What is existential sickness
The AEDLs according to Monika Krohwinkel
We identify our care model with the AEDLs according to Monika Krohwinkel. The realization of life activities has an impact on life and health. But life and health also depend on how people can deal with existential experiences of life that they have in connection with the realization of their life activities.
On the basis of the theoretical conception, a corresponding structural model was developed and specified for the activities and existential experiences of life (AEDL).
As activities and existential experiences of life, 13 areas were included that are related to each other without a hierarchical structure.
Perceptual ability, expression v. Feelings, gestures, emotional needs, language, writing, facial expressions, hearing, seeing (aids), memory, concentration
active & passive contracture prophylyaxe, walking, positioning, balance, balance disorders
3. Maintain vital functions of life
Vital signs, RR, BZ, breathing ability, heat regulation
4. Take care of yourself
Body care, skin condition, skin damage
5. Eating and drinking
Forms of diet, needs, enrichment, preparation (vomiting)
Constipation, diarrhea, continent, incontinent, toilet training
7. Dress up
8. Rest and sleep
Sleep habits, sleep disorders, sleep rhythm
9. occupy yourself
Organization of the day, hobbies, independent activities
10. Feel like a man / woman
11. Provide a safe environment
mental security, guidance
12. Secure social areas in life
13. Dealing with existential experiences in life
maintain existing relationships
(Acquaintances, relatives) adequacy of living spaces
Death, dying belief life history experiences
The AEDLs and their meaning:
You promote the relationship and support communication. According to Krohwinkel (1993), this includes the state of consciousness, orientation in relation to people, time and space, the ability to remember and concentrate, as well as the ability to communicate verbally and in writing. Facial expressions / gestures, expression of feelings and the ability to perceive with regard to hearing, sight and field of vision, reading etc. also fall within the scope of communication, as well as understanding and recognizing verbal and written information. Likewise, the ability to feel warmth / cold and express pain is classified here according to Krohwinkel. In addition, in this area of responsibility, the nurses have to consider which tools they need to support the patients.
General mobility is promoted and aids are given, e.g. when changing position, getting up, sitting and walking. According to Krohwinkel, this includes body movement inside and outside the bed. You also pay attention to paralysis and spasticity as well as other restrictions of movement, e.g. for head control. Balance and imbalance disorders, as well as positioning, also fall into this area, whereby endangered body regions are taken into account in this context. Dealing with contractures, decubitus ulcers and position-related edema formations also belong to this area of life.
Maintain vital functions of life
The ability to breathe, circulation and heat regulation are promoted, etc. Krohwinkel includes everything that has to do with breathing, e.g. breathing behavior, coughing, mucus, infections, breathing disorders, shortness of breath. This also includes the circulatory situation (blood circulation, blood pressure, pulse) as well as temperature regulation (fever) and perspiration (sweating, freezing)
Take care of yourself
Individual body care is encouraged and supported. Here, attention is paid to the skin condition, general skin care (e.g. cosmetics) and special skin care. When washing the patient, attention is paid to whether someone can wash themselves or needs help. A distinction is made between care with regard to individual body areas (e.g. mouth / nose / eye / nail / hair / genital area care). Furthermore, attention must be paid to skin damage (redness, swellings, blistering, edema, skin defects, allergies, infections).
To eat and drink
Patients are supported in their individual needs and habits with regard to eating and drinking. When eating, one takes into account the amount of food consumed, the appetite and the taste sensation of the person in need of care, as well as the type of food preparation (passed diet), diets, tube feeding, parenteral nutrition). When drinking, you pay attention to how liquids are absorbed and how large the amount of water the person in need of care consumes. The teeth also play a role in this context (dental status, situation of the gums, condition of the dentures). Chewing and swallowing (lip closure, salivation, floor of the mouth, tongue, cheek muscles, soft palate, cones) and the coordination of chewing and swallowing must be taken into account as well as the tolerance of food and drinks (nausea, vomiting).
The focus here is on promoting continence. Nursing aids are also given to help them cope with individual incontinence problems. The urine excretion is about quantity, rhythm, incontinence, micturition disorders, urinary behavior, urinary tract infections, etc., with stool excretion also about quantity, rhythm, incontinence as well as constipation, diarrhea.
To get dressed
Here you pay attention to the individual needs regarding clothing and try to promote independence in this area. One observes the preferred clothing during the day and night. This also includes assistance with dressing and undressing.
