Journal of Korean Clinical Health Science. http://kschs.or.kr Vol. 6, No. 2, December 2018, pp. 1097-1105 DOI: http://doi.org/10.15205/kschs.2018.12.31.1097
A Study on Concept Analysis of Loneliness
1)
Yun-kung Jung1, Jeong-hwa Lee2*
1Department of Nursing, University of Gyeongnam Geochang 2Department of Nursing, Kyungwoon University (Received September 12, 2018; Revised September 28, 2018; Accepted October 26, 2018)
Abstract
Purpose: Loneliness is an extremely subjective experience that is influenced by life experiences and circumstances. This study attempted to provide basic data for the development of nursing inter- vention strategies to understand the concept of loneliness and to reduce loneliness on various topics. Methods: The research analysis method is based on the framework of concept analysis proposed by Walker and Avant (1988). Results: The results of this study are as follows: 1) Self-alienation 2) Isolation of human beings 3) Psychological damage reaction 4) Pain 5) Loneliness is the loss of a comfortable "frame". The pre- requisites can be divided into personal characteristics and situational characteristics. Empirical cri- teria include intimate others, lack of social relationships or problems, family and friendship, belong- ing, recognition or expression of loneliness, emotional state changes and changes in health behavior, and physical symptoms. Conclusions: Loneliness is an important indicator of well-being and a cause of physical and mental illnesses, so nurses facing various subjects should be able to recognize the signs and symptoms of loneliness. By promoting and sustaining their interest, they should be able to enjoy lonely people.
Keyword: Concept analysis, Empirical criteria, Loneliness, Prerequisite,
*Corresponding author : [email protected]
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Ⅰ. Introduction liness can enhance the understanding of the lone- liness experienced by the subject1). Therefore, the 1. Background purpose of this study is to provide understanding of concept of loneliness and to provide basic data Human beings are social animals that require for development of nursing intervention strategy social contact and want to interact with others1). which can reduce loneliness to various subjects Therefore, they have a desire to have an intimate by confirming concept attribute and definition of relationship with others continuously and want to loneliness. satisfy them. Contact with others provides accept- ance, support, love, and satisfaction, and any 2. Methods change or loss in contact with others can inter- fere with maintaining human contact and in- In this study, concept analysis method of 8) timacy, eventually leading to feelings of lone- Walker and Avant was applied to analyze the liness2). concept of loneliness. The concrete procedure is Loneliness is a complex, multidimensional as follows. global phenomenon3) and is an unpleasant emo- 1) Select a concept. tion that occurs when the supportive network of 2) Determine the purpose of concept analysis. individuals is lacking in quantitative or qual- 3) Confirm the scope of use of the concept. itative terms4). Loneliness is the emotion experi- 4) Identify the properties of the concept. enced by all age groups during the developmental 5) Construct a concept model case. period and may be an important emotional prob- 6) Construct boundary cases, related cases, and lem for everyday life. In addition, because it is a reverse cases. subjective experience different from objective so- 7) Identify the precedents and results of the cial isolation, humans can be alone, lonely, and concept. lonely while in the crowd4). 8) Identify empirical standards. Patients with a feeling of loneliness, a stressful life experience, are physically affected by the im- Ⅱ. Main subject mune response, resulting in deterioration of health, causing social isolation5), Psychological 2.1. Use of Loneliness Concept persistence of loneliness threatens the mental well-being and increases the risk of suicide6). 1) Dictionary Definition of Loneliness If loneliness persists, people will generally be According to the National Korean Language introverted, timid, and generally problematic in Standard Dictionary9), 'solitude' is a very lonely, interpersonal relationships7). parentless child and a childless old man, as if Although the study of loneliness has been con- alone in the world. 'Loneliness' is a feeling of ducted for decades and has been used for theoret- solitude, and 'loneliness' means a lonely mind or ical development and research1), it has been re- feeling alone. ported that in Korea, where loneliness and sol- According to the YBM English Dictionary9), itude are used as synonyms, studies on elderly, 'loneliness' is voluntary solitude; It has been youth, and infants are being conducted. A clear translated into despair. According to Doosan definition of the attributes of the concept of lone- Donga English Dictionary9), 'loneliness' is sol-
