title: Effect of situational and clinical variables on the likelihood of physicians ordering physical restraints.
abstract: OBJECTIVE
  To model clinical and situational variables that may affect likelihood of physicians to order physical restraints.
  
  
  METHODS
  Cross-sectional, factorial survey.
  
  
  METHODS
  One academic medical center.
  
  
  METHODS
  One hundred eighty-nine physicians: interns in all specialty practices and resident and attending physicians in departments of surgery, general internal medicine, family practice, emergency medicine, and psychiatry.
  
  
  METHODS
  Vignettes were randomly generated using different values of six situational and eight clinical variables. Each physician received five unique vignettes for which they indicated their likelihood to order restraint on a 10-point scale.
  
  
  RESULTS
  Nine hundred six distinct vignettes were completed. The mean likelihood that physicians would order restraint was 3.9 + or - 3.0 (range 0 (not at all) to 9 (absolutely)). Exploratory regression analysis on physician's likelihood to restrain with independent variables of secondary diagnosis, patient age, sex, time of day, familiarity and trust with requesting nurse, patient behavior, vital signs, oxygen saturation, and dehydration explained 12.5% of variance (F=5.43, P<.001). Independent factors of unsafe patient behavior (P=.001) and secondary diagnosis of dementia (P=.06) resulted in greater likelihood of ordering restraint, whereas lack of trust in the judgment of the reporting nurse (P=.008) resulted in lower likelihood of ordering restraints.
  
  
  CONCLUSIONS
  Patients' clinical status had less influence on physicians' likelihood of ordering physical restraints than the working relationship with the requesting nurse or the patient's behavior. Interdisciplinary team approaches with active physician input for nonrestraint strategies in the management of patient behavior is emphasized to minimize restraint use.
authors.affiliation: Independence Foundation Professor of Nursing, Vanderbilt University School of Nursing, Nashville, TN 37240, USA. lorraine.c.mion@vanderbilt.edu
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Mion
authors.forename: Satinderpal K
authors.initials: SK
authors.lastname: Sandhu
authors.forename: Rabia Halim
authors.initials: RH
authors.lastname: Khan
authors.forename: Ruth
authors.initials: R
authors.lastname: Ludwick
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
authors.forename: James
authors.initials: J
authors.lastname: Pile
authors.forename: Michael
authors.initials: M
authors.lastname: Harrington
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Janice
authors.initials: J
authors.lastname: Winchell
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012149:Restraint, Physical / Q000295:instrumentation / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors