Research Assistant Professor, University of Kansas School of Nursing USA.
Research Associate Professor, University of Kansas School of Nursing USA.
Int J Nurs Stud. 2021 Jun;118:103925. doi: 10.1016/j.ijnurstu.2021.103925. Epub 2021 Mar 10.
Modifiable unit characteristics, including nurse work environment, education, certification, and staffing have been shown to impact patient safety. Physical restraints are an important patient safety issue, however the relationships between these modifiable unit characteristics and physical restraint use on critical care units has not been explored.
Our objective was to determine the role of nursing work environment, nurse education and certification, and nurse staffing on physical restraint use.
The study was a secondary analysis of 2017-2018 unit-level restraint rates from the National Database of Nursing Quality Indicators linked to Registered Nurse survey and hospital characteristics data.
Work environment was examined at the unit-level using total Practice Environment Scale of the Nursing Work Index and subscale scores. Unit-level nurse expertise included the percent of nurses with at least a Bachelor of Science in Nursing degree and percent with certification. Nurse staffing was the unit-level Registered Nurse hours per patient day and skill mix. Analyses included descriptive statistics, bivariate correlations, and Structural Equation Modeling. We used a first order model to estimate predicted restraint use from the five subscales of the Practice Environment Scale of the Nursing Work Index. A higher order model predicted restraint use from a total work environment factor score.
The sample included 408 critical care units from 226 hospitals. Mean restraint rate was 15% (SD 12, range 0-53%). In the first-order model, the Collegial Nurse-Physician Relations subscale had a positive relationship with restraint use (β = 0.167, 95% confidence interval 0.010-0.333). In the higher order model, the total work environment score had a negative relationship with restraint use (β = -0.088, 95% confidence -0.178- -0.014). Registered Nurse hours per patient day had a negative relationship to restraint use in both the first order (β = -0.114, 95% confidence interval -0.222--0.025) and higher order models (β = -0.117, 95% confidence interval -0.223- -0.012).
We found that better nurse-physician relationships were associated with higher restraint use. This finding is supported by previous literature and may reflect physician trust in nursing judgement when using restraints. However, a better work environment overall was associated with lower restraint rates. Further, Registered Nurse hours per patient day, but not skill mix, was associated with lower restraint rates. We conclude that improving the overall nurse work environment and nurse staffing, as well as using interprofessional interventions, may be successful in decreasing restraint use on critical care units.
可改变的单位特征，包括护士工作环境、教育、认证和人员配备，已被证明会影响患者安全。身体约束是一个重要的患者安全问题，然而，这些可改变的单位特征与重症监护病房身体约束使用之间的关系尚未得到探索。
我们的目的是确定护理工作环境、护士教育和认证以及护士人员配备对身体约束使用的作用。
这项研究是对 2017-2018 年全国护理质量指标数据库中与注册护士调查和医院特征数据相关的单位水平约束率的二次分析。
使用护理工作指数实践环境量表的总分和子量表评分来评估单位水平的工作环境。单位水平的护士专业知识包括至少拥有护理学士学位的护士比例和认证护士的比例。护士人员配备是单位水平的每患者每天注册护士小时数和技能组合。分析包括描述性统计、双变量相关性和结构方程模型。我们使用一阶模型来估计护理工作指数实践环境量表的五个子量表对约束使用的预测。高阶模型预测了工作环境总因子得分对约束使用的影响。
样本包括来自 226 家医院的 408 个重症监护病房。平均约束率为 15%（标准差 12，范围 0-53%）。在一阶模型中，同事护士-医师关系子量表与约束使用呈正相关（β=0.167，95%置信区间 0.010-0.333）。在高阶模型中，工作环境总得分与约束使用呈负相关（β=-0.088，95%置信区间-0.178-0.014）。每患者每天注册护士小时数与约束使用呈负相关，在一阶模型（β=-0.114，95%置信区间-0.222--0.025）和高阶模型（β=-0.117，95%置信区间-0.223-0.012）中均如此。
我们发现，更好的护士-医师关系与更高的约束使用率相关。这一发现得到了先前文献的支持，可能反映了医生在使用约束时对护理判断的信任。然而，整体工作环境的改善与较低的约束率相关。此外，每患者每天注册护士小时数，但不是技能组合，与较低的约束率相关。我们的结论是，改善护士工作环境和护士人员配备，并采用多专业干预措施，可能有助于减少重症监护病房的约束使用。