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itude; Loneliness, alone or with no friends or tual level of social relations is solitary, whether colleagues, is a calm feeling. Collins Cobuild loneliness is temporary or long term7). Advanced Learner's English Dictionary9) means Loneliness can be a pandemic of modern soci- that loneliness is a misfortune because you do ety in the integrated literature review and not have any friends or you have no one to talk meta-analysis, and it is difficult to define it be- to. The Wikipedia Encyclopedia9) translates the cause it is unique to each individual in today's meaning of lonely into socially isolated lone- self-centered atmosphere, which is regarded as a liness, chronic loneliness, and human condition. negative and embarrassing state11). Loneliness al- Wikipedia9) means 'loneliness' is a lonely mind so has a variety of causes and consequences that and feeling alone. A shy person thinks that it is may be the same. It may be confused with sim- easier to be alone than to be with others, and ilar but different states, such as depression and there are a lot of people around because extrovert self-esteem. But in the end, when the word lone- people enjoy being with others. Therefore, ex- liness is mentioned in the dialogue, everyone un- trovert people often have more loneliness than derstands what it means to them, and how pain- introverts. In a similar way, there is 'solitude', ful it is. Everyone is lonely to some extent, even and loneliness can lead to depression for a long though they pretend not to be solitary. It is be- time. When you feel a sense of social isolation cause it is a part of human beings. When discus- and feel isolated from people around you, it is sing how to solve what is in such a painful con- said that the parts that actually feel the pain of dition in nursing research, loneliness is rather the brain are activated. The 'bullying' and ' out- viewed from a basic and superficial point of casting', which have become problems in recent view, but this is not the usual solution. years, are psychological acts of sufferings by Loneliness is a natural part of the human mind making many people isolate one person psycho- and can not be resolved like a mystery. logically and socially. Loneliness can only be mitigated or less painful. It can only be achieved by raising human under- 2) Literature definition of loneliness standing of this painful condition, where every- Kim1) summarized the opinions of scholars one has to endure and form at some point in about loneliness, and found that they can find the their lives, and there is nothing to be embar- following common features. First, loneliness oc- rassed about. If a person who is not lonely can curs when an individual lacks social relations. In talk to people who seem to be lonely and smile other words, loneliness occurs when there is a or say a word, even though they think selfishly discrepancy between the actual social relationship 'if I did not have the grace of God I would have of an individual and the social relationship that become like that', such a small gesture would the individual needs or desires. Second, because make their routine less painful It might be. loneliness is a subjective experience different Killeen11) states, "It is human nature; It is from objective social isolation, humans can be inhuman. It is conscious; It is self-pity. It is alone and lonely, and lonely even in the crowd. empty; It gives a sense of accomplishment. It is Third, loneliness is an unpleasant experience4)10). connotative; It is real. It is all your world; It is Loneliness is present when the achievement not the world. It is in your heart that you keep level is lower than the required level, because the it; It does not have to say. It is a mystery. difference between the demand level and the ac- Everyone is right. It is true. It is objective; It is
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subjective. It takes away the mind; It can be ship dimension. ignored. It is absurd; It is a pity. It is all; It is (1) Loneliness on the universal level means nothing. It is controversial; It is hardly discussed. that the relationship between the actual It stimulates emotions; It has no feeling. It is perceived reality and the self, in which the overbearing; It has no sense. It is a taboo; It is individual can be referred to as the uni- there. It exists". verse or nature, and the perceived experi- ence of the collapse or weakening of the 3) Related concepts of loneliness relationship between the god or the abso- Similar to loneliness, there is a sense of social lute and his self. isolation. Loneliness and social isolation are psy- (2) Loneliness at the cultural level is often ex- chological problems but they are distinct con- perienced by immigrants who leave their cepts12). Loneliness refers to the discrepancy be- homelands. Cultural heritages due to fre- tween the actual social network and the desire quent mobility, cultural heritages that have for social contact, and the social isolation is the become part of personal life or part of subjective perception of the decrease in the num- character due to rapid social change ber of contact with others, thereby integrating the (values, Attitudes, beliefs, lifestyles) and individual into the social environment to which the self are weakened. the individual belongs. In a previous study, social (3) Loneliness at the social level is often expe- isolation was related to loneliness13), loneliness rienced in people who have experienced was depressed, family function, residence and self-perception as a member in a group living arrangements, and educational level13)14). that desires or believes that an individual Killeen11) shows the relationship between alien- is important, such as emotional experi- ation and agency in figure 111). ences such as rejection, perceived feelings, and boredom . (4) Loneliness experienced at interpersonal lev- el can be regarded as the self-awakening of the fact that important interpersonal re- lationships are threatened to be severed or weakened. This loneliness is more shock- ing to individuals than any level of lone- liness mentioned above, and appears as a
