The relationship between organizational factors and psychiatric nurses' decision to restrain

This study examined the relationship of organizational factors, specifically-work empowerment and nursing practice with nurses' decision to restrain on psychiatric units with low restraint rates. It also examined the relationship between individual patient and nurse characteristics with nurses' decision to restrain on psychiatric units with low restraint rates.; Psychiatric nurses at four sites were surveyed. Three survey instruments were administered: Conditions of Work Effectiveness-II (CWEQ II), Practice Environment Scale of the Nursing Work Index (PES-NWI), and Psychiatric Nurses' Decision to Restrain. Findings supported an association between empowerment and psychiatric nurses' decision to restrain. Results did not support a relationship between nursing practice environment and psychiatric nurses' decision to restrain. Patient variables (age, familiarity of the patient, and diagnoses) and nurse characteristics (experience as a nurse and as a psychiatric nurse) were factors in psychiatric nurses' decision to restrain. Aggression towards self or others was the most frequently identified patient cue influencing restraint decisions.; This study revealed a number of secondary findings. Nurses viewed and explained the same patient's behavior in different ways. Nurses chose the least restrictive alternatives initially and advanced towards more restrictive alternatives when less restrictive choices were unsuccessful. A key finding was that nurses chose PRN medication with high frequency. Also, nurses were inconsistent in their decision making, both in cue utilization and pattern of intervention choices.; Further research is needed to clarify reasons for variations in decision making among nurses, to clarify differences in how nurses perceive and explain patient behavior, to examine the efficacy and effectiveness of PRN medication, and to explore whether organizational factors such as empowerment or nursing practice environment are key variables in restraint use.; Psychiatric nurses' decisions about restraint use are complex phenomenon which cannot be easily explained. It remains unclear whether organizational factors have a significant impact on restraint decisions or use. Despite those who have suggested that changing the organizational and unit culture will have the greatest impact on reducing restraint use, there remains considerable variation in restraint use and practices. Further examination is needed to explore what factors will effectively reduce restraint use.