a double bind is a
state in which a family member receives conflicting messages at the same
time or high emotional expression in the family that hinders to connect
with the environment outside the family.
b. Stressor Precipitation
The precipitation engine generally includes a stressful life such as loss, which
affects the individual's ability to relate to others and cause anxiety.
Precipitation engines can be grouped into two categories:
1) Socio-cultural Stressor
Stress can be caused by several factors such as family factors such as
decreasing the stability of the family unit and separating from significant
people in their life, for example, being hospitalized.
2) Psychological Stressor
Severe anxiety levels will lead to decreased ability individuals to connect
with others. The intensity of anxiety extreme and elongated with limited
individual ability to overcome the problem is believed will cause various
problems of interference (social isolation).
c. Behavior
The usual behavior appears in social isolation in the form of: less
spontaneous, apathetic (less indifferent to the environment), facial expression
less glow (sad expression), dull affects. Not taking care and paying attention
to personal hygiene, verbal communication is decreased or absent. The client
is not conversing with another client or nurse, isolating (alone). Clients appear
to separate themselves and others, not or less aware of the environment.
Impaired food and beverage intake, urinary and fecal retention, decreased
activity, lack of energy (power), low self-esteem, fetal position during sleep,
refusing relationships with others. The client decides the conversation or
leaves if invited to a conversation.
d. Source Koping
Coping resources related to maladaptive social responses include:
involvement in wide relationships within family and friends, using creativity
to express interpersonal stress such as art, music, or writing.

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 e. Defensive Mechanism
Mechanisms used as an attempt to overcome anxiety which is a real loneliness
that threatens him. The mechanisms often used in social isolation are
regression, repression, and isolation.
1) Regression is retreated to a period of past development.
2) Repression is feelings and thoughts that can not
3) accepted, consciously dammed so as not to arrive at consciousness.
4) Isolation is an unconscious mental mechanism that results in defensive
failure in linking behavior with motivation or conflict between
attitudes and behavior.

H. Action Planning Strategy

According to Direja (2011), nursing issues that may arise in social isolation are as follows:
1) Social Isolation
Intervention
According to Direja (2011), the goals and actions / interventions in social isolation
patients are:
a. Social isolation
Aim
Patients are able to:
1. Recognizing the causes of social isolation
2. Interacting with others
Results Criteria IS (Implementation Strategy) 1:
After several meetings, the patient is able to:
a) Fostering a relationship of trust.
b) Recognizing the causes of social isolation, the advantages and disadvantages
of interacting
c) with other people.
d) Interact with others gradually
SP 1
1. Identify the cause
a) Who is one house with the patient
b) Who is close to the patient
c) Who is not close to the patient
2. Ask about the advantages and disadvantages of interacting with others
a) Ask the patient's opinion about the habit of interacting with others
b) Ask what causes the patient not to interact with others

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 c) Discuss the benefits when the patient has many friends and get along
with them
d) Discuss the loss if the patient is confined alone and does not associate
with others
e) Explain the effect of social isolation on the patient's physical health
3. Train acquainted
a) Explain to clients how to interact with others
b) Give examples of how to interact with others
c) Give the patient the opportunity to practice how to interact with others
done in front of the nurse
d) Begin helping patients interact with one friend / family member
e) If the patient has progressed, increase the number of interactions with
2, 3, 4 people and so on
f) Praise each interaction progress made by the patient
g) Ready to listen to the expression of the patient's feelings after
interacting with others, maybe the patient will reveal the success or
failure, give encouragement continuously so that the patient keep the
spirit to improve interaction
4. Enter the patient activity schedule
SP 2
1. Evaluation of past activities (SP 1)
2. Train social contacts gradually
3. Input in patient activity schedule
SP 3
1. Evaluation of past activities (SP 1 and 2)
2. Train how to get acquainted with 2 or more people
3. Input in patient activity schedule

A destination for families

Family able:
Caring for patients with social isolation at home
Criteria Results SP 1:
After several meetings, the family was able to explain about:
a) Issue of social isolation and its impact on patients
b) The cause of social isolation
c) Family attitudes to help patients overcome their social isolation
d) Continuous treatment by preventing drug dropouts.
e) Referral sites and health facilities available to patients

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SP 1:
4. Identify the problems faced in caring for the patient
5. Explanation of social isolation
6. How to care for social isolation patients
7. Train (stimulation)
8. Family RTL / family schedule to treat the patient
SP 2:
1. Evaluation of SP 1 capability
2. Train (direct to patient)
3. Family RTL / family schedule to care for the patient
SP 3:
1. Evaluation of SP 1 capability
2. Train (direct to patient)
3. Family RTL / family schedule to take care of the patient
SP 4:
1. Evaluation of family ability
2. Evaluate patient's ability
3. Family follow-up plan
Follow up
reference

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 REFERENCES

Fitria, Nita.2010.Prinsip Dasar dan aplikasi penulisan Laporan Pendahuluan dan Strategi
Pelaksanaan Tindakan keperawatan ( LP dan SP). Jakarta: Salemba Medika

Keliat A,Budi Akemat. 2009. Model Keperawatan Profesional Jiwa, Jakarta

Yosep Iyus, 2009. Keperawatan Jiwa. Bandung: Refika Aditama.

Clinical Teacher, Clinical Instructor,

Dewi Setya P., Ns., M.Kep (...)

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