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Concept analysis of isolation. This article uses Walker and Avant's methodological approach in distinguishing the concept of isolation between the normal, ordinary language usage and the scientific usage of the concept. The importance of social contact has long been recognized as a fundamental need for humans. The concept of isolation is used throughout the lay and scientific literature and has a primarily negative connotation for humans. The experience is sometimes severe enough to result in serious reductions in adaptation and performance. The Medline, CINAHL, and Google Scholar databases were searched using the key terms of concept analysis, human, and isolation with no restriction on the year of publication. English language reports were used exclusively. Three attributes were identified: sensory deprivation, social isolation, and confinement. Antecedents included individual perception and situational dimensions. Consequences included anxiety, depression, mood disturbances, anger, loneliness, and adverse health events. Through this concept analysis, isolation has been theoretically defined as a state in which an individual experiences a reduction in the level of normal sensory and social input with possible involuntary limitations on physical space or movement. Systematic studies of isolation using this concept can ultimately enhance nurses' knowledge base and contribute to the quality of life for isolated persons.
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Isolation: A Concept Analysis
Heather M. Gilmartin, MSN, RN, FNP, Patti G. Grota, PhD, RN, CNS-M-S, and Karen Sousa, PhD, RN, FAAN
Heather M. Gilmartin, MSN, RN, FNP, is Adjunct Clinical Faculty, College of Nursing, University of Colorado, Aurora, CO;
Patti G. Grota, PhD, RN, CNS-M-S, is Assistant Professor of Nursing, Schreiner University, Kerrville, TX; and Karen Sousa,
PhD, RN, FAAN, is Professor and Associate Dean for Research and Extramural Affairs, College of Nursing, University of
Colorado, Aurora, CO.
Keywords
Communicable disease, concept
analysis, nursing theory
Correspondence
Heather M. Gilmartin, MSN, RN,
FNP, College of Nursing, University
of Colorado, Aurora, CO
E-mail: heather.gilmartin@
ucdenver.edu
Funding: This research received
no specific grant from any funding
agency in the public, commercial,
or not-for-profit sectors.Conflict of
Interest Statement: No conflicts of
interest have been declared by the
authors.
TOPIC. Concept analysis of isolation.
PURPOSE. This article uses Walker and Avant’s methodological approach
in distinguishing the concept of isolation between the normal, ordinary
language usage and the scientific usage of the concept.
BACKGROUND. The importance of social contact has long been recog-
nized as a fundamental need for humans. The concept of isolation is used
throughout the lay and scientific literature and has a primarily negative
connotation for humans. The experience is sometimes severe enough to
result in serious reductions in adaptation and performance.
DATA SOURCES. The Medline, CINAHL, and Google Scholar databases
were searched using the key terms of concept analysis, human, and
isolation with no restriction on the year of publication. English language
reports were used exclusively.
CONCLUSION. Three attributes were identified: sensory deprivation,
social isolation, and confinement. Antecedents included individual per-
ception and situational dimensions. Consequences included anxiety,
depression, mood disturbances, anger, loneliness, and adverse health
events. Through this concept analysis, isolation has been theoretically
defined as a state in which an individual experiences a reduction in the
level of normal sensory and social input with possible involuntary limi-
tations on physical space or movement. Systematic studies of isolation
using this concept can ultimately enhance nurses’ knowledge base and
contribute to the quality of life for isolated persons.
Introduction
It is generally recognized that humans are social
animals whose behavior is significantly determined by
their needs and reactions to other people. This social
aspect of human existence is nowhere more evident
than when he or she is isolated from others (Haythorn,
2008). People have been subjected to isolation for
centuries, as evidenced through accounts of solitary
confinement in the penal system, Arctic explorers, and
ocean sailors (Haney, 2003; Laing & Crouch, 2009;
Zubek, 2008). Isolation has also been used as a tool to
prevent the spread of infectious disease through the
physical separation of those infected from the popula-
tion (Abad, Fearday, & Safdar, 2010; Gensini, Yacoub,
& Conti, 2004). Isolation is now being recognized as an
outcome for those with mental, physical, infectious,
and age-related issues that limit a person’s ability to
connect with their social network (Abad et al., 2010;
Furr et al., 2007; Hagedoorn & Molleman, 2006;
Maunder, 2004; Nicholson, 2009; Trout, 1980; Victor,
Scambler, Bond, & Bowling, 2000).
The anecdotal literature, field, and laboratory
studies indicate that isolation is stressful to many indi-
viduals and that the stress is sometimes severe enough
to result in serious reductions in adaptation and per-
formance (Catalano et al., 2003; Haythorn, 2008).
This article attempts to distinguish the normal, ordi-
nary language usage of the concept of isolation and
the scientific usage, and develop an operational defi-
nition of isolation using the methods of Walker and
Avant (2011) because of its ease and straightforward
bs_bs_banner AN INDEPENDENT VOICE FOR NURSING
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approach. The key procedures in the concept analysis
include identifying definitions, defining attributes,
related cases, model, borderline and contrary cases,
and empirical referents.
Uses of the Concept
Ordinary
The Merriam-Webster Dictionary defines isolation
as the condition of being alone (Isolation, 2011c).
WordNet.com (Isolation, 2011d), a word-defining
Web site, adds, “A state of separation between persons
or groups and a feeling of being disliked or alone,” and
etymology.com (Isolation, 2011b), an online etymol-
ogy dictionary, identifies the origin of isolation as the
Latin insulatus, or “made into an island.” The popular
literature has described isolation in song, such as Iso-
lation by John Lennon (1970), literary essays, such as
Papillion (Charriere, 2006), The Scarlet Letter (Haw-
thorne, 1999), and The Colony: The Harrowing True Story
of the Exiles of Molokai (Tayman, 2007). These works tell
the stories of persons forced into isolation because of
their social situation, as a penalty or because of fear of
contagion. A consistent theme among the ordinary
use of isolation is a physical or emotional separation
that is negatively experienced by the individual or
group.
Scientific
The term isolation is defined in the field of chemistry
as the separation of a pure chemical substance from a
compound or mixture; in computer science, it is
defined as the ability of a logic circuit having more
than one input to ensure that each input signal is not
affected by any of the others; in evolution, it is defined
as the restriction or limitation of gene flow between
distinct populations because of barriers to interbreed-
ing; in health care, it is defined as the separation of an
individual with a communicable disease from other,
healthy individuals; in microbiology, it is defined as
the separation of an individual strain from a natural,
mixed population; in physiology, it is defined as the
separation of a tissue, organ, system, or other part of
the body for purposes of study; and in psychology, it is
defined as the dissociation of a memory or thought
from the emotions or feelings associated with it (Iso-
lation, 2011a). Science uses the concept of isolation as
a separation of one object or individual from another.
