Home and Community Care Digest

Home and Community Care Digest 6(2) May 2007 : 0-0

Nurse working conditions and restraint use in long-term care


Research has shown that elderly residents in long-term care facilities face a relatively high risk of being restrained. Restraints can take the form of physical devices which restrict movement, or anti-psychotic drugs where there is no diagnosis of psychiatric illness. Past studies have shown that restraint use is related to the amount of nursing staff, however, it has not been clear whether their perception of job demands and job control is related to the risk of restraint use. This research demonstrates that when the job demands of nursing staff are high, the risk of restraint use increases. However, even when job demands are high, if nursing staff perceive that they have a high level of job control, the risk of restraint use is not affected. The findings suggest that care practice, in terms of decreased restraint use, might be improved by enhancing the working conditions of nursing staff.
Background: Nurses who work in long-term care facilities may make use of physical devices or medications to restrain elderly residents. Physical restraints may be employed for a variety of reasons including poor physical functioning or behavioral problems of the resident. Anti-psychotic drugs are used to restrain residents who present with behavioral and psychological symptoms such as restlessness, and are more often used with patients with dementia. Residents who are subject to the use of restraints may experience resulting health problems, falls or even death. Previous research has shown that long-term care facilities with higher levels of nurse staffing use less restraints on their residents. This study aims to determine whether job demands and job control can predict the use of restraints in long-term care facilities. Specifically the researchers hypothesized that excessive job demands and low levels of job control increases the risk of restraint use and that high job demands and high job control decreases the risk of restraint use.

Methods: Data for the study was collected from 23 residential homes and 8 health centres in Finland. Information about the residents' physical, cognitive and emotional functioning was obtained from the Resident Assessment Instrument system which is used in every long-term care facility in Finland. Data were also collected on the nursing staff levels at each facility. Nursing staff were asked to complete a questionnaire which measured their job demand and job control, and 1172 staff members (67%) completed the questionnaire. Job demand was measured using a scale which asks about the physical demands of work, how hard work is, and whether there is insufficient time to work. Job control was measured using two scales; one which assesses skill discretion (learning new things on the job, ability to develop new skills, job requiring skill, task variety, non-repetitious work, required creativity), and one which measures the decision making authority (freedom to make decisions, choice about how to perform work, and having a lot of say in the job). Finally, data about the use of restraints at each facility was measured by determining whether a physical restraint (trunk or limb restraint, chair that prevents rising) was used within the past 7 days and/or the frequency of anti-psychotic medication administered to the resident without a diagnosis of any psychotic disease during the past 7 days.

Findings: In the facilities studied, physical restraints were used less frequently than anti-psychotic medications. Not surprisingly, physical restraint use was associated with the patients' abilities to complete activities of daily living and with their cognitive abilities. Anti-psychotic restraints were also associated with residents' behavioral problems. Restraint practices were not found to be associated with either unit size or nurse staffing levels. Staff job demands were not associated with anti-psychotic restraint use. Staff job demands were highly associated with physical restraint use in units where staff reported low job control but not in units where staff reported high job control. Additionally, in units where staff reported high job control and high job demand, the risk of anti-psychotic restraints decreased.

Conclusions: The results of this study indicate that nurses' perception of job demand and job control has an effect on the amount of restraints used in the long-term care units studied. This effect is independent of resident and staffing differences across facilities. Interestingly, high job demand alone does not increase the risk of restraint use. Job demands strongly increase the risk of restraint use in units where staff do not have opportunities to make decisions and use their skills. In addition, in units where staff have high job demands but where the perception of job control is also high, this study shows that anti-psychotic restraint use is decreased. While this study did not examine the influence of other factors such as the institutional policy on the use of restraints, the findings suggest that care practices could be improved by enhancing nurses' level of job control in long-term care facilities.

Reference: Pekkarinen L, Elovainio M, Sinervo T, Finne-Soveri H, Noro A. "Nursing working conditions in relation to restrain practices in long-term care units." Medical Care. 2006; 44(12):1114-1119.


Rashmitha Mohanarajah wrote:

Posted 2012/10/23 at 08:05 PM EDT

Who is the author of this article?


Rebecca Hart wrote:

Posted 2012/10/24 at 01:08 PM EDT

This isn't actually an article, it is a review of an article, you'll see a reference to the original article at the end of the review, which can be found in the journal, Medical Care.


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