Organizational characteristics and restraint use for hospitalized nursing home residents.
OBJECTIVE
To examine the effect of organizational characteristics on physical restraint use for hospitalized nursing home residents.


METHODS
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.


METHODS
Eleven medical and surgical units in one 600-bed teaching hospital.


METHODS
One hundred seventy-four nursing home residents aged 61 to 100, hospitalized for a total of 1,085 days.


METHODS
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).


CONCLUSIONS
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.
Bourbonniere
Meg
M
School of Nursing, University of Pennsylvania, Philadelphia, USA. Meg_Bourbonniere@Brown.edu
Strumpf
Neville E
NE
Evans
Lois K
LK
Maislin
Greg
G
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005851:Geriatric Nursing; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D009735:Nursing Homes; D016017:Odds Ratio; D011446:Prospective Studies; D012149:Restraint, Physical; D012307:Risk Factors