Huizing Anna R, Hamers Jan P H, de Jonge Jan, Candel Math, Berger Martijn P F
Maastricht University, Maastricht, The Netherlands.
Soc Sci Med. 2007 Sep;65(5):924-33. doi: 10.1016/j.socscimed.2007.04.030. Epub 2007 Jun 1.
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.
本文报告了一项关于老年精神科疗养院居民使用身体约束措施与机构及居民特征之间关系的研究。研究假设居民的身体机能障碍以及机构特征，如护理人员工作量大、病房全职等效人员（FTE）比例低，与身体约束措施使用增加有关。在一项涉及15个荷兰老年精神科疗养院病房的横断面研究中，选取了432名居民参与，其中371人实际参与。通过观察来测量约束状态。使用最小数据集（MDS）确定其他居民特征，如认知状态。通过不同的自我报告测量方法确定工作特征，如工作量。病房特征，如FTE比例，来自病房登记系统。56%的老年精神科疗养院居民使用了身体约束措施。双变量分析表明工作和病房特征与约束措施使用无关。双变量和多水平分析表明居民特征，如行动能力和认知状态与约束措施使用显著相关。此外，多水平分析表明护理人员体验到的较高工作自主性以及病房中较高的FTE比例也与约束措施使用增加有关。总之，与居民特征相比，工作和病房特征与约束措施使用的关联没有那么强。居民的身体机能障碍，如行动不便，与约束措施的使用密切相关。因此，建议对护理人员进行教育和提供支持，以照顾行动不便的老年精神科疗养院居民，从而减少疗养院中身体约束措施的使用。
