["Tied down"--the process of becoming bedridden through gradual local confinement]

To be bedridden is a common phenomenon in nursing. However, there is no solid base of knowledge on reasons, types, development of and coping with this situation. The concept of being bedridden is applied in an arbitrary manner and the state of being bedridden is far from being clearly defined. A literature review revealed that only pathophysiological effects of this state are sufficiently explained. The aim of this study was to gain knowledge of the development of being confined to bed. Thirty-two interviews with elderly, bedridden people (nineteen women, thirteen men) were conducted. They were asked about their perspective on and their experience of the development of being confined to bed. Half of the interviewees lived in a nursing home, the others were cared for at home. Data collection and analysis were performed by using a Grounded Theory approach as developed by Strauss and Corbin. "Gradual local fixation" was identified as the core category. Becoming bedridden is a slow process by which the person is increasingly confined to one location. This development is related to an increasing need for support and to negative consequences such as a pathology of immobility, narrowing of interests, and loss of time. These consequences again are responsible for a downward spiral development. This study reveals phases of development and a range of factors influencing them. Many of these factors arise from the person and his/her interactional behaviour in the circumstances, other influences are structural factors such as external pressure caused by time constraints of professional nursing services or unfavourable arrangements of furniture. A lot of factors of being confined to bed are changeable. Long periods of being bedridden can be prevented in many cases, if early warning signs are being recognized and preventive measures are taken in time.