J Nurs Acad Soc.  1994 Dec;24(4):597-615.

A Ethnographic Field Study for a Model Development of the Chronic Bed-ridden Patient's Home-ward

• Kim TY
• Chung YK

Abstract

This study is designed to facilitate the creation of home environment conducive to the family taking care of chronic bed-ridden patients with more effective method. The need for this study has emerged against the background of marked changes in the structure of ailments and causes of death, resulting in the number and plights of chronic bed-ridden patients as well as of a rapid increase in demand for medical care and resulting premature discharge. Keeping these in mind, this study focused on home wards where the majority of chronic bed-ridden patients are being cared for. Despite their overriding importance, home-words are less than efficient in caring for chronic bed-ridden patients. These circumstances require the designing of home-wards that can offer greater comfort to patients and at the same time make things easier for caregivers, on the basis of an overall analysis of patients' life and home-ward situation. Accordingly this study adopted a Participant Observation Method derived cultural anthropology. Toward this end, 3 patients were chosen as subjects of this study for intensive interviewing and participant observation. In the process of this field research efforts were made to collect emprical data, that is, to faithfully record the words of the subjects and their caregivers for analysis and interpretation. The findings of these analyses are as follows. Firstly, the chronic bed-ridden patients are mostly being taken care by close family members. Secondly, a room for the exclusive use of the patient, floor, kitchen, bathroom, and multipurpose space were found to be necessary for proper caring of the patient. These spaces were respectively used with a view to 1) accomodating the patient as well as caregivers' activities, 2) keeping general and medical supplies and other appliances for patient's care and drying the patient's washing, 3) preparing and keeping the patient's foods and beverages, 4) keeping the supplies necessary for cleaning the patient's body and treating the patient's eliminations, 5) washing the patient's clothes, under wears and bedclothes. The patient's room in turn is subdivided into six portions in terms of uses; specifically the places for accomodating 1) the patient, 2) medical supplies, 3) medicines, 4) linens and clothes, 5) bedclothes and, 6) diapers. Thirdly, the activities of the caregiver are subdivided into seven key areas; hygiene, exercise, diet, elimination, therapeutic nursing, prevention of sore, and other activities. Each area is further classified into several different activities of caring. These activities are mainly carried out in the patient's room. Fourthly, the supplies for caring the chronic bed-ridden patient is divided into two large domains: medical and general supplies. Finally, three main problems areas were found in this study on the part of caregivers, that is, sore prevention, hygiene problem related frequent urination/defecation, the caregiver's physical, psychological and emotional burden. In consideration of the aforesaid problem areas, a model home-ward was developed in this study. The newly developed model has been found to have the following six advantages. Firstly, the time and effort required for maintaining the patient's hygiene are reduced, thus relieving the caregiver's physical and psychological burden. Secondly, the patient's hygiene can be maintained in satisfactory conditions, because the patient's eliminations are more easily removed. Thirdly, skin irritations caused by the patient's eliminations were remarkably reduced and so were the patient's sores due to moisture and bacteria. Fourthly, the home-ward have a tilt-table effect thanks to the inclining room floor. This improves the patient's cardiovascular function as well as constantly changes pressed skin areas and thus prevents sores. Fifthly, improved shelf arrangements help make the best use of patient's supplies. Sixthly, the trouble of continuously changing clothes, underwears, diapers and bedclothes is remarkably reduced simply by covering the patient with cotton sheets when laid in bed. This is espected to cut down expenses by reducing the comsumptions of diapers and other disposable supplies.

MeSH Terms

Anthropology, Cultural
Bacteria
Bedding and Linens
Beverages
Caregivers
Cause of Death
Diet
Equipment and Supplies
Humans
Hygiene
Nursing
Skin