Defining Attributes
To distinguish isolation from other related concepts,
it is essential to identify its defining characteristics
(Walker & Avant, 2011). Three major attributes of
human isolation have been identified in the scientific
literature: sensory deprivation, social isolation, and
confinement (Rasmussen, 2008; Sells, 2008; Zucker-
man, Persky, & Link, 1968). Studies have indicated
that these attributes, when experienced in combina-
tion, are stressful to many individuals and that
the stress is sometimes severe enough to result in
serious decrements in adaptation and performance
(Haythorn, 2008).
Sensory Deprivation
Sensory deprivation, or the removal of reception
and/or perception of human stimuli (Chodil & Will-
iams, 1970), is noted to be disturbing to many indi-
viduals. The importance of continued, varied sensory
input is a noted necessity for the maintenance of
normal, intelligent, and adaptive behavior in humans
(Bexton, Heron, & Scott, 1954). The experience of
sensory deprivation has been tested in lab studies by
the complete restriction of communication, sights, and
sounds from the external world (Bexton et al., 1954;
Zubek, 2008). In the field, sensory deprivation has
been described through the practice of solitary con-
finement in the penal system (Haney, 2003), for hos-
pitalized patients in isolated environments (Abad
et al., 2010; Barratt, Shaban, & Moyle, 2010;
Gammon, 1999), and for persons with restriction on
one or many of their senses because of injury or treat-
ment (Chodil & Williams, 1970).
In laboratory studies, the outcomes of sensory and
stimulus deprivation were summarized by researchers
into three themes: tedium stress, reflecting concern
with the boredom and monotony of isolation; unreal-
ity stress, concerned with the novel and frightening
reactions to stimulus reduction; and positive contem-
plation, reflecting the positive reactions of some indi-
viduals to the opportunity that isolation provides for
thinking about one’s life and the meaning of things
(Haythorn, 2008). These themes have been validated
in observational and qualitative studies in the health-
care literature with patients in source isolation for
infectious disease and protective isolation for cystic
fibrosis and cancer reporting boredom, stress, fear, and
positive reactions to the experience (Abad et al., 2010;
Barratt et al., 2010; Bolin, 1974; Campbell, 1999;
H. M. Gilmartin et al. Isolation: A Concept Analysis
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Gammon, 1999; Knowles, 1993; Madeo, 2001; Russo,
Donnelly, & Reid, 2006; Skyman, Sjostrom, & Hell-
strom, 2010; Ward, 2000; Wassenberg, Severs, &
Bonten, 2010).
In addition, Wexler, Mendelson, Leiderman, and
Solomon (1958) summarized the outcomes of previ-
ous studies on experimental sensory deprivation,
stating that subjects in these studies demonstrated an
inability to tolerate or adapt to the stress of sensory
isolation; subjects attempted to obtain extrinsic physi-
cal and social stimuli during the experience; and the
progressive failure, in certain subjects, of reality
contact led to the emergence of pathological thought
processes and behaviors. In essence, sensory depriva-
tion acts as a stressor for humans for it jeopardizes a
subject’s hold on external reality because of the chal-
lenges to the person’s reality orientation. Negative
outcomes, such as anxiety, depression, and hallucina-
tions, have been reported by subjects (Abad et al.,
2010; Bexton et al., 1954; Gammon, 1999; Vernon &
McGill, 1957; Wexler et al., 1958; Zuckerman et al.,
1968).
Social Isolation
Social isolation emphasizes the separation of
persons from significant others, groups, activities, and
social situations that subsequently impairs a person’s
social processes (Biordi & Nicholson, 1995; Sells,
2008). There have been no direct laboratory studies
testing the separate effects of social isolation from
those of confinement and sensory deprivation, but
Haythorn (2008) supports the hypothesis that social
isolation by itself is a significantly stressful condition
for at least a substantial number of people and that
the reactions to it are distinguishable from those of
confinement and sensory deprivation. Observational
studies in the healthcare literature have described
social isolation as an alienating, lonely experience
with negative health consequences for all ages
(Nicholson, 2009; Skipper, Leonard, & Rhymes, 1968;
Trowbridge, 2008). Social isolation ranges from the
voluntary isolate who seeks disengagement from
social intercourse to those whose isolation is involun-
tary or imposed by others (Biordi & Nicholson, 1995).
Isolation can occur at four layers of the social
concept. The first social layer is the larger community,
such as peer groups, next is organizations, such as
school and work, followed by confidantes, such as
friends and family, and last is the inner person’s ability
to apprehend and interpret relationships (Lin, 1986).
In a concept analysis of social isolation in older
adults, Nicholson (2009) identified five attributes that
define social isolation in this population: number of
contacts, feeling of belonging, fulfilling relationships,
engagement with others, and quality of network
members. In addition, Biordi and Nicholson (1995)
have described social isolation to have three additional
attributes: the experience of alienation, loneliness,
and aloneness. In summary, the experience of social
isolation has been well defined in the literature and is
noted to lead to negative health consequences for all
ages.
Confinement
Confinement connotes a forced, or involuntary,
limitation in the amount of physical space and/or
restraint on actual physical movement for a person.
Confined subjects report emotional overreactions
and physical discomfort because of the experience
(Haythorn, 2008). Researchers have attempted to
isolate the experience of confinement, but they have
reported challenges due to the overlapping experi-
ences of social isolation and sensory deprivation that
occur during confinement (Haythorn, 2008; Zubek,
2008). Because of these challenges, confinement has
been broadly defined as a physical concept that then
can lead to the psychological concept of isolation,
through a combination of social isolation and/or
sensory deprivation (Rasmussen, 2008).
Confinement is practiced in the penal system
through solitary confinement, where a prisoner is
physically segregated from the rest of the prison popu-
lation and is excluded from normal programming
and collective activities (Haney, 2003). Confinement
through geography is seen with travel to distant or
isolated locations (Laing & Crouch, 2009) and in geo-
graphically isolated populations (Haggard, 2008).
Confinement is seen in health care through the use of
source and protected isolation, where patients are not
permitted to leave their rooms (Abad et al., 2010;
Campbell, 1999; Catalano et al., 2003; Gammon,
1998, 1999; O’Connell, 1984; Russo et al., 2006) and
in persons who are bedridden because of pregnancy
(Schroeder, 1996) or illness (Ishizaki et al., 1994).
Definition of Isolation
Taking into account the attributes, the following
definition of isolation is suggested: a state in which an
Isolation: A Concept Analysis H. M. Gilmartin et al.
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individual experiences a reduction in the level of
normal sensory and social input with possible invol-
untary limitations on physical space or movement. It is
not possible to state which of the attributes must be
present for a person to be defined as isolated because
the balance of each attribute varies on the individual’s
perception or segment of society the person is func-
tioning at.
