title: Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards.
abstract: OBJECTIVE
  Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards.
  
  
  METHODS
  A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors.
  
  
  RESULTS
  Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate model indicated that the following factors independently predicted greater use: type of hospital ward (emergency department and intensive care unit), staff perception of a higher level of expression of anger and aggression among team members, perception of the frequency of incidents of physical aggression against the self among patients, and perception of insufficient safety measures in the workplace.
  
  
  CONCLUSIONS
  These findings represent the first stage of a research program aimed at reducing use of seclusion and restraint in psychiatric settings. They underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when examining reasons for use of these controversial interventions.
authors.affiliation: Department of Social Psychiatry, University of Montreal,Montreal, Quebec, Canada. luigi_db@hotmail.com
authors.forename: Luigi
authors.initials: L
authors.lastname: De Benedictis
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumais
authors.forename: Nida
authors.initials: N
authors.lastname: Sieu
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Mailhot
authors.forename: Geneviève
authors.initials: G
authors.lastname: Létourneau
authors.forename: Minh-Anh Marie
authors.initials: MA
authors.lastname: Tran
authors.forename: Irena
authors.initials: I
authors.lastname: Stikarovska
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bilodeau
authors.forename: Sarah
authors.initials: S
authors.lastname: Brunelle
authors.forename: Gilles
authors.initials: G
authors.lastname: Côté
authors.forename: Alain D
authors.initials: AD
authors.lastname: Lesage
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D010356:Patient Isolation / Q000706:statistics & numerical data*; D011792:Quebec; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires