Organizational Characteristics and Restraint Use for Hospitalized Nursing Home Residents
Article first published online: 31 JUL 2003
Journal of the American Geriatrics Society
Volume 51, Issue 8, pages 1079–1084, August 2003
How to Cite
Bourbonniere, M., Strumpf, N. E., Evans, L. K. and Maislin, G. (2003), Organizational Characteristics and Restraint Use for Hospitalized Nursing Home Residents. Journal of the American Geriatrics Society, 51: 1079–1084. doi: 10.1046/j.1532-5415.2003.51355.x
- Issue published online: 31 JUL 2003
- Article first published online: 31 JUL 2003
- physical restraint;
- hospital care;
- health services
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.