Related Concepts
Related cases are instances of concepts that are
related to the concept being studied but that do not
contain all of the defining attributes (Walker and
Avant, 2011). However, the concept of isolation is
often interchanged with the concept of solitude. Soli-
tude, historically, has had a more purposeful, positive,
and healthful definition (Phelps, 1966). Solitude is
defined as a state of being alone without being lonely
and can lead to self-awareness through a positive and
constructive state of engagement with oneself
(Marano, 2003). Solitude, at times, is desirable and
can replenish the soul (Marano, 2003). Throughout
history, many philosophers, spiritual leaders, and
artists have attested to the benefits of solitude (Long &
Averill, 2003).
In addition, seclusion and privacy are related to
isolation. The Merriam-Webster Dictionary (2011)
defines seclusion as being screened or hidden from view
and privacy as the quality or state of being apart from
company or observation. These three concepts have
similar descriptions, but in opposition to the proposed
definition of isolation, they are acts of willing sensory
and social reduction with voluntary limitations on
space or movement.
Antecedents and Consequences
Walker and Avant (2011) describe antecedents
as those events or incidents that must occur or be in
place prior to the occurrence of the concept and con-
sequences as the events or incidents that are an
outcome of the concept (see Table 1). An understand-
ing of the individual and the group or segment of
society in which the person is functioning is necessary
to shed light on the social contexts of isolation (Ras-
mussen, 2008). In addition, the situational dimensions
that have significant implications on isolation can help
define the experience. Situational dimensions include
the voluntary versus involuntary nature of the event;
the purpose, or instrumental reason; the planning
and preparation permitted prior to; the duration of
isolation; whether isolation occurs to an individual or
as a group; if confinement is severe; if there is a sub-
jectively viewed threat from isolation; current social
and support conditions; and lastly the environmental
variability during isolation (Sells, 2008). The conse-
quences, or outcomes, of isolation have been reported
in the ordinary and scientific literature as anxiety,
depression, mood disturbances, anger, loneliness, and
adverse health effects (Abad et al., 2010; Bekhet,
Zauszniewski, & Nakhla, 2008; Catalano et al., 2003;
Gammon, 1998; Kennedy & Hamilton, 1997; Kuni-
tomi et al., 2010; Tarzi, Kennedy, Stone, & Evans,
2001).
Model Case of Isolation
Walker and Avant (2011) define a model case as an
example of the use of the concept that demonstrates
all of the defining attributes of the concept. An
Table 1. Isolation: A Concept Analysis
Concept Attributes Antecedents Situational dimensions Consequences
Isolation Sensory deprivation Individual perception Voluntary versus involuntary Anxiety
Social isolation Situational dimension Instrumental versus obstructive Depression
Confinement Planned versus unplanned Mood disturbances
Duration Anger
Individual versus group Loneliness
Space restriction Adverse health events
Threat
Social conditions
Support conditions
Environmental variability
H. M. Gilmartin et al. Isolation: A Concept Analysis
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example of isolation would be a person with multi-
drug resistant tuberculosis that requires strict airborne
isolation. This young man lives in a single 8-square
meter space with no windows to view the outdoors.
The room has a thick metal door with a 1 ¥1 meter
window that faces the hallway. The young man is
required to be in this room at all times, except for
periodic examinations. His activity is limited to actions
within his room. He is permitted a television for stimu-
lus and has control over the lights in the room, but he
is deprived of natural sounds, such as activities in the
building or outdoors. Visitation is permitted but
strictly limited. His mandated time in isolation will be
6 months.
Borderline Case of the Concept
Borderline cases are those examples or instances
that contain most of the defining attributes of the
concept being examined, but not all of them (Walker
and Avant, 2011). Sarah is undergoing a bone marrow
transplant and will be placed in protective isolation for
2 weeks during the treatment and recovery phase. She
will be alone in a special room with the door closed at
all times. She is not permitted to leave the room,
except for special circumstances. She is permitted to
have visitors, but they will be required to wear gloves,
gowns, and masks during their time in the room. She
and her parents have met with a recreation counselor
to plan for activities and schoolwork to keep her mind
active and entertained during her isolation. She is
scared, but she and her parents are ready for the
isolation because they know that it will help her heal,
and it will protect her from illness when she is most
susceptible.
Contrary Case of the Concept
Contrary cases are clear examples of what is not the
concept (Walker and Avant, 2011). An example is a
mystic who electively separates herself from others
and confines herself to small spaces with the goal of
inducing a mode of consciousness that permits clarity,
relaxation, and internal assessment. She limits her
movements to those essential for existence. She is
emotionally, physically, and socially isolated from the
world. She is not isolated though because she elec-
tively enters into isolation to achieve her goals, and
she is free to return to her normal life at any time.
Empirical Referents
Empirical referents are classes or categories of actual
phenomena that by their existence or presence dem-
onstrate the occurrence of the concept itself (Walker
and Avant, 2011). After an extensive review of the
literature, no empirical referents of the concept of
isolation were found, but tools to assess the outcomes
of isolation have been reported. Anxiety, depression,
mood disturbances, anger, and loneliness have been
assessed using instruments, such as the University of
California, Los Angeles Loneliness Scale; the Hospital
Anxiety and Depression Scale; the Hamilton Anxiety
Rating Scale; the Hamilton Depression Rating Scale;
the Health Illness Questionnaire; the Self-Esteem
Scale; the Consumer Assessment of Healthcare Provid-
ers and Systems; the Beck Depression Inventory; the
State Anxiety Inventory; the Profile of Mood States;
the Abbreviated Mental Test Score; the Barthel Index;
the Geriatric Depression Scale; and the Crown-Crisp
Experiential Index (Abad et al., 2010; Catalano et al.,
2003; Gammon, 1998; Kennedy & Hamilton, 1997;
Stelfox, Bates, & Redelmeier, 2003; Tarzi et al., 2001;
Wassenberg et al., 2010)
Discussion
The limitations of this concept analysis include the
interpretation of the research and potential for not
locating source references. Although the literature
was used to guide the process, any interpretation is
subjective in nature. An extensive search was under-
taken, but it is unlikely that this was all-inclusive.
This concept analysis presents an opportunity to
develop nursing theory through the adoption of a
theoretical model that supports the concept of isola-
tion. Nicholson (2009) proposed Roy’s adaptation
model as a nursing conceptual model that fits well
with social isolation. This will require further study to
determine if the model will encompass all the
attributes of isolation.
According to Walker and Avant (2011), after con-
structing an operational definition of a concept, the
location of a research instrument is necessary to con-
struct and test theoretical relationships between isola-
tion and outcome variables. There is a need for more
research to explore implications of the suggested defi-
nition. Further clarification is needed to revise and test
the attributes of isolation in clinical situations. System-
atic studies of isolation can ultimately enhance nurses’
Isolation: A Concept Analysis H. M. Gilmartin et al.
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© 2013 Wiley Periodicals, Inc
Nursing Forum Volume 48, No. 1, January-March 2013
knowledge base and contribute to the quality of life for
isolated persons.
