Bedridden
When bedridden , the person concerned spends most of the day and night in bed for a longer period of time. The main cause of being bedridden is the loss of the ability to get out of bed of one's own accord, for example due to physical weakness, dementia, impaired motor skills as a result of an illness or due to an accident . Further reasons can be the alleged protection of a sick person through bed rest or concern for his safety. Unwanted bed restraint as a state of being is (according to Zegelin 2004) at the end of a development over several phases. Bedridden people are in need of help and care from others and often also need care . Nursing tries to counteract bed rest and its undesirable consequences, such as the breakdown of muscles or the development of pressure ulcers , through mobilization .
The term is not applied to small children who cannot yet leave their camp on their own.
The bed rest , however, is not a complication, but a medically prescribed temporary measure, for example, after operations .
On the concept of being bedridden
The term "bedridden" is rarely described in the nursing literature, although nurses are often confronted with it. Rather, it deals with consequences and measures. In the assessment guidelines of the Medical Service of the Central Association of Health Insurance Funds (MDS) from 1997, complete immobility is equated with bed-restraint: “[...] complete immobility is a condition that results from a lack of physical or psychological strength in a patient, often in the form of a so-called bedridden. ”In the first editions of the textbooks Thiemes Altenpflege und Pflege Today , the term was not included in the register, but possible consequences and corresponding prophylaxis and measures were described. In the nursing textbooks by Liliane Juchli and Altenpflege von Köther / Gnamm, 'bed restraint' is listed in the register, but here, too, the development of such a condition is not dealt with, but only the avoidance of immobility and the possible consequences and appropriate measures. In Duden it says: "Forced to lie in bed by illness".
Five stages of bedridden development
The nursing scientist Angelika Zegelin interprets bed rest as the result of an ongoing process. It begins with instability and develops through the further phases of event, immobility in space and fixation to bed-restraint .
Unsteady gait, perception or sensitivity disorders or circulatory problems characterize the first phase. Aids such as walking sticks or walkers are used; If necessary, adjustments are made in the living area. The instability continues to increase so that the range of motion becomes smaller. Out-of-home activities are becoming increasingly rare, often out of fear of possible falls or unpleasant incidents, for example in connection with incontinence. The avoidance strategy is confirmed when such an event actually occurs. Precautions are reinforced, which in the further course leads to immobility in the room . Movement is increasingly taking a back seat. Resting periods while sitting or lying are longer. Switching between the different seats and loungers becomes more difficult; if it is no longer possible on its own, help is needed: now the location has been fixed .
You cannot leave the sitting position on your own, you have to wait for help. If this is only rarely used out of consideration for those providing help, a further avoidance strategy develops: the bed becomes the preferred place to stay, which is only left on certain occasions, for example to go to the toilet. Since the lack of movement increases the weakness through muscle breakdown, getting up is only possible with great effort and soon no longer possible; this is the last phase of strict bed restraint . The bed is the only place to stay; the most important personal things that need to be within reach are concentrated on the bedside table. Contact with the outside world is limited to visits, phone calls, radio and television.
Influencing factors
The phases of bedridden development are influenced by five constant factors: lying pathology, disease progression, individuality and temperament, coping with the situation, attitude and competence . Lying pathology means that measures against the lack of exercise become more and more difficult to implement, the longer the state of the respective phase persists. The progression of the disease leads to the fact that efforts to stop the decline in strength are again undone. The individuality and temperament can motivate the person concerned to adopt an optimistic point of view and to behave adherently , or to give up and to submit to a supposedly inevitable fate.
One resource can be to fall back on previous experience of dealing with the situation . A resilience helps to deal with crises, such as those incurred by disease progression or accidents. It is also helpful to have the attitude and competence of the person concerned, their relatives and caregivers, so that bed rest is not accepted as inevitable, but rather avoided or reduced.
Consequences of being bedridden
After a few days of strict bed rest, the functions of all organ systems change, for example breathing, so that the risk of pneumonia increases. The bowel activity decreases, which promotes constipation . When lying down for a long time, cognitive abilities and perception decrease, up to sensory deprivation , the concentration decreases, the continence is lost. In addition, the risk of contractures, thrombosis and the development of pressure ulcers increases .
Bed rest as a result of diseases and syndromes
End-stage disease or syndromes such as amyotrophic lateral sclerosis , coma , locked-in syndrome , Pick's disease and other serious neurological disorders inevitably lead to bed restraint, even if these patients are regularly mobilized. Even when sitting in armchairs or wheelchairs, these patients remain immobile and fixed in place, even if not bedridden in the strict sense.
At the end of life , measures for mobilization must be weighed with regard to the benefit for the dying person.
See also
literature
- Elisabeth Höwler: Preventing bedridden elderly people: Breaking the fateful cascade. In: Pflegezeitschrift , 2006, 59th vol.
- Angelika Zegelin: Being nailed down - the process of becoming bedridden. Verlag Hans Huber, Bern 2005, ISBN 3-456-84211-2
Web links
swell
- ^ Prophylaxis of bed restraint. Worksheet from I care Pflege , Georg Thieme Verlag, Stuttgart 2015 ; accessed on December 21, 2018
- ↑ duden.de ; accessed on December 21, 2018
- ^ A. Zegelin: To be nailed down. In: Pflege No. 18, 2005; Pp. 282-283; DOI: 10.1024 / 1012-5302.18.5.281