The Homebound Concept Analysis

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Abstract

The paper presents an analysis of the phenomenon of interest of the homebound patient using the Walker and Avant method. The analysis’s main goal was to explain the concept and its connection with other concepts such as bed-bound status and voluntary quarantine. Firstly, the paper addresses the concept’s relevance in modern conditions of the COVID-19 pandemic. Next, the analysis features such elements as an exploration of the concept’s uses, determination of its attributes, and identification of its antecedents and consequences. Lastly, the paper defined the empirical referents and discussed the importance of the concept for research and practice purposes.

Introduction

My topic of interest and subject of concept analysis is the relevant concept of the homebound patient. The purpose of this paper is to analyze the concept to provide a definition of the homebound condition and determine the differences between the concept and bed-bound condition and voluntary quarantine. The paper will feature an explanation of the concept’s importance and describe common uses of the concept, as well as its attributes and consequences.

Homebound Concept

For the concept analysis subject, I chose the concept of homebound. The concept includes a broad range of conditions and requirements and intersects with many other concepts. Thus, it is necessary to provide definition of the concept to ensure healthcare providers’ understanding of the homebound patient’s state.

Concept Selected

The healthcare system experienced a significant impact from the recent COVID-19 pandemic in changes to the delivery of care, increased pace of digitalization of healthcare, and revisions in systems of care to reduce low-value services. Meanwhile, during the quarantine and social distancing, when people had to stay home to prevent the virus from spreading, many had experiences similar to homebound people. Furthermore, the pandemic and voluntary quarantine imposed certain changes to the definition of homebound. Thus, I selected this concept because it is important in current conditions and experienced significant alterations in the last three years.

Aim of Analyzing the Concept

This concept analysis aims to clarify the meaning of the concept of homebound and define its differences from related concepts. The concept and its use in the healthcare system experienced significant alterations in the conditions of the pandemic. Thus, the concept analysis will provide vital information about the concept and define the influence of the pandemic on the use of the concept and its meaning to assist future nursing research.

Use of the Concept

Firstly, the concept analysis requires considering the meanings of words in the concept. While there are many uses of the concept, the definition of the word homebound generally appeals to traveling direction or confinement to the home. The Merriam-Webster dictionary (n.d.) suggests that the first known use of homebound as an adjective for an individual’s direction towards home was recorded in 1598. On the other hand, the first use of homebound as an adjective representing an individual’s confinement in a specific location was recorded significantly later in 1882 (Merriam-Webster, n.d.). The word is constructed from two parts, with the first part “home,” referring to the Middle English word ‘hom,’ which stands for ‘dwelling’ (Merriam-Webster, n.d). The second part of the word, ‘bound,’ can represent both a bind, meaning a close connection or tightly fastened objects, or a restraint (obligation) (Merriam-Webster, n.d). Thus, analyzing the wording of the concept defined that the word homebound could represent individuals’ confinement in the location or obligation to stay at home for good reasons.

Furthermore, the concept of homebound is generally associated with aging adult patients. The study by Cheng et al. (2020) connects the concept of homebound with the patient’s status, which defines the patient as someone who never or rarely leaves home. Furthermore, the study defines that semi-homebound status represents that patient needs assistance or has difficulties in leaving home (Cheng et al., 2020). The study also associates the concept with negative effects on patients’ mental and physical health, such as social isolation, loneliness, and decreased level of life satisfaction. Thus, the concept refers to a patient’s unwillingness, inability, or difficulties in leaving home and separates different levels of homebound as a voluntary decision and confinement.

During the COVID-19 pandemic, people were subjected to lockdowns of 40 days in many countries. The study conducted by Gallego-Gómez et al. (2020) focused on the impact of the lockdown on the stress levels among nursing students. In the study, nursing students were characterized as homebound despite being much younger than the general audience of homebound patients and the involuntary nature of their decision to stay at home. Thus, the pandemic caused a significant deviation in the uses of the concept.

Lastly, the homebound concept is closely connected with the severity of the patient’s illness. The research conducted by Major-Monfried et al. (2018) focuses on the concept of homebound through the prism of care, emphasizing the importance of management in reducing illness symptoms among homebound adults. In the research, the authors emphasize the importance of home-based palliative care for chronically ill homebound adults. The research defines homebound patients as patients eligible for homebound status in the Medicare program (Major-Monfried et al., 2018). Thus, the homebound concept is often used to imply the legal status of the patient and the type of care he receives.

Attributes

Thus, exploring the common uses of the homebound concept provides an opportunity to define six primary attributes of the concept. The homebound state can be characterized as an individual’s relation to a specific location (home). Next, the concept includes the factor of the individual’s unwillingness or inability to leave the place. Furthermore, the inability can be sourced in recommendations for an individual’s illness, voluntary decision, or adherence to the requirements of the epidemiological situation. The concept is associated with the individual receiving a specific type of care (home-based). Moreover, depending on the severity of the individual’s illness, medical care can focus on a palliative approach. Lastly, the concept is associated with a negative influence on individuals’ mental and physical health and increased mortality risks.