Conclusion
Being alone does not make a person isolated. The
state of isolation that can lead to negative experiences
and outcomes requires a combination of psychological
and physical factors to experience the deleterious
effects. The research presented here has identified and
examined important characteristics of isolation. Isola-
tion is defined as a state in which an individual expe-
riences a reduction in the level of normal sensory and
social input with possible involuntary limitations on
physical space or movement. Nursing has an impor-
tant role to play in recognizing isolation and in acting
to minimize the event on their patient’s behalf.
Visit the Nursing Forum blog at http://www.
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participate in a discussion.
References
Abad, C., Fearday, A., & Safdar, N. (2010). Adverse effects of
isolation in hospitalised patients: A systematic review.
Journal of Hospital Infection,76(2), 97–102. doi:10.1016/
j.jhin.2010.04.027
Access Science. (2011a). Isolation. Retrieved July 22, 2011,
from http://www.accessscience.com/popup.aspx?id=
52746&name=def
Barratt, R., Shaban, R., & Moyle, W. (2010). Behind barriers:
Patients’ perceptions of source isolation for methicillin-
resistant Staphylococcus aureus (MRSA). Australian Journal
of Advanced Nursing,28(2), 53–59.
Bekhet, A. K., Zauszniewski, J. A., & Nakhla, W. E. (2008).
Loneliness: A concept analysis. Nursing Forum,43(4),
207–213. doi:10.1111/j.1744-6198.2008.00114.x
Bexton, W. H., Heron, W., & Scott, T. H. (1954). Effects of
decreased variation in the sensory environment. Cana-
dian Journal of Psychology/Revue Canadienne de Psychologie,
8(2), 70–76.
Biordi, D. L., & Nicholson, N. R. (1995). Social isolation. In
I. M. Lubkin (Ed.), Chronic illness: Impact and interventions
(pp. 168–190). Boston: Jones and Bartlett.
Bolin, R. H. (1974). Sensory deprivation. Nursing Forum,13,
240–258. doi:10.1111/j.1744-6198.1974.tb00569.x
Campbell, T. (1999). Feelings of oncology patients about
being nursed in protective isolation as a consequence of
cancer chemotherapy treatment. Journal of Advanced
Nursing,30(2), 439–447. doi:10.1046/j.1365-2648.1999.
01099.x
Catalano, G., Houston, S. H., Catalano, M. C., Butera, A. S.,
Jennings, S. M., Hakala, S. M., & Laliotis, G. J. (2003).
Anxiety and depression in hospitalized patients in resis-
tant organism isolation. Southern Medical Journal,96(2),
141–145. doi:10.1097/01.SMJ.0000050683.36014.2E
Charriere, H. (2006). Papillion. New York: Harper Perennial
Modern Classics.
Chodil, J., & Williams, B. (1970). The concept of sensory
deprivation. Nursing Clinics of North America,5(3), 453.
Etymology. (2011b). Isolation. Retrieved June 8, 2011, from
http://www.etymonline.com/index.php?search=isolated
&searchmode=none
Furr, L. A., Wiggins, O., Cunningham, M., Vasilic, D.,
Brown, C. S., Banis, J. C. Jr, . . . Barker, J. H. (2007).
Psychosocial implications of disfigurement and the future
of human face transplantation. Plastic and Reconstructive
Surgery,120(2), 559. doi:10.1097%2F01.prs.0000267584.
66732.e5
Gammon, J. (1998). Analysis of the stressful effects of hos-
pitalisation and source isolation on coping and psycho-
logical constructs. International Journal of Nursing Practice,
4(2), 84–96. doi:10.1046/j.1440-172X.1998.00084.x
Gammon, J. (1999). The psychological consequences of
source isolation: A review of the literature. Journal of
Clinical Nursing,8(1), 13–21. doi:10.1046/j.1365-2702.
1999.00201.x
Gensini, G. F., Yacoub, M. H., & Conti, A. A. (2004). The
concept of quarantine in history: From plague to SARS.
Journal of Infection,49(4), 257–261. doi:10.1016/j.jinf.
2004.03.002
Hagedoorn, M., & Molleman, E. (2006). Facial disfigurement
in patients with head and neck cancer: The role of social
self-efficacy. Health Psychology,25(5), 643. doi:10.1037/
0278-6133.25.5.643
Haggard, E. A. (2008). Some effects of geographic and social
isolation in natural settings. In J. Rasmussen (Ed.), Man in
isolation and confinement (pp. 99–145). New Brunswick,
NJ: Aldine Transaction.
Haney, C. (2003). Mental health issues in long-term solitary
and “supermax” confinement. Crime and Delinquency,
49(1), 124. doi:10.1177/0011128702239239
Hawthorne, N. (1999). The Scarlet Letter. Boston: Bartleby.
Haythorn, W. W. (2008). The miniworld of isolation: Labo-
ratory studies. In J. Rasmussen (Ed.), Man in isolation and
confinement (pp. 219–240). New Brunswick, NJ: Aldine
Transaction.
Ishizaki, Y., Fukuoka, H., Katsura, T., Nishimura, Y., Kir-
iyama, M., Higurashi, M., & Gunji, A. (1994). Psychologi-
cal effects of bed rest in young healthy subjects. Acta
Physiologica Scandinavica. Supplementum,616, 83.
Kennedy, P., & Hamilton, L. R. (1997). Psychological impact
of the management of methicillin-resistant Staphylococcus
aureus (MRSA) in patients with spinal cord injury. Spinal
Cord,35(9), 617–619. doi:10.1038/sj.sc.3100469
Knowles, H. E. (1993). The experience of infectious patients
in isolation. Nursing Times,89(30), 53–56.
Kunitomi, A., Iida, H., Kamiya, Y., Hayashi, M., Suwa, T.,
Kanda, J., & Sao, H. (2010). Insomnia and depression
during protective isolation in patients with hematological
disorders. Internal Medicine,49, 17–22. doi:10.2169/
internalmedicine.49.2404
Laing, J. H., & Crouch, G. I. (2009). Lone wolves? Isolation
and solitude within the frontier travel experience.
H. M. Gilmartin et al. Isolation: A Concept Analysis
59
© 2013 Wiley Periodicals, Inc
Nursing Forum Volume 48, No. 1, January-March 2013
Geografiska Annaler. Series B, Human Geography,91(4), 325–
342. doi:10.1111/j.1468-0467.2009.00325.x
Lennon, J. (Writer). (1970). Isolation, John Lennon and the
Plastic Ono Band. Retrieved December 3, 2012, from http://
www.sing365.com/music/lyric.nsf/Isolation-lyrics-John-
Lennon/AD7BD56D0E09243948256BCA00072087
Lin, N. (1986). Conceptualizing social support. In N. Lin, A.
Dean, & W. Ensel (Eds.), Social support, life events, and
depression (pp. 17–30). New York: Academic Press.
