Organisational determinants of the use of physical restraints: a multilevel approach.

This paper reports a study of the relationship between the use of physical restraints with psycho-geriatric nursing home residents and the characteristics of organisations and residents. It is hypothesised that impairment in residents and organisational characteristics, such as a high workload of nursing staff and a low full-time equivalent (FTE) ratio on the wards, are associated with increased restraint use. In a cross-sectional study involving 15 Dutch psycho-geriatric nursing home wards, 432 residents were selected for participation, of which 371 actually participated. Restraint status was measured using observations. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set (MDS). Job characteristics, such as workload, were determined by different self-reported measures. Characteristics of the wards, such as the FTE ratio, were derived from the registration system of the wards. Physical restraints were used with 56% of the psycho-geriatric nursing home residents. Bivariate analysis showed that job and ward characteristics were not associated with restraint use. Bivariate and multilevel analysis showed that residents' characteristics, such as mobility and cognitive status were significantly associated with restraint use. Furthermore, multilevel analysis showed that higher job autonomy experienced by nursing staff and a higher FTE ratio on the wards were also associated with increased restraint use. In conclusion, job and ward characteristics were not as strongly associated as residents' characteristics with restraint use. Impairments in residents, such as immobility, were strongly related to the use of restraints. Therefore, education and support of nursing staff in caring for psycho-geriatric nursing home residents with poor mobility is recommended to reduce the use of physical restraints in nursing homes.