The building blocks of nursing theories are concepts; however, some concepts are difficult to operationalize, lack clarity, and are ambiguous. According to Levi et al. (2020), Walker and Avant concept analysis is used to evaluate the essential elements to ensure conceptual clarity and concrete concepts. This analysis will use the Walker and Avant method because it has a structure, a systematic approach to a concept, and is an extensive method used in nursing.
Homebound is a common experience caused by temporary situations and, in some cases, critical situations like quarantine or a broken leg. This experience is usually the same as the feeling of boundedness of individuals who are permanently incapable of going outside their houses due to infection of some diseases. A homebound situation is common, and it happens to 5.6% of the overall population for medical benefits (Tlusty & Hanna, 2021). Homebound individuals also have a notably higher mortality threat than non-homebound and homebound are associated with 2-year mortality independently of functional impairments and diseases. Individuals who are Homebound exhibit more chronic diseases, hospitalization, polypharmacy, and numerous consequences. If the conditions of high prevalence, the multifactorial effects, and mortality risk are opposed, the primary programs for individuals in homebound where nurses are combined into interdisciplinary groups. Numerous studies have revealed that these programs positively affect caregiver, individual, and systems results. This is a clear indication of homebound as a concept used in nursing. Therefore, this analysis aims to increase understanding of homebound and its practical and theoretical implications for nursing more widely.
Definitions and Uses of the Concept
Scientific Literature Definitions and Uses of the Concept
Homebound is defined differently with similarities but does not have consistency in consequences, definition, or antecedents. The following purposes are used when describing homebound. Homebound refers to a situation where an individual is not allowed to leave their home independently without being assisted. Leaving their homes is only possible with assistance or under great difficulty or physical effort, for example, using special transportation, assistive devices, or using others. In some instances, homebound patients’ out-of-home visits are possible within a specified time, like once per week. In addition, homebound is classified as mostly homebound, semi-homebound, and completely homebound. Mostly homebound refers to individuals who can leave their homes once per week or less (Schirghuber & Schrems, 2021). Semi-homebound is used to describe individuals who can leave their houses with many challenges and need help from another individual. Completely homebound refer to individuals who are not allowed to leave their homes.
Patients under the homebound program can handle most of their indoor activities of daily living (ADL) without any help. On the other hand, they have minimal operational status in the instrumental activities of daily living (IADL). They encounter challenges when climbing stairs and walking, and they can walk for about 5m independently or move inside using a walker or a cane. They infrequently leave home with great strains for medical treatment or a short while, such as attending church service, visiting hairdressers, radiation therapy, or chemotherapy. Homebound patients must lie down in bed or stay at rest all day long.
Uses and Definition of Homebound in Dictionary
When bound is used as an adjective, it means likely or sure to occur or be or do something. When being bound is combined with restricted or confined to home refers to the inability to leave a place due to unwanted conditions like illness or injury. In some instances, homebound individuals have poor health, leading them to the undesirable situation of not walking very far (Ratih & Gusdian, 2018). All these definitions and uses in the dictionary are closely related to nursing.
The outcomes of the homebound attributes are six crucial attributes discussed below.
- Endurance– Individuals in homebound programs are permanently bound to their house, which implies that going outside is limited to a few minutes per day, once a week, or even twice per month.
- Need assistance when leaving the life-space– Homebound individuals need assistance from other people, especially when going outside their home with aids like special transportation, walker, crutches, cane, or wheelchair.
- Powerlessness– people who are homebound feel powerless due to incapability of changing the undesired and acquired medical issue (like frailty or chronic disease) that has led to homebound.
- Need of assistance in IADL/ADL– Homebound individuals need help with IADL, but they can manage most of ADL indoors independently.
- Limitation of mobility– The mobility of homebound individuals is limited because they can independently walk for short distances (Ratih & Gusdian, 2018). They experience difficulties walking as well as climbing stairs; therefore, movement around the house only happens with the use of a walking aid or stick or holding on to furniture.
- Life-space confinement– Individuals in homebound are limited to their living space because they cannot go outside their house without assistance.
Physical immobility and physiological instability are the antecedents that are strongly associated with homebound. Physical immobility is distinguished by the loss or limitation of physical functionality like the incapability to maintain a posture, balance problems, gait, hand strength, and physical stability (Lebel et al., 2018). This implies that individuals cannot move around while maintaining balance, stably support themselves on their feet and walk upright. Physiological instability is distinguished by pathological changes of physiological variables, dynamic state, as well as maintaining a balance of physiological variables. Physiological variables include Cortisol level, pulse rate, arterial pressure, and respiratory rate. Emotional states are experienced when slight variations occur on the physiological variables. While maintaining a balance of physiological varies only slightly in the development of disruptive elements.
When using thematic analysis, four factors influence the homebound antecedents: booster, complexity, illness, and burden. Illness includes musculoskeletal diseases (such as osteoporosis, hip fractures, and arthritis) and chronic diseases (such as cancer and cardiovascular and metabolic disorders). Illness is a crucial factor that influences physical immobility and physiological instability that potential affecting factors can strengthen as booster, burden, and complexity (polypharmacy and multimorbidity). Both complexity and illness can affect an individual at any age, but complexity is associated with other conditions such as old age, sarcopenia, and frailty. The burden includes illness, symptoms, and suffering (Robles-Bello et al., 2020). Booster distinguishes all exogenous and endogenous influencing factors that can escalate complexity, responsibility, and illness.