Long, C. R., & Averill, J. R. (2003). Solitude: An exploration
of benefits of being alone. Journal for the Theory of Social
Behaviour,33(1), 21–44. doi:10.1111/1468-5914.00204
Madeo, M. (2001). Understanding the MRSA experience.
Nursing Times,97(30), 36–37.
Marano, H. E. (2003). What is solitude? Psychology Today.
Retrieved from http://www.pshychologytoday.com/
articles/200308/what-is-solitude
Maunder, R. (2004). The experience of the 2003 SARS out-
break as a traumatic stress among frontline healthcare
workers in Toronto: Lessons learned. Philosophical Trans-
actions of the Royal Society of London. Series B, Biological Sci-
ences,359(1447), 1117. doi:10.1098/rstb.2004.1483
Merriam-Webster Dictionary. (2011). Seclusion. Retrieved
July 8, 2011, from http://www.merriam-webster.com/
dictionary/seclusion
Merriam-Webster Dictionary. (2011c). Isolation. Retrieved
June 8, 2011, from http://www.merriamwebster.com/
dictionary/isolation
Nicholson, N. R. (2009). Social isolation in older adults:
An evolutionary concept analysis. Journal of Advanced
Nursing,65(6), 1342–1352. doi:10.1111/j.1365-2648.
2008.04959.x
O’Connell, S. R. (1984). Recreation therapy: Reducing the
effects of isolation for the patient in a protected environ-
ment. Children’s Health Care,12(3), 118–121.
Phelps, R. (1966). Colette: Earthly paradise. New York: Farrar,
Straus and Giroux.
Rasmussen, J. (2008). Introduction. In J. Rasmussen (Ed.),
Man in isolation and confinement (pp. 1–6). New Brunswick,
NJ: Aldine Transaction.
Russo, K., Donnelly, M., & Reid, A. J. M. (2006). Segrega-
tion: The perspectives of young patients and their
parents. Journal of Cystic Fibrosis,5, 93–99. doi:10.1016/
j.jcf.2005.12.002
Schroeder, C. A. (1996). Women’s experience of bed
rest in high risk pregnancy. Journal of Nursing Scholar-
ship,28(3), 253–258. doi:10.1111/j.1547-5069.1996.
tb00360.x
Sells, S. B. (2008). The taxonomy of man in enclosed space.
In J. Rasmussen (Ed.), Man in isolation and confinement (pp.
281–304). New Brunswick, NJ: Aldine Transaction.
Skipper, J. K., Leonard, R. C., & Rhymes, J. (1968). Child
hospitalization and social interaction. Medical Care,VI(6),
496–506. doi:10.1097/00005650-196811000-00005
Skyman, E., Sjostrom, H. T., & Hellstrom, L. (2010). Patients’
experiences of being infected with MRSA at a hospital
and subsequently source isolated. Scandinavian Journal
of Caring Studies,24, 101–107. doi:10.111/j.1471-6712.
2009.00692.x
Stelfox, H. T., Bates, D. W., & Redelmeier, D. A. (2003).
Safety of patients isolated for infection control. Journal of
the American Medical Association,290(14), 1899–1905.
doi:10.1001/jama.290.14.1899 290/14/1899 [pii]
Tarzi, S., Kennedy, P., Stone, S., & Evans, M. (2001).
Methicillin-resistant Staphylococcus aureus: Psychological
impact of hospitalization and isolation in an older adult
population. Journal of Hospital Infection,49(4), 250–254.
doi:10.1053/jhin.2001.1098 S0195-6701(01)91098-9
[pii]
Tayman, J. (2007). The colony: The harrowing true story of the
exiles of Molokai. New York: Simon and Schuster.
Trout, D. L. (1980). The role of social isolation in suicide.
Suicide and Life-Threatening Behavior,10(1), 10–23.
Trowbridge, S. (2008). Hospital-acquired infections and
infection control practices: What are the consequences to
the elderly patient? Perspectives,33(1), 16–22.
Vernon, J. A., & McGill, T. E. (1957). The effect of sensory
deprivation upon rote learning. American Journal of
Psychology,70(4), 637–639.
Victor, C., Scambler, S., Bond, J., & Bowling, A. (2000).
Being alone in later life: Loneliness, social isolation and
living alone. Reviews in Clinical Gerontology,10(04), 407–
417. doi:doi.org/10.1017%2FS0959259800104101
Walker, L. O., & Avant, K. C. (2011). Strategies for theory
construction in nursing (5th ed.). Boston: Prentice Hall.
Ward, D. (2000). Infection control: Reducing the psychologi-
cal effects of isolation. British Journal of Nursing,9(3),
162–170.
Wassenberg, M. W., Severs, D., & Bonten, M. J. (2010).
Psychological impact of short-term isolation measures in
hospitalised patients. Journal of Hospital Infection,75(2),
124–127. doi:10.1016/j.jhin.2010.01.023
Wexler, D., Mendelson, J., Leiderman, P. H., & Solomon, P.
(1958). Sensory deprivation: A technique for studying
psychiatric aspects of stress. Archives of Neurology and
Psychiatry,79(2), 225.
WordNet. (2011d). Isolation. Retrieved June 8, 2011,
from http://wordnetweb.princeton.edu/perl/webwn?s=
isolation&sub=Search+WordNet&o2=&o0=1&o8=1&o1=
1&o7=&o5=&o9=&o6=&o3=&o4=&h=
Zubek, J. P. (2008). Behavioral and physiological effects of
prolonged sensory and perceptual deprivation: A review.
In J. Rasmussen (Ed.), Man in isolation and confinement
(pp. 9–84). New Brunswick, NJ: Aldine Transaction.
Zuckerman, M., Persky, H., & Link, K. E. (1968). Experi-
mental and subject factors determining responses to
sensory deprivation, social isolation, and confinement.
Journal of Abnormal Psychology,73(3 Pt 1), 183.
Isolation: A Concept Analysis H. M. Gilmartin et al.
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© 2013 Wiley Periodicals, Inc
Nursing Forum Volume 48, No. 1, January-March 2013
... I N HEALTHCARE SETTINGS, transmission-based precautions may involve some degree of isolation and potentially limit patient interactions with others, including members of the healthcare team. [1][2][3][4][5] Studies have shown that patient isolation can negatively affect patients' emotional well-being. [1][2][3][4][5][6][7] As such, it is imperative to understand the patient's experience to promote effective interventions and patient coping strategies. ...
... [1][2][3][4][5] Studies have shown that patient isolation can negatively affect patients' emotional well-being. [1][2][3][4][5][6][7] As such, it is imperative to understand the patient's experience to promote effective interventions and patient coping strategies. ...
... While studies on adult patients' experiences of isolation are widely available, there is a lack of understanding of the pediatric experience. [1][2][3][4][5][6][7] A few pediatric studies have included the parent's perspective and observation of the child's behavior. 8 One study used the draw-and-write technique to interpret the viewpoint of school-age children after hospitalization. ...
