Silvia Thomann1, Sabine Hahn2, Silvia Bauer3, Dirk Richter2,4,5, Sandra Zwakhalen6. 1. Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. silvia.thomann@bfh.ch. 2. Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. 3. Department of Nursing Science, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria. 4. Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Murtenstrasse 46, 3008, Bern, Switzerland. 5. University Hospital for Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3060, Bern, Switzerland. 6. Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, PO BOX 616, 6200, MD, Maastricht, The Netherlands.
Abstract
BACKGROUND: In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). METHODS: A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016-2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. RESULTS: The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. CONCLUSIONS: The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible.
BACKGROUND: In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). METHODS: A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016-2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. RESULTS: The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. CONCLUSIONS: The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible.
Entities:
Keywords:
Hospitals; Multilevel analysis; Organisational culture; Quality of health care; Restraint
Authors: A Perren; D Corbella; E Iapichino; V Di Bernardo; A Leonardi; R Di Nicolantonio; C Buschbeck; L Boegli; A Pagnamenta; R Malacrida Journal: Minerva Anestesiol Date: 2014-10-22 Impact factor: 3.051
Authors: Silvia Thomann; Gesche Gleichner; Sabine Hahn; Sandra Zwakhalen Journal: Int J Environ Res Public Health Date: 2022-06-10 Impact factor: 4.614