Rest and sleep
Nursing provides support with individual rest and relaxation needs. One tries to promote a physiological sleep-wake rhythm and supports the elderly in coping with sleep disorders. Just as important are phases of rest and relaxation, as well as desired breaks for those affected. When sleeping, one takes into account the quality of sleep, sleep duration and sleep times.
To keep oneself busy
In this area of life, the organization of the day, hobbies, interests, independent activities play a role as well as the activities that are undertaken together with other people (e.g. relatives, caregivers, physiotherapists, occupational therapists and speech therapists).
Feeling and behaving as a man or woman
This is an area that may seem a bit unusual in this context. What is meant is that care work should promote a positive and life-affirming self-perception of the patient as a man or woman. In care you have to accept the sexuality of the person in need of care, otherwise you cannot care for well. Through the intensive contact that one has with patients, one automatically experiences the crises that older people have through the loss of their youth and / or their partner as well as through their loneliness. One accompanies the patients who suffer from disturbances in the area of proximity / distance. In the area of life "feeling and behaving as a man or woman", connections to the areas of "taking care of oneself", "leaving", "dressing", "securing social areas in life" and "dealing with existential experiences in life" are particularly taken into account.
Provide a safe and supportive environment
What is meant here is that one should also promote people's general self-care skills. They are supported in the area of a safe life. In addition to housekeeping, this also includes mental security. One encourages or supports the residents / clients / patients, if necessary, in the design of their living area. One tries to estimate the patients in need of care from injuries and limitations, and one considers together with them which orientation aids are useful for them, etc. Here, according to Krohwinkel, the spatial equipment, the type and arrangement of the furnishings, the equipment of the bed, the seating play a role , Aids for orientation such as calendar, clock, newspaper, magazines, radio, television etc. play a role.
Secure social areas of life
In this area of life one supports older people in maintaining existing relationships and tries to promote their integration into a self-chosen social environment and to protect them from sensory deprivation and isolation. The social relationships to life partners, friends, neighbors, acquaintances and the primary personal reference persons are also taken into account, as well as the profession, the current and previous professional activities of the person concerned and his / her job-related responsibilities, as well as private obligations, e.g. taking care of the life partner. The apartment also belongs in this area. The advantages and disadvantages of the local conditions, the risks such as steps or stairs, as well as the appropriateness of living spaces, toilets, hallways and bathroom furnishings are also to be taken into account according to Krohwinkel.
Dealing with existential experiences in life
Here Krohwinkel means that caregivers accompany the patient in dealing with existential experiences such as fear, isolation, uncertainty, dying and death. Nursing also supports life-enhancing experiences such as integration, security, hope, well-being and joie de vivre. Experiences that can promote or endanger existence, e.g. culture-related experiences, worldview, belief, practice of religion, life history experiences, biography also play a role here.
It is difficult to divide the tasks of nursing into medical, nursing and social care tasks. Nursing services are provided on a multidimensional basis in the AEDL areas. The AEDL areas should be used as a guide for assessing the problems, needs and abilities of the person in need of care.
Loss of independence, worry / fear, distrust, separation, isolation, uncertainty, hopelessness, pain, death
Regaining independence, trust, confidence / joy, integration, security, hope, well-being
"Experiences that promote or endanger existence:"
culture-bound worldview, practice of religion, life history experiences
The primary nursing interest:
The central interest of holistic rehabilitation process care is the person in need of care, their care needs / problems (deficits) and their abilities related to the activities of life and to their handling of existential experiences in life. Summarized AEDL`s)
Primary influencing factors such as:
Environment and living conditions
Health and disease processes
Diagnostics and therapy
The primary nursing objective:
Maintaining, promoting or regaining independence and well-being of the person in need of care in their activities in life and their handling of existential experiences in life.
In order to achieve this, the skills of the person in need of care and / or their personal reference persons (relatives, life partners) must be systematically recorded, supported and promoted.
These goals remain in place, regardless of whether the person in need of care is healthy, sick, disabled or whether they are dying.
The primary nursing assistance (nursing methodology) of professional nursing is available to five basic methods of assistance, which are used in a need-oriented and goal-oriented manner:
1. Act for the person in need of care
2. lead and guide him
3. Provide an environment that is conducive to positive development
4. support him
5. Guide, advise, instruct and support the person in need of care and / or their personal caregivers
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