Article
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There is a lack of understanding of the pediatric patient experience in isolation. This qualitative, descriptive study interviewed adolescent patients during their hospital stay about their perception of isolation. This article analyzes the themes gleaned from the interviews as well as nursing practice implications and strategies in caring for young patients in isolation.
... Loneliness and social isolation are related concepts and not current only in the COVID-19 pandemic. Social isolation refers to the separation of individuals from important caregivers, groups, activities and social situations that subsequently interfere with a person's social processes [5]. Antecedents for social isolation are individual perception and the situational dimension. ...
... The consequences of isolation are described as anxiety, depression, mood disorders, anger, loneliness, and health impairment. Therefore, social isolation may be individually perceived, and loneliness may occur as the subjective feeling of being alone [5,6]. ...
Article
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Background There is limited data on the use of digital technologies in outpatient care in Switzerland. Our objectives were therefore to determine which digital technologies are used and whether they had an impact on loneliness and social isolation in the wake of the COVID-19 pandemic. Methods A cross-sectional survey design was used with a convenience sample of 1272 outpatient care providers in Switzerland. The questionnaire used is based on an unsystematic literature review and a previous qualitative study with six outpatient caregivers and two caring relatives, based on which the 30 items for this questionnaire were developed. Data were analyzed descriptively, and group comparisons were made using the Kruskal Wallis test. Changes over time were measured using Friedman test with Bonferroni post hoc tests and Wilcoxon test for paired samples. Results The impact of the COVID-19 pandemic was evident both on the part of the health care system, e.g., inadequate protective equipment; on the part of health care providers, e.g., increasing fatigue in keeping abreast of the virus as the pandemic progressed; and on the part of clients, who reduced services of care, e.g., out of fear of infection. According to the assessment of the outpatient caregivers, loneliness and social isolation of the clients was high in spring 2020 and increased strongly in the following winter. Alternative solutions, such as digital technologies, were hardly used or not used at all by the clients. Conclusions The results suggest that the pandemic is dramatically impacting clients. This highlights the urgent need to invest in the development of appropriate digital technologies reducing the impact of social isolation and loneliness and the associated long-term costs to the healthcare system.
... Isolation is an established method to control MDRO transmission [1], but is accompanied by three concerns -sensory deprivation, social isolation, and confinement-which impose unconscious limitations on access to spaces or physical activities of patients, with an attendant decrease in the levels of normal sensory and social activities [4]. Owing to the sense of isolation caused by movement and visitor restrictions, isolated patients experience loneliness, boredom, fear, and anger [5] and perceive that their treatment is at a level below that of other patients [6]. ...
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Background The global increase in the prevalence of vancomycin-resistant enterococci (VRE) and carbapenem-resistant Enterobacterales (CRE) among multidrug-resistant organisms (MDROs) has necessitated contact precaution and isolation in medical institutions. Contact isolation has a negative effect on the mental health of patients, but few interventions have addressed this issue. Aim This study evaluated an isolation-coping programme developed for patients colonized or infected with VRE or CRE. Methods To mitigate the negative effects of isolation due to having MDRO, an infection control nurse in the present study 1) developed an isolation-coping programme and 2) validated the programme’s effect on the uncertainty, anxiety, depression, and knowledge of patients isolated because of MDRO (VRE or CRE) using a pre–post quasi-experimental design. Findings The experimental group (n=56) received education and emotional support via the isolation-coping programme, while the control group (n=55) received only verbal isolation guidelines provided by the medical institution. Compared with the control group, the experimental group showed a reduction in uncertainty (t=-8.925), anxiety (Z=-6.131), and depression (Z=-5.379), and better knowledge (Z=-8.372) (p<.001 for all). Conclusion The novel isolation-coping programme is an effective intervention to improve uncertainty, anxiety, depression, and knowledge in patients isolated with VRE or CRE.
... Anxiety and disturbances of mood mostly caused by sensory deprivation [30,31] . Alternatively, shared prevalent etiologic factors such as, cardiovascular disease, age [32] , or other demographic factors could underlie any noted correlation between HI and anxiety [33] . ...
Article
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Purpose: With an increasing incidence for hearing impairment, it is necessary to search for the psychological impact on patients. Anxiety prevalence may be raised in people with hearing impairment. This study aimed to evaluate the prevalence of anxiety in hearing loss patients. Methods A case control study included 100 subjects: 50 controls and 50 subjects diagnosed with hearing loss of variable types, degree, and causes. They underwent audiological and Modified Arabic Beck anxiety inventory questionnaire evaluation. First Pure-Tone Audiometry (PTA) was performed in all frequencies to determine the type and level of hearing impairment, then Beck anxiety inventory questionnaire (Modified Arabic form) was done. Results The sample collected showed results of 42% single sided hearing loss while, 58% was bilaterally affected. Anxiety was estimated in 68% of hearing impairment patient with a percentage of 41% male and 59% females. Conclusion Anxiety is a very prevalent problem facing not only subjects with hearing impairment, but also affects a noticeable ratio of apparently normal subjects. So, the psychological assessment and support are needed to be in mind.
... For instance, patients suffering from cancer (24) or severe immunodeficiency (25) may need to socially distance from others to protect their weakened immune system from additional strain. Social distancing could even refer to solitary confinement, which in essence corresponds to isolating a person from contact with others (26). Social distancing in all its forms can enhance loneliness and related declines in mental health (15,16,19,27). ...
Article
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A variety of factors contribute to the degree to which a person feels lonely and socially isolated. These factors may be particularly relevant in contexts requiring social distancing, e.g., during the COVID-19 pandemic or in states of immunodeficiency. We present the Loneliness and Isolation during Social Distancing (LISD) Scale. Extending existing measures, the LISD scale measures both state and trait aspects of loneliness and isolation, including indicators of social connectedness and support. In addition, it reliably predicts individual differences in anxiety and depression. Data were collected online from two independent samples in a social distancing context (the COVID-19 pandemic). Factorial validation was based on exploratory factor analysis (EFA; Sample 1, N = 244) and confirmatory factor analysis (CFA; Sample 2, N = 304). Multiple regression analyses were used to assess how the LISD scale predicts state anxiety and depression. The LISD scale showed satisfactory fit in both samples. Its two state factors indicate being lonely and isolated as well as connected and supported, while its three trait factors reflect general loneliness and isolation, sociability and sense of belonging, and social closeness and support. Our results imply strong predictive power of the LISD scale for state anxiety and depression, explaining 33 and 51% of variance, respectively. Anxiety and depression scores were particularly predicted by low dispositional sociability and sense of belonging and by currently being more lonely and isolated. In turn, being lonely and isolated was related to being less connected and supported (state) as well as having lower social closeness and support in general (trait). We provide a novel scale which distinguishes between acute and general dimensions of loneliness and social isolation while also predicting mental health. The LISD scale could be a valuable and economic addition to the assessment of mental health factors impacted by social distancing.