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egory is related to the status of loneliness, which the recognition that it is not socially necessary can be influenced by factors such as moving, and is either left alone or abandoned, and it has health changes, workplace competencies, and so- two elements of discontinuity and social cial networking, which can be described as tran- rejection. Disconnection is a feeling of being so- sient and reactive16). The second category is lone- cially and emotionally distant from others. Social liness in the form associated with characteristics rejection is the real sense of rejection often felt or personality that arises from mother-related by people with loneliness. The abandonment im- problems, for example, from infant attachment. plies an individual's belief that it is intentionally Each category of loneliness should be addressed left or abandoned, and has two components: in- through different interventions16). The third cat- timacy, betrayal. Intimate denial refers to the egory is to regard loneliness as an essential con- feeling of rejection from a close and intimate dition in the fundamental sense of existential person (eg mother, girlfriend). It is a general loneliness, and it can never be eliminated16). feeling that betrayal is not accepted and wel- comed by others17). 2.2. Attributes of Concept 3) Distressed reactions Based on the results of the above literature re- Psychological impairment reactions experi- view, the attributes of loneliness are derived as enced by people with loneliness consist of phys- follows. iological and behavioral pain, self-deprecation, voluntary social separation and fixation. 1) Self-alienation Physiological and behavioral distress is accom- Self-alienation is a separate feeling from one- panied by physical complaints such as headache, self, core, and identity, which has two compo- nausea, or abdominal pain, or behavioral stress nents: emptiness and impersonation. Emptiness is such as crying or sleeping usually. Self-depre- a hollow feeling and dark feeling that lonely peo- cation refers to a generalized negative attitude to- ple feel. The impersonalization is characterized ward oneself. Voluntary social separation reflects by unrealistic and confused identity17). the lack of intimacy with others whom they meet. It has two elements. Forbidden and active 2) Interpersonal isolation separation. Forbidden reflects the need to be in- The isolation of human beings has the emo- different to "gentle attitudes," and aggressive sep- tional, geographical, and social feelings of being aration refers to more aggressive separation or alone, and has three components: absence of in- "refusing to open the mind"17). timacy, perceived social exclusion, and abandonment. The lack of intimacy is an element 4) Agony of anxiety among the characteristics of loneliness, Pain depicts the pain and suffering of solitary and it means the lack of close, familiar, and car- people, including internal confusion and emo- ing relationships. It also focuses on the general tional changes. Internal confusion indicates an at- lack of relationship and the loss of a special rela- tempt to find answers and insights internally, and tionship in one's life, that is, the absence of a includes three elements: defenselessness, con- person who no longer exists or any intimate fusion, and insensitivity. The defenseless state re- relationship. The perceived social alienation is flects the individual's internal psychological dis-
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tress and despair. Confusion involves mixed emo- continues to lose appetite, leading to weight loss, tions, inaccurate thoughts, and numbness de- insomnia and fatigue. Watching out the window scribes the way an individual feels as a result of all day long without going out or watching tele- loneliness. Emotional fluctuations mean the turn- vision became the whole life. She really feels ing emotions of pain and suffering, including that she is alienated from the people around her, anxiety, fear, anger, hostility, and anxiety about and that she has lost the meaning of life. the existence of the afterlife, as well as feelings of embarrassment, shame, and humiliation17). 2) Borderline case A similar case is that most of the attributes of 5) Loneliness is the loss of a comfortable the concept of loneliness are included but not all "frame". of them. Most or all of the attributes can be in- cluded, but there is a difference in duration or in- 2.3. Various examples of loneliness tensity of occurrence8). The 45-year-old, Sa-lang Kim, is single and 1) Model Case she is an ordinary office worker who is usually The model case is an example of using con- active and active. However, she was diagnosed cepts that represent all the important attributes of with diabetes a few months ago, recently diag- the concept of loneliness8). nosed with chronic renal failure due to complica- Malro-Jeong, a 65-year-old woman, had a hus- tions, and has been receiving hemodialysis three band who died a year ago from gastric cancer. times a week. Because of the pressure to come She has two sons who are now married and liv- to the hospital three times a week, she resigned ing abroad. She lives alone in an apartment, and from her job. She was denied illness and treat- she has no occupation or religion. Before the be- ment, and she had to stay at home all the time reavement, she was a member of a mountain- except for the time to go to the hospital in the eering club, and her husband and her husband state of bitterness and emptiness filled with the climbed one or two times a week. The last thought that she should live like this for the rest Sunday of each month was attended by a married of my life. Her friends and relatives often visited couple. After bereavement with her husband, it and comforted her. She thinks that she is grateful was really awkward for her to go to a mountain- and lucky to have a conversation, a reliance, and eering party without her husband, so she was ab- a person to depend on, but she thinks that after sent from the meeting. Mountaineering