Organizational Characteristics and Restraint Use for Hospitalized Nursing Home Residents

Abstract

OBJECTIVES: To examine the effect of organizational characteristics on physical restraint use for hospitalized nursing home residents. DESIGN: Secondary analysis of data obtained between 1994 to 1997 in a prospective phase lag design experiment using an advanced practice nurse (APN) intervention aimed at reducing physical restraint for a group of hospitalized nursing home residents. SETTING: Eleven medical and surgical units in one 600‐bed teaching hospital. PARTICIPANTS: One hundred seventy‐four nursing home residents aged 61 to 100, hospitalized for a total of 1,085 days. MEASUREMENTS: Physical restraint use, APN intervention, age, perceived fall risk, behavioral phenomena, perceived treatment interference, mental state, severity of illness, day of week, patient–registered nurse (RN) ratio, patient–total nursing staff ratio, and skill mix. RESULTS: Controlling for the APN intervention, age, and patient behavioral characteristics (all of which increased the likelihood of restraint use), weekend days as an organizational characteristic significantly increased the odds of restraint (weekend day and patient–RN ratio on physical restraint use: odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.38–2.68, P < .001; weekend day and patient–total staff ratio on physical restraint use: OR = 1.91, 95% CI = 1.37–2.66, P < .001; weekend day and skill mix on physical restraint use: OR = 1.91, 95% CI = 1.37–2.67, P < .001). CONCLUSION: Key findings suggest that organization of hospital care on weekends and patient characteristics that affect communication ability, such as severely impaired mental state, English as a second language, sedation, and sensory‐perceptual losses, may be overlooked variables in restraint use.

Substantive Areas of Clinical Nurse Specialist Practice

“…Examples include a ''critical care bug team'' implemented to decrease the incidence of ventilator-associated pneumonias 336 and a ''rock and roll'' critical care program developed to prevent complications from immobility. 337 Administrators have relied upon CNSs to develop researchbased protocols, 229,338-347 clinical pathways, 348,349 guidelines, 278,[350][351][352][353][354][355][356] and policies [357][358][359][360][361][362][363][364][365][366] in their institutions. For instance, CNSs have championed policy changes related to assessment and treatment of pain.…”

Practices Used in Israel by Nurses Who Care During Hospitalization for Older Patients With Dementia or Who are Bedridden

“…61 Another study found that weekend days and lower patient-registered nurse (RN) ratio and patient-total staff ratio were connected with increased restraint use. 62 However, to the best of our knowledge, no previous study examined a variety of practices that nurses use in general hospitals with regard to older patients who are bedbound and patients with dementia. The purpose of this study is 2-fold: (a) to collect information from nurses about their approaches toward practices that should be used when there are older patients who are physically functionally dependent compared to patients who have dementia.…”

Advancing the Science in the Measurement of Health Care Quality Influenced by Nurses

“…Based on data provided from 98 hospitals surveyed by the California Nursing Outcomes Coalition (CalNOC 2004), mean restraint use was higher in ICUs compared to medical and surgical units (25% vs. 5%) and among smaller hospitals (100-199 beds) compared to larger ones (>301 beds; 39% vs. 9%) (CalNOC 2004). There is a vast body of evidence linking restraint use and nurse staffing, nurse-to-patient ratios, and other nursing variables in NHs (Bourbonniere et al 2003;Castle 2002;Donat 2002;Happ et al 2001;Mion et al 2001;Sullivan-Marx et al 1999;Whitman et al 2002). For example, the organizational variable "weekend" significantly increased the odds of restraint use among hospitalized NH patients (Bourbonniere et al 2003).…”

“…There is a vast body of evidence linking restraint use and nurse staffing, nurse-to-patient ratios, and other nursing variables in NHs (Bourbonniere et al 2003;Castle 2002;Donat 2002;Happ et al 2001;Mion et al 2001;Sullivan-Marx et al 1999;Whitman et al 2002). For example, the organizational variable "weekend" significantly increased the odds of restraint use among hospitalized NH patients (Bourbonniere et al 2003). Available evidence suggests that there is a substantial opportunity to improve quality of patient care in hospitals by reducing the use of physical restraints.…”