... Social isolation is a major concern among people with hearing loss [1][2][3][4]. Uncorrected hearing loss can lead to both reduced interaction with others and to an increased subjective perception of loneliness [5][6][7]. Social isolation increases with increasing auditory threshold after hearing loss, and is also predicted by a rapid decline in understanding speech in noise [8,9]. ...
Article
Full-text available
For social animals that communicate acoustically, hearing loss and social isolation are factors that independently influence social behavior. In human subjects, hearing loss may also contribute to objective and subjective measures of social isolation. Although the behavioral relationship between hearing loss and social isolation is evident, there is little understanding of their interdependence at the level of neural systems. Separate lines of research have shown that social isolation and hearing loss independently target the serotonergic system in the rodent brain. These two factors affect both presynaptic and postsynaptic measures of serotonergic anatomy and function, highlighting the sensitivity of serotonergic pathways to both types of insult. The effects of deficits in both acoustic and social inputs are seen not only within the auditory system, but also in other brain regions, suggesting relatively extensive effects of these deficits on serotonergic regulatory systems. Serotonin plays a much-studied role in depression and anxiety, and may also influence several aspects of auditory cognition, including auditory attention and understanding speech in challenging listening conditions. These commonalities suggest that serotonergic pathways are worthy of further exploration as potential intervening mechanisms between the related conditions of hearing loss and social isolation, and the affective and cognitive dysfunctions that follow.
... Adolescents increase in their affinity for solitude as they age, and beginning in adolescence, time alone can have a positive effect on emotional states by facilitating freedom, creativity, introspection, and spirituality (Long and Averill 2003). However, time alone may be negative for development when characterized by sensory deprivation, social isolation and confinement, resulting in stress and maladaptation (Gilmartin et al. 2013), and depressive symptoms (Hall-Lande et al. 2007). ...
Article
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For decades, researchers and the general public have debated whether children without siblings differ from children with siblings in ways that are meaningful for development. One area that is underexplored in the literature on only children versus children with siblings concerns time use and emotional states in alone time and in social interactions. Resource dilution theory and the prior literature suggests that adolescent only children and adolescents with siblings may differ in some social interactions, such as in time with parents, but not in others, such as in time alone, due to offsetting effects or the universality of certain experiences among adolescents. This study tested these arguments by comparing companionship patterns and four emotional states (happiness, sadness, stress, and meaningfulness) among adolescents (ages 15–18) without siblings (N= 465) and adolescents with siblings (N= 2513) in the nationally representative American Time Use Survey (2003–2017). Relative to adolescents with siblings, adolescents without siblings spent more time alone, similar amounts of time with peers, and more time exclusively with parents. Only children were not as happy when spending time alone and with peers as adolescents with siblings, but their emotions in these settings were not more negative or less meaningful. In most other social interactions, emotional states were similar between adolescents with and without siblings. These findings show that adolescents with and without siblings differed mainly in their companionship patterns within the household and in their levels of happiness when alone and with peers.
... Belonging is a fundamental human need (Baumeister and Leary 1995;Hagerty et al. 1992;Peplau and Perlman 1982), so when this need is satisfied the expected result is positive psychological, physiological, social, and spiritual consequences (Hagerty et al. 1992;Newman, Lohman, and Newman 2007). Conversely, a low sense of belonging is likely to be associated with social exclusion, isolation and loneliness, which are highly undesirable states for most people (Gilmartin, Grota, and Sousa 2013). ...
Article
Full-text available
This study examines if labeling customers as ‘member’ versus ‘non-member’ in the context of a firm’s loyalty program can influence the customers’ evaluations of the firm. It was assumed that firms’ membership-related labels, which typically are euphemisms in relation to the mere discounts offered by many loyalty programs, can (a) prime customers so that positively charged content in a general member category is activated, and that (b) this content can have a positive impact on evaluations of firms with loyalty programs. An experiment showed that evoking customers’ membership status resulted in a higher level of sense of belonging, and higher customer satisfaction, for members than for non-members. Sense of belonging mediated the impact of evoking membership status on customer satisfaction. A second study confirmed that the content of customers’ general member construct is indeed associated with sense of belonging and satisfaction.
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Majority of the indigenous people who are the original inhabitants in Malaysia inhibit the remote area of tropical forest which is rich in natural resources. Their lives are separated from the outside community due to several factors such as geography, low literacy, negative perceptions of the surrounding community, and the closed-door attitude of the indigenous people. Consistent preaching activities have changed the faith of the indigenous people from animism orientation towards believing in the Oneness of God. The practice of Islam as a way of life in the lives of indigenous peoples is found to be difficult to practice because the fiqh approach presented to them does not celebrate their local condition. In this regard, this study will examine the socio-cultural isolation of indigenous peoples and their impact on the interpretation of Islamic law. To achieve this objective, the researchers have applied the library research method by referring to the literatures related to the discussion of Islamic scholars in various disciplines of fiqh and usūl al-fiqh. The research found that there is rukhsah and taysir approach given to isolated people as well as with local background to facilitate the religious affairs of the indigenous people. Abstrak Majoriti masyarakat Orang Asli yang merupakan penduduk asal di semenanjung Malaysia mendiami kawasan pedalaman di hutan hujan tropika yang kaya dengan khazanah alam. Kehidupan mereka terasing daripada masyarakat luar disebabkan beberapa faktor seperti geografi, kadar literasi yang rendah, pandangan negatif masyarakat sekitar dan sikap tertutup masyarakat Orang Asli. Gerakan dakwah yang dijalankan secara konsisten telah membawa perubahan kepercayaan sebahagian masyarakat Orang Asli daripada berorientasikan animisme kepada mempercayai Tuhan yang Esa. Pengamalan Islam sebagai cara hidup dalam kehidupan masyarakat Orang Asli didapati agak sukar untuk dipraktikkan lantaran pendekatan fiqh yang disampaikan kepada mereka tidak meraikan suasana setempat mereka. Sehubungan itu, kajian ini akan meneliti keadaan isolasi sosio-budaya masyarakat Orang Asli dan kesannya terhadap pentafsiran hukum Islam. Bagi mencapai objektif tersebut, pengkaji menggunakan kajian kepustakaan sepenuhnya dengan menelusuri literatur berkaitan dengan perbincangan sarjana Islam dalam pelbagai disiplin ilmu fiqh dan usul fiqh. Hasil kajian mendapati terdapat rukhsah dan pendekatan taysir diberikan kepada mereka yang hidup terasing serta berlatar belakang budaya setempat bagi memudahkan urusan keagamaan masyarakat Orang Asli.
