'Tied down'- the process of becoming bedridden through gradual local confinement

To raise awareness of the process of being bedridden, to create knowledge about the different causes and types of being bedridden, to highlight what exactly constitutes being bedridden, to describe which factors influence being bedridden.

Being 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.

Data collection and analysis were performed by using a Grounded Theory approach as developed by Strauss and Corbin.

Thirty-two interviews with older, bedridden people 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.

'Gradual local confinement' 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.

The study is the first research on the topic of being bedridden; no research in this field had been done before. There are some research results on bedrest, based on a purely medical perspective. The problem of being bedridden from the perspective of nursing is totally different. This study reveals phases of development and a range of factors influencing the problem of becoming bedridden. 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.

Many factors that lead to being confined to bed are alterable. Long periods of being bedridden can be prevented in many cases, if early warning signs are recognised and preventive measures are taken in time. The result of this research could be the basis for a change of attitude and behaviour of professionals dealing with those patients. It could have a major impact on the quality of life of the patients and, in addition costs of treatment might be reduced.