Initiation of physical restraint in nursing home residents following restraint reduction efforts

In this pilot study a one group pretest posttest design was employed to ide ntify resident characteristics and environmental factors associated with in itiation of physical restraint. Predictors of restraint initiation for olde r adults were examined using secondary analysis of an existing data set of nursing home residents who were subjected to a federal mandate and signific ant restraint reduction efforts. Lower cognitive status (OR = 1.5 [for ever y 7-point decrease in Mini-Mental State Examination], 95% CI = 1.0, 2.1) an d a higher ratio of licensed nursing personnel (OR = 3.7, 95% CI = 1.2, 11. 9) were predictive of restraint initiation. Key findings suggest that restr aint initiation occurs, despite significant restraint reduction efforts, wh en a nursing home resident is cognitively impaired or when more licensed nu rsing personnel (predominantly licensed practical nurses) are available for resident care. Achievement of restraint-free care in nursing homes require s specific and individualized approaches for residents who are cognitively impaired, as well as greater attention to staff mix of registered nurses, l icensed practical nurses, and nursing aides. (C) 1999 John Wiley & Sons. In c.