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Résumé Cet article fait état d’une étude préparatoire portant sur le suivi psychologique de patients hospitalisés en secteur protégé d’hématologie. La littérature anglo-saxonne, dont les auteures ont publié une recension, montre que le secteur protégé est délétère pour la santé psychologique des patients et qu’il est nécessaire de penser aux modalités de prise en charge psychologique. Il existe peu d’études en France sur ce sujet. Le présent travail rend compte, sous forme de trois études de cas, d’une phase exploratoire au cours de laquelle les patients ont été inclus dans un dispositif basé sur l’aire transitionnelle et le soutien à la narrativité. Les résultats de cette étude montrent que : 1/les modalités de régression dont dispose le sujet, elles-mêmes liées à sa tolérance à supporter la passivité sont déterminantes pour affronter la maladie et l’isolement ; 2/cette expérience extrême fait caisse de résonance, réactivant chez les patients des pans douloureux de leur histoire.
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This article discusses the recent increase in the use of solitary-like confinement, especially the rise of so-called supermax prisons and the special mental health issues and challenges they pose. After briefly discussing the nature of these specialized and increasingly widespread units and the forces that have given rise to them, the article reviews some of the unique mental-health-related issues they present, including the large literature that exists on the negative psychological effects of isolation and the unusually high percentage of mentally ill prisoners who are confined there. It ends with a brief discussion of recent caselaw that addresses some of these mental health issues and suggests that the courts, though in some ways appropriately solicitous of the plight of mentally ill supermax prisoners, have overlooked some of the broader psychological problems these units create.
Conference Paper
Purposes/Aims This paper uses Walker & Avant’s methodological approach in distinguishing the concept of isolation between the normal, ordinary language usage and the scientific usage of the concept. Description/Definition of Theory/Concept Three attributes were identified: sensory deprivation, social isolation and confinement. Antecedents included: individual perception and situational dimensions. Consequences included: anxiety, depression, mood disturbances, anger, loneliness, and adverse health events. Through this concept analysis, isolation has been theoretically defined as a state in which an individual experiences a reduction in the level of normal sensory and social input with possible involuntary limitations on physical space or movement. Internal Consistency of the Theory/Concept A model case of isolation would be a person with multi-drug resistant tuberculosis that requires strict airborne isolation. This young man lives alone in a single eight-square meter space with no windows to view the outdoors. The room has a thick metal door with a one x one foot window that faces the hallway. The young man is required to be in this room at all times, except for periodic examinations. His activity is limited to actions within his room. He is permitted a television for stimulus and has control over the lights in the room, but is deprived of natural sounds such as activities in the building or outdoors. Visitation is permitted but strictly limited. His mandated time in isolation will be six months. Logic Linking Theory/Concept to Practice/Research Problem This concept analysis presents an opportunity to develop nursing theory through the creation of a theoretical model that supports this definition of isolation. It will require further study to determine if a model could encompass all the attributes of isolation and provide guidance for the assessment of individual antecedents. The goal would be the creation of screening instruments to assess individual characteristics that make patients vulnerable to the detrimental effects of isolation. Conclusions, including utility of theory/concept Being alone does not make a person isolated. The state of isolation which can lead to negative experiences and outcomes requires a combination of psychological and physical factors to experience the deleterious effects. The analysis presented here has identified and examined important characteristics of isolation. Systematic studies of isolation using this concept could ultimately enhance nurses’ knowledge base and contribute to the quality of life for isolated persons.
Article
In lieu of an abstract, here is a brief excerpt of the content: Hawaii's leprosy settlement at Kalaupapa, Molokai, was made famous a century ago by popular writers such as Robert Louis Stevenson, Jack London, Edward Clifford, and Charles Warren Stoddard. John Tayman skillfully retells these stories, adding details from personal diaries, popular accounts, colony folklore, academic research, and his own observations. He has produced a great book for the casual reader accustomed to the descriptive "sound-bite," but one that is disappointing for the historian trying to fit the colony into Hawaiian history. The major weaknesses of Tayman's account are its lack of historical and political perspective and his careless handling of sources. He portrays the Native Hawaiian patients as weak victims, deprived of food, shelter, and medicine, and left to degenerate into social deviants. But sending the victims of leprosy to Kalaupapa was a political issue from the beginning, especially the allegation of patient abuse. The extraction of Kalaupapa and leprosy from the Hawaiian political context precludes understanding leprosy as part of Hawaii's history. Scarcely a paragraph is given to the overthrow of the monarchy. The retelling of Jack London's account of "Ko'olau the leper" ignores its relevance as rebellion against the provisional government that deposed Queen Lili'uokalani and disenfranchised the Native Hawaiian. Tayman would have us believe that Ko'olau feared an "uncivilized community populated by ghouls with hollowed eyes and limbless frames" (p. 9), yet he later reveals that Ko'olau had volunteered to go there (p. 11). Ko'olau was not afraid of Kalaupapa; rather, he had hoped that the legislature would establish regional leprosaria—a proposition opposed by the autocratic new government. Most disturbing is the book's portrayal of the early colony as a place of misery, imprisonment, and lawlessness, with "epic battles erupting over food, water, blankets, and women" (p. 2). This colonial image is revitalized by omitting or committing to footnotes the evidence that contradicts it. Houses, gardens, and three trails providing access to the peninsula were left by previous landowners. Although provisions did not always arrive on time, the people were never left to starve, and most patients kept gardens themselves. They were often rebellious, usually when the board failed to respond to their petitions, or when they disagreed with a superintendent. Mostly they continued to correspond with relatives and elected officials, celebrate holidays, love, quarrel, go fishing, and live as best they could. There was medicine—most notably the Goto baths, which offered tremendous relief from the festering sores of leprosy. The settlers were civilized Hawaiians who contracted a disease. They governed themselves, dealing with deviants or insisting upon their removal. What little evidence of these historical truths is provided in Tayman's account is obscured by negative images. While Tayman extols the virtue of American heroes, he neglects the considerable talent shown by Native Hawaiian leaders at Kalaupapa. Former legislator William Humphreys served as translator and assistant to Superintendent Donald Walsh, and later held the position himself when the residents requested native leaders. He is dismissed as a criminal (p. 66) because of his rebellion against Donald's wife, Caroline. While Tayman treats Caroline and her violent son sympathetically, Humphreys and other Hawaiian leaders are disregarded: Kaho'ohuli as a superstitious fanatic (p. 80); Ragsdale, a dandy (p. 100); and William Sumner II, a mere footnote. Even if there is truth in these characterizations, these men played an important role in mediating between native patients and nonnative members of the Board of Health. Although Tayman implies that he did extensive archival research, most of his information is taken from secondary sources, and sometimes carelessly. The opinion that inmates refusing to work should "feel the consequences, hunger and hardship must teach them to do their duty" (p. 49) was not that of Kalaupapa superintendent Louis Lepart, but of Honolulu Board of Health members. Most of the information about the early colony, especially the sensationally dismal native leper, comes not from archived sources but from politically and racially biased colonial accounts and hearsay, most contradicted in later research. As a popular writer rather than a scholar Tayman successfully pulls together a variety of sources that offers the casual reader an introduction to leprosy in Hawaii, albeit an...