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

Eileen M. Sullivan-Marx, Neville E. Strumpf, Lois K. Evans, Mona Baumgarten, Greg Maislin

Research output: Contribution to journalArticle


In this pilot study a one group pretest posttest design was employed to identify resident characteristics and environmental factors associated with initiation of physical restraint. Predictors of restraint initiation for older adults were examined using secondary analysis of an existing data set of nursing home residents who were subjected to a federal mandate and significant restraint reduction efforts. Lower cognitive status (OR = 1.5 [for every 7-point decrease in Mini-Mental State Examination], 95% Cl = 1.0, 2.1) and a higher ratio of licensed nursing personnel (OR = 3.7, 95% Cl = 1.2, 11.9) were predictive of restraint initiation. Key findings suggest that restraint initiation occurs, despite significant restraint reduction efforts, when a nursing home resident is cognitively impaired or when more licensed nursing personnel (predominantly licensed practical nurses) are available for resident care. Achievement of restraint-free care in nursing homes requires specific and individualized approaches for residents who are cognitively impaired, as well as greater attention to staff mix of registered nurses, licensed practical nurses, and nursing aides.

Original languageEnglish (US)
Pages (from-to)369-379
Number of pages11
JournalResearch in Nursing and Health
Issue number5
StatePublished - Oct 1999


  • Elderly
  • Nurse staffing
  • Nursing homes
  • Physical restraint

ASJC Scopus subject areas

  • Nursing(all)

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