Basic care

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A typhus patient asks about the bedpan , the nurse tells him the price. Reproduction of a lithograph by Noël Dorville; around 1901.

Basic care or direct care refers to basic and usually regularly recurring care services in the care professions of health care and nursing , child health care and nursing , care for the elderly and curative care. These include the areas of personal hygiene , nutrition and mobility , as well as other non-medical care activities in the areas of activities of daily living . The implementation of medically prescribed treatments, such as the administration of medication , injections and changing of dressings , is referred to analogously as treatment care.

Both terms are considered out of date in nursing science .

History of the term

The pair of terms “basic and treatment care” was introduced in German-speaking countries in 1967 by the hospital economist Siegfried Eichhorn . The two terms arose as an imprecise translation of an English-language work from 1954. According to Eichhorn's interpretation, basic care is provided regardless of the underlying disease and is therefore the same for all patients, both in terms of the scope of activity and the time required. For Eichhorn, basic care includes all body-related activities such as helping with body care, food intake, elimination and mobilization. According to him, these activities can be neglected in the event of staff shortages and work summits in favor of smooth therapy or treatment care. Following his line of thought, this suggests that basic care is faster and easier to learn, which is in fact a devaluation of basic care, which is reflected in the frequent assignment to inexperienced carers or unskilled temporary workers.

The dualism associated with this division of nursing practice between the provision of basic physical needs and medically prescribed activities was abandoned with a changing understanding of the profession and the emergence of nursing science in favor of a more holistic approach .

Completion graphic created by Sr. Liliane Juchli from her book "Pflege"

In 1969, Liliane Juchli used the title Comprehensive Nursing - Basic Care - Treatment Care in her first manuscript (manuscript of the Theodosianum school) for a nursing textbook, which she wrote with other authors . In the first editions, the terms general and special nursing care are derived from basic and treatment care , which not only gave the title until 1979, but were also a structural element in terms of content. According to this, basic care includes body care, patient observation, ("simple") mobilization, prophylaxis and mental support, which Juchli describes as a "large sector" of "tasks and duties". In her remarks on care, Juchli already makes holistic considerations, from which she subsequently develops the care-theoretical approach of Roper, Logan and Tierney in the care recording instrument of activities of daily life (ATL).

In 1981, the Swiss nursing educators Martha Meier and Verena Fiechter defined three areas of activity for the independence of a nurse instead of basic and treatment care: the independent, the dependent and the interdisciplinary area of activity in which all those involved, including the patient, make decisions together. Then there are different priorities according to the respective area of ​​application of care: In hospitals, the dependent area predominates, in home care the independent area and in rehabilitation facilities the interdisciplinary area.

In Germany, criticism of the concept of basic and treatment care was first expressed in 1992. From 2004, the use of the terms in textbooks for nursing professions was rejected if they were still mentioned. However, they found their way into the Social Security Code and were also used there, although there was no legal definition .

Monika Krohwinkel adopted this terminology in the revision of her care model in 2013 and explains: “... The terms basic care and treatment care should be viewed as outdated. Instead, reference should be made to nursing and nursing's collaborative tasks, as was justified, examined and developed in the study on promoting process maintenance in connection with the management model. In this model, the main tasks and responsibilities of occupational nursing are not primarily assigned to the employee tasks for other professional groups, but rather to person-centered nursing in the direct nursing process, documentation and the person-oriented organization of nursing processes with the corresponding allocation of personnel, time and material resources. ... "

In the Second Care Strengthening Act, which came into force in 2017 and provided for various changes to the Eleventh Book of the Social Security Code , the designation basic care was replaced by the terms “body-related care measures” and “care-giving measures”.

Former importance under care insurance law

Until the end of 2016, the individual need for basic care was of decisive importance for the classification of a person in need of care in the care levels of the care insurance and the corresponding cost assumption by the care insurance . For example, those in need of care who need help of at least 120 minutes with basic care and a total care need of at least 180 minutes a day at at least three different times of the day were assigned to care level II. Since other classification criteria have been in effect in long-term care insurance since 2017 and the term “basic care” is no longer used, this meaning under long-term care insurance law no longer applies.

Basic and treatment care in social law (Germany)

In the home care or in a hospital inpatient treatment basic care and treatment in Germany is a performance of the health insurance , in-patient care performance of long-term care . The care benefits in kind provided by long-term care insurance in the home only include basic care, but not treatment care measures that have to be prescribed separately.

