Willemse Bernadette M, de Jonge Jan, Smit Dieneke, Dasselaar Wouter, Depla Marja F I A, Pot Anne Margriet
Program on Aging,Netherlands Institute of Mental Health and Addiction,P.O Box 725,3500 AS Utrecht,the Netherlands.
Department of Industrial Engineering and Innovation Sciences,Human Performance Management Group,Eindhoven University of Technology,Paviljoen J.06,P.O. Box 513 5600 MB Eindhoven,the Netherlands.
Int Psychogeriatr. 2016 Jun;28(6):983-94. doi: 10.1017/S1041610216000028. Epub 2016 Feb 2.
Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints.
Data were derived from the first wave (2008-2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ).
Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints.
Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making - especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.
研究表明，长期护理机构在精神药物和身体约束措施的使用上差异很大。本研究的目的是调查痴呆症患者护理机构中不健康工作环境的特征是否与更多的精神药物处方和身体约束措施相关。
数据来自荷兰一项全国性监测研究的第一波（2008 - 2009年）。本文使用了来自111家长期护理机构、4796名居民的精神药物处方和身体约束措施的数据。还考虑了996名工作人员和1138名居民样本的调查数据。记录了开具苯二氮䓬类药物、抗精神病药物和使用身体约束措施的居民数量。使用莱顿工作质量问卷（LQWQ）评估工作环境。
逻辑回归分析表明，更多的上级支持与更少的苯二氮䓬类药物处方相关。发现同事支持与更少的深座椅使用相关。未发现工作要求和决策权力是精神药物和身体约束措施的预测因素。
工作人员的工作特征与精神药物处方和身体约束措施几乎没有关联。这一发现表明，在护理人员工作环境不健康的机构中，开具药物或采取约束措施的可能性并不会更高。需要进一步进行纵向研究，特别关注多学科决策——尤其是医生的角色、工作人员的知识、护理理念和机构政策，以进一步深入了解影响精神药物使用和约束措施的因素。