club they return home, she eventually remains alone members and members of the group have con- in the world. tacted for some time after their bereavement, but have not made much contact in recent years. In 3) Related Case fact, there are many young couples living in The related case is an example of a concept apartments where she lives, and there is very lit- related to the concept of loneliness but not an tle contact with her neighbors. She thinks that all attribute. The relevant case is similar to the con- of her husband, children, and friends are not cept being analyzed, and in some sense it is around and left alone. Also, she often cries be- linked to the concept8). cause there is no one to depend on and the feel- Mi-ji Lee, a student in the fourth grade of ele- ing of loneliness is hard to endure. Indeed, she mentary school is living alone with her mother,
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and her mother is going to work. In the late af- There are personal and situational character- ternoon when she came home from school, her istics as a prerequisite for loneliness15). Individual grandmother-in-law would take care of her. One personality traits can affect loneliness because day, a sudden thing happened to her grand- they affect the response to personal interpersonal mother-in-law, and she came home from school relationships. Intrinsic, easily shy personality, low waiting until her mother came home from work. self esteem1). Situational characteristics can lead She thought it was scary and heartbreaking to be to loneliness because an individual changes the alone and she was waiting for her mother to opportunity to create and maintain optimal social come home while waiting on the computer. relationships. Environment, social role, family structure, and marital status1). For example, di- 4) Contrary Case vorce, bereavement with a spouse, admission to a The opposite case does not include the concept hospital, moving, and new job. figure 211). of loneliness8). The 38-year-old woman, Mal-eum Na, is not pregnant until the third year of marriage but has conceived her first child through a fertility clinic. She is a high school teacher and very positive and always smiles. Colleagues teach her about pregnancy, childbirth and various prenatal care and maintain good relationships. She feels happi- ness no more than the fact that whenever a baby is born she is accompanied by a precious new
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and empirical criterion for loneliness are the development of nursing intervention strategy same. which can understand the concept of loneliness The most widely used tools for measuring and reduce loneliness to various subjects. The loneliness are the revised UCLA Loneliness analysis method was applied. Scale, RULS of the revised UCLA (University of The results of this study are as follows: 1) Self California, Los Angeles) developed by Russell, - alienation 2) Human - isolation 3) Peplau and Cutrona 18). Most of Korean studies Psychological damage reaction 4) Pain 5) use RULS10) as a tool for studying the Loneliness Loneliness is a loss of comfortable "frame" The Research Tool (RULS). It is a Likert 4 point prerequisites can be divided into personal charac- scale consisting of 10 positive and 10 negative teristics and situational characteristics. Empirical items. It has a range of 20 ~ 80 points. The criteria include intimate others, lack of social re- higher the score, the higher the degree of lationships or problems, family and friendship, loneliness. Austin19) reported that RULS is a tool belonging, recognition or expression of lone- with three dimensional factors: intimate perime- liness, emotional state changes and changes in ters, social surroundings, and lack of belonging. health behavior, and physical symptoms. Asher and Wheeler20) developed a tool for Loneliness is an important indicator of children's loneliness questionnaire (LCQ). Kim21) well-being and causes physical and mental has adopted the LCQ. The tool includes 16 items illness. It is a challenge for nurses facing diverse that focus on the child's lonely feelings, social subjects to be able to recognize signs and symp- adjustment or maladjustment, or a child's sub- toms of loneliness and to encourage and sustain jective assessment of peer relationships, and 8 the interest of the subjects so that everyone can items that focus on the child's hobbies or pre- enjoy daily life experiences3)23). ferred activities The total score is composed of 24 items, ranging from 16 to 80 points. The References higher the score, the greater the degree of loneliness. 1. Kim OS. Loneliness: Concept Analysis. 22) Emotional / Social Loneliness Inventory was Nursing Science, 1997;9(2):29-38. also developed as a multidimensional tool to 2. Shearer R, Davidhizer R. It can be never be measure four concepts: emotional loneliness, so- the way it was: Helping elderly woman adjust cial loneliness, emotional isolation, and social to change and loss. Home Health Care Nurse, isolation. 1994;12(4):60-65. 3. Murphy F. Loneliness: a challenge for nurses caring for older people. Nursing Older People, Ⅲ. conclusion 2006;18(5):22-25. 4. Peplau LA, Perlman D. Perspectives on Loneliness is an extremely subjective experi- loneliness. New York: Wiely. 1982. ence that is influenced by life experiences and 5. ElSadr CB, Noureddine S, Kelley J. Concept circumstances17). Analysis of Loneliness with Implications for In this study, the concept of Walker and Nursing Diagnosis. International Journal of Avant8) was used to identify the concept and def- Nursing Terminologies & Classifications, inition of loneliness and to provide basic data for 2009;20(1):25-33.
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