Antecedents

In general, antecedents of homebound include physiological instability, such as low mobility and inability to move independently without additional assistance. According to Schirghuber and Schrems (2021), instability can be sourced in changes in physiological parameters, pathological or dynamical, or balance in physiological parameters. Furthermore, the emergence of antecedents is influenced by illness, its complexity, symptoms, and environmental factors, which cause additional discomfort (Schirghuber & Schrems, 2021). However, according to Das et al. (2021), the antecedents also may include behavioral control and subjective norms of pro-active character. Thus, antecedents of the homebound concept can be internal such as physiological instability caused by illness or other painful/uncomfortable symptoms, and external, such as epidemiological situation, financial situation, availability of transport, and barrier-free environment.

Consequences

The consequences of the manifestation of the homebound concept predominantly include negative effects. Firstly, being homebound can often result in loss of physical activity. According to Schirghuber and Schrems (2021), for patients with physical disabilities, lack of physical activity can result in the progression of the illness and cause additional risks of becoming bedridden. Next, homebound is closely associated with social isolation, which carries the risk of additional stress on mental health, resulting in increased chances of developing depression (Kim & Jung, 2022). Lastly, due to social isolation, homebound older adults have a higher mortality risk (Sakurai et al., 2019). Thus, the consequences of homebound concept include lack of physical activity, social isolation, increased chances of depression, and higher mortality risks.

Empirical Referents

Many articles in the existing body of knowledge elaborate on the concept of homebound. The research conducted by Ankuda et al. (2021) analyzes the longitudinal outcomes of homebound among older adults. Furthermore, the article by Xiang et al. (2020) examines future trajectories in homebound adults to define prominent risk factors. Thus, the existing research on the concept of homebound primarily focuses on determining factors that negatively affect homebound older adults to improve their quality of living. The concept is very important in practice because it allows healthcare providers to assess the patient’s needs. Lastly, defining the concept is necessary for research because it will attract more attention to the topic of high mortality risks among homebound older adults.

Conclusion

In conclusion, the concept analysis defined the homebound concept as generally associated with the individual’s inability or unwillingness to leave the house. Furthermore, the concept was more often applied to older adults with chronic illnesses who cannot leave the house without additional help or experience physical-activity-related issues. However, the concept analysis defined that in modern understanding, the antecedents of the homebound concept can be sourced from internal or external reasons. Internal reasons present health conditions and their symptoms, such as physical instability. External influence can manifest in an insufficiently accessible environment, which limits the individual’s possibilities or epidemiological situation threat. Moreover, while the homebound concept is primarily associated with older adults, after the COVID pandemic, the status can also spread to other people regardless of age. Lastly, the consequences of being homebound include lack of physical activity, social isolation, increased chances of depression, and higher mortality risks.

References

Ankuda, C. K., Husain, M., Bollens-Lund, E., Leff, B., Ritchie, C. S., Liu, S. H., & Ornstein, K. A. (2021). The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012–2018.Journal of the American Geriatrics Society, 69(6), 1609-1616. Web.

Cheng, J. M., Batten, G. P., Cornwell, T., & Yao, N. (2020). A qualitative study of health-care experiences and challenges faced by ageing homebound adults.Health Expectations, 23(4), 934-942. Web.

Das, A. K., Jilani, M. M. A. D., Uddin, M. S., Uddin, M. A., & Ghosh, A. K. (2021). Fighting ahead: Adoption of social distancing in COVID-19 outbreak through the lens of theory of planned behavior.Journal of Human Behavior in the Social Environment, 31(1), 373-393. Web.

Gallego-Gómez, J. I., Campillo-Cano, M., Carrión-Martínez, A., Balanza, S., Rodríguez-González-Moro, M. T., Simonelli-Muñoz, A. J., & Rivera-Caravaca, J. M. (2020). The COVID-19 pandemic and its impact on homebound nursing students.International Journal of Environmental Research and Public Health, 17(20), 1-12. Web.

Homebound. (n.d.) In Merriam-Webster.com dictionary. Web.

Kim, Y. R., & Jung, H. S. (2022). Effects of social interaction and depression on homeboundness in community-dwelling older adults living alone.International Journal of Environmental Research and Public Health, 19(6), 1-12. Web.

Major-Monfried, H., DeCherrie, L. V., Wajnberg, A., Zhang, M., Kelley, A. S., & Ornstein, K. A. (2018). Managing pain in chronically ill homebound patients through home-based primary and palliative care.American Journal of Hospice and Palliative Medicine, 36(4), 333–338. Web.

Sakurai, R., Yasunaga, M., Nishi, M., Fukaya, T., Hasebe, M., Myrayama, Y., Koike, T., Matsunaga, H., Nonaka, K., Suzuki, H., Saito, M., Kobayashi, E., & Fujiwara, Y. (2019). Co-existence of social isolation and homebound status increase the risk of all-cause mortality. International Psychogeriatrics, 31(5),703-711. Web.

Schirghuber, J., & Schrems, B. (2021). Homebound: A concept analysis.Nursing Forum: An Independent Voice for Nursing, 56(3), 742-751. Web.

Xiang, X., Chen, J., & Kim, M. (2020). Trajectories of homebound status in Medicare beneficiaries aged 65 and Older.The Gerontologist, 60(1), 101-111. Web.

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