Resource clusters and variation in physical restraint use.

Minnick AF, Fogg L, Mion LC, Catrambone C, Johnson ME
J Nurs Scholarsh. 2007 39 (4): 363-70

PMID: 18021138 · DOI:10.1111/j.1547-5069.2007.00194.x

PURPOSE - To describe (a) the extent of inter- and intrainstitutional variation in labor, capital, and process-of-care variables related to nursing service on U.S. adult acute and intensive care units; (b) the extent to which resource clustering exists; and (c) an analysis of resource cluster role that explains variation in physical restraint rates.

DESIGN - Descriptive.

METHODS - Staff at 82 adult acute care and 55 intensive care units from 40 randomly selected U.S. hospitals provided data about more than 100 capital, labor, and process variables via (a) a staff nurse survey, and (b) interviews with unit leaders and measurement of unit design. These data described resources during the period in which physical restraint rate was established via direct observation.

FINDINGS - Depending on the resource variable, 7% to 57% of hospitals in which more than one ICU was studied showed resource variation between their ICUs; the comparable statistics for adult acute units were 5% to 45%. Cluster