The principal consequences of being homebound are spiritual, physical inactivity, social, psychological, and physical consequences. Spiritual effects are influential to individuals who cannot contact clergy or attend religious services. Physical inactivity decreases outdoor activities such as developing the IADL/ADL status and use of life-space. Social consequences include loss of social relationships, isolation, and loneliness (Lebel et al., 2018). Psychological effects include escalation of psychological stress, anxiety, depression, dementia, cognitive impairment, or cognitive impairment. Physical consequences have an increasingly physical disability and increased risk of becoming bedridden or poor nutrition or risk of falling.
Empirical referents are crucial because they develop assessment instruments and measure or identify the defining attributes. Some tools concentrate on homebound details, such as calculating mobility restriction and the de Morton Mobility Index (DEMMI) (Braun et al., 2018). This index contains the World Health Organization (WHO) definition of mobility, which states that it moves by changing body location or position or transmitting from one place to another by transporting, pushing, or manipulating items using a form of transportation. The life-space evaluation questionnaire evaluates mobility in the perspective that older people walk and how often they can walk without help.
Levels of life-space include outside the house, the bedroom, the town, the neighborhood, and the home. Tools used to evaluate Lawton’s instrumental and daily living activities measure the attributes that need IADL and ADL’s help (Lebel et al., 2018). Powerlessness Evaluating Tool is used to measure powerlessness as a homebound attribute. To measure weakness involves endurance (measured by the attribute) as well as force measurements as clinical evaluation.
There are three classifications of case studies used to explain the concept of homebound. Cases can be found in the literature or invented, but those used in this analysis were derived from real examples of preventing homebound patients from falling (Tlusty & Hanna, 2021). Names used to identify every case are fictitious because they are not dependent on participants’ real names, provided that target group data was classified and collected by group respondent number. The model case illustrates all the homebound attributes, while the borderline case has some defining attributes. This assists in more fully articulating the meaning of the homebound concept. The last case is the contrary case, a prices example of the opposite of the concept.
Model Case and Analysis
John is a 72-year-old male who lives in Miami, Florida. He is bounded to his living space because his mobility is restricted, and he cannot go outside his house independently. Due to the risk of falling, he needs assistance to leave the house to visit the doctor once per week and handle his IADL. He is assigned a nurse who helps him go outside using a wheelchair. The nurse is also responsible for helping him to manage indoor activities such as a daily shower. On the other hand, he can handle ADL indoors independently when holding onto furniture. He spends most of his time either in the bed or sitting on the sofa. This means that he has enough energy to be active in the house. John says, “Getting old is not lovely! I used to travel a lot. Now, I am feeling too weak even I can go, for example, to church. I am powerless, and I cannot change this enduring condition. This model case has all the six attributes of homebound because John needs help, mobility is limited, powerless, weak, endurance, and encounters confinement of life-space.
Borderline Cases and Analysis
Lana is 36 years old female who is bounded in her life-space because she has acquired an injury that limits her mobility. The injury has made Lana feel too weak and cannot move independently for more than five meters. Due to this, her brother is helping her handle IADL, but Lana can manage all ADL in the house. During the day, she spends most of her time outside the home, walking with a cane or walking up the stair to get to her bedroom without help from her brother. When Lana is not in her bedroom or walking, she spends her on the ground floor. This injury has made her feel powerless, and she does not have an accurate time for her full recovery. This borderline case has five of the six attributes of homebound because Lana needs assistance, weak, powerlessness, limitation of mobility, and confinement of life-space.
Lydia is a female who is 40 years old, and she knows what life is all about. She needs a walking stick but can go outside their home without help. Recently, Lydia traveled for a business trip and acquired a barrier-free apartment to walk independently. In the new neighborhood, she can go swimming and drive a car. Lydia can handle all IADL and ADL without help, and she feels strong enough to control her life independently. This is the opposite case that does not have any attributes of homebound.
Implications for Nursing Practice
Homebound is a situation that no sufficient studies have been conducted to offer a base for nursing comprehension. Analysis of the concept of homebound assists nurses in understanding homebound patients and the risk they encounter being homebound. Nursing working on homebound patients will use homebound attributes to know what they are passing through and help them appropriately (Lebel et al., 2018). In addition, nurses will understand their roles on homebound patients and what functions are supposed to be left for caregivers or relatives. Therefore, understanding this concept analysis will ensure the success of homebound programs.
Homebound is inclusive because of spiritual, physical, and psychosocial consequences. Anybody can be affected by the condition regardless of their age or gender. It is crucial to understand homebound to develop preventive measures and prevent possible effects. Due to this, there is a need to prove the content viability of the concept of homebound as well as create nursing diagnoses as required by further steps. Therefore, nurses should take on a principal role in healthcare and interdisciplinary context to prevent homebound and its consequences.
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