Nursing working conditions in relation to restraint practices in long-term care units

Objectives: This study examined the effects of nursing working conditions on the use of physical restraints and antipsychotics as restraints in long-term care units for elderly residents. Design: Cross-sectional data were obtained in Finland in 2002 from long-term care units that used the Resident Assessment Instrument (RAI) system and participated in a survey on working conditions. Setting: A sample of 91 inpatient units in 31 facilities (23 residential homes and 8 health centers). Participants: Data included 2430 resident assessments and 977 nursing staff survey responses. Measurements: We measured unit-level mean scores of physical restraint and antipsychotics use as restraints and resident characteristics (activities of daily living, cognitive impairment, and daily behavioral problems) based on the RAI system as measured by the Minimum Data Set 2.0. Head nurses reported the structural factors (nurse staffing levels and unit size). Nursing working conditions were measured by the Job-Demands and Job-Control Scales in the staff survey questionnaire. Results: Controlling for resident characteristics, nurses' job demands and control had a combined effect on restraint practices. Job demands strongly increased the risk of physical restraint use in units where nurses reported low job control (odds ratio [OR] = 13.31, 95% confidence interval [CI] 1.55-114.30, P = 0.019), but not among high-control units (OR = 0.23, 95% CI 0.04-1.29, P = 0.090). Although the use of antipsychotics was not related to job demands in units with low control (OR = 1. 11, 95% CI 0.26 -4.99, P = 0.891), the antipsychotics use in particular decreased when high job demands were coupled with high job control (OR = 0. 17, 95% CI 0.03-0.91, P = 0.038). Conclusion: The results suggest that restraint use can be reduced by enhancing working conditions so that the nursing staff has possibilities for skill usage and decision-making.