Basic care services

In the directive on the regulation of home nursing , the following activities are mentioned as basic care services:

  • Food and fluid supply, help with tube feeding: administration of food (if necessary via a gastric tube or percutaneous endoscopic gastrostomy (PEG) or jejunostomy, using a syringe, gravity or pump, checking the position of the probe, rinsing the probe after application, cleaning if necessary of the multiple system used).
  • Personal care: showering, bathing, washing; Oral, dental, lip and skin care; Shave, hair and nail care; Care of an eye prosthesis; Oral care as prophylaxis for patients with a weakened immune system or with a greatly reduced general condition.
  • Dressing and undressing: preparing individual clothes, help with putting on and taking off clothes, stockings or tights, bandages, putting on and taking off prostheses or orthotics, support corsets, trusses, etc.
  • Help with excretion and elimination of urine, stool, sweat, sputum, stomach contents; Use of incontinence products (e.g. protective pants, condom urinal); Cleaning a urethral catheter and the urethral opening, changing the catheter bag; Cleaning and care of a urostomy or enterostomy; Continence or toilet training.

The patient observation is always included, as well

  • Necessary nursing prophylaxis (for the prevention of e.g. contractures, constipation, parotitis, pneumonia, thrush, thrombosis, desiccation of the cornea, intertrigo); Pressure ulcer prophylaxis (if there is no such skin defect yet)
  • Positioning (flat position, upper body elevation, prone position, lower or upper leg position, side position, possibly using positioning aids)
  • Help to improve mobility (as part of activating care, e.g .: getting up from a lying or sitting position in the form of standing up to standing, walking and standing, climbing stairs, transferring or moving, sitting down and lying down, beds for an immobile patient, Storage, general movement exercises).

literature

  • Nicole Menche (Ed.): Pflege heute , Urban & Fischer bei Elsevier, 4th edition: July 4th, 2007, ISBN 343726771X
  • Liliane Juchli , Edith Kellnhauser , Susanne Schewior-Popp, Franz Sitzmann, Ursula Geißner, Martina Gümmer, Lothar Ulrich (eds.): THIEMEs care: Experience professionalism , Thieme, Stuttgart, 10th edition, April 2004, ISBN 3135000109
  • Ulrike Brög-Kurzemann, Hannes Sieber, Bernhard Weh: Basic care. Treatment care : structured according to AEDL , Vincentz Network GmbH & Co KG, 2000, ISBN 3878706200

Web links

Individual evidence

  1. ↑ SGB XI, §14, paragraph 4
  2. ↑ www.g-ba.de Guideline of the Federal Joint Committee on the regulation of home nursing. As of September 2018. Accessed February 1, 2019.
  3. ↑ E. Müller: Basic care and treatment care. Historical roots of a term of care in need of reform. In: PfleGe 3rd year No. 2, 1998; P. 1
  4. ↑ Heiner Friesacher: Theory and Practice of Nursing Action: Justification and Draft of a Critical Theory of Nursing Science, p. 192 f. Osnabrück University Press at V&R unipress GmbH, Osnabrück 2007, ISBN 978-3-89971-403-6 . Online: limited preview in Google Book search
  5. ^ Elke Müller: Nursing in the field of tension between American theory import and German nursing tradition. In: Helga Krüger, Gudrun Piechotta, Hartmut Remmers (eds.): Innovation in care through science. Perspectives and positions. Altera Verlagsgesellschaft, Bremen 1996. pp. 137–146
  6. ↑ E. Müller: Basic care and treatment care. Historical roots of a term of care in need of reform. In: PfleGe 3rd year No. 2, 1998; Pp. 2-3
  7. ↑ Verena Fiechter, Martha Meier: Care planning. A guide for practice. Recom, Basel 1993, 9th edition. ISBN 3-7244-8574-3
  8. ↑ E. Müller: Basic care and treatment care. Historical roots of a term of care in need of reform. In: PfleGe 3rd year No. 2, 1998; P. 5
  9. ↑ Federal Ministry of Justice, legal text SGB V, § 37. Retrieved on August 15, 2011 .
  10. ↑ Michael Seidel: Treatment care in the disabled aid - guidelines for inpatient facilities of the working group health policy of the professional associations of the disabled aid, 2009. (PDF; 615 kB) Retrieved on August 15, 2011 .
  11. ^ Beate Rennen-Allhoff: Handbook of nursing science. Study edition, p. 771 ff. Juventa Verlag, Weinheim 2003, ISBN 978-3-7799-0785-5 . Online: limited preview in Google Book search
  12. ↑ cf. also Müller 2001, Bartholomeycik 2005
  13. ↑ Krohwinkel, Monika. Promotional process maintenance with integrated ABEDLs. Research, theory and practice. Verlag Hans Huber: Bern 1st edition 2013, p. 154.
  14. ↑ Federal Law Gazette 2015, Part 1 No. 54; Article 2, 3. Accessed August 14, 2019
  15. ^ Johann-Matthias Graf von der Schulenburg : Insurance Economics : A Guide for Study and Practice , Verlag Versicherungswirtschaft, 2005, ISBN 3899521226 , pages 508 to 518, Chapter 6.3 Tasks and services
  16. ↑ www.g-ba.de Guideline of the Federal Joint Committee on the regulation of home nursing. As of September 2018, pp. 13–16. Retrieved February 5, 2019.