Abstract

Objectives: Bedriddeness is a creeping process of increasing immobilization (Zegelin, 2013). In institutional long-term care, 50-99% of residents are becoming increasingly immobile (Statistisches Bundesamt, 2015; Schrank et al., 2013). However, mobility also increases at around 10% (Wingenfeld, 2014), from which it can be concluded that for some of the residents the process of increasing immobilization can be slowed down, stopped or even reversed. Two Holistic Case Studies conducted at the Institute of Nursing Science of the University of Vienna result in a theoretical basis for the understanding of the processes and their influencing factors. Bedriddeness is accordingly a process-developing and multifactor-influenced phenomenon, which is influenced by physiological, institutional and personal factors. The aim of the study was to develop and evaluate a multi-factorial intervention for the prevention of bedriddeness.

Methods: The overall study is methodologically based on the principles of the Utrecht model (van Meijel et al., 2004) and the UK MRC framework (Craig et al., 2008) for the development of complex interventions. Based on the framework concept from the previous studies and the principle of action-oriented research, case studies were used to reflect and validate the theoretical framework in practical application. At the same time case analyzes and literature were used to develop a concrete intervention. For this purpose, three workshops with intervening practical and theoretical phases were carried out. 15 employees from two long-term care facilities were involved. The developed intervention was tested in a first pilot in a long-term care facility and evaluated for feasibility during the process and analyzed for possible secondary outcomes. Individual interviews based on the feasibility questions according to Browen et al. (2009), as well as observations, but also standardized instruments, such as the Barthel Index (Mahoney & Barthel 1965) and the Esslinger transfer scale (Runge & Rehfeld, 1995) are used.

Results: It has turned out that nursing care conferences are the only possible intervention, which has a certain degree of standardization in the theoretical framework as well as a maximum individuality in implementation. Multi-perspectivity and interdisciplinarity are realized, as practitioners from different professions and with different background experiences participate in case conferences. The theoretical framework has been operationalized in a structured guideline, which addresses the different levels of influencing factors. The case conference is accordingly based on this structured guideline as well as on defined process structures and roles. Although the pilot test has already started, but has not yet been completed, there are no concrete results from the accompanying evaluation. They are expected in June 2018.

Conclusions: Through the theory-based but action-oriented and participatory approach, it was possible to develop an intervention that can do justice to the complexity in the sense of multiple factors influencing the process of creeping immobilization, as well as nursing practice and its thinking and process patterns or implementation options. They are standardized to a certain extent but preserve and focus the individuality of the individual. In the next study phase, an intervention study based on this program theory is planned, the results of which will in turn be used to refine the program and the development of sustainability strategies as well as the further development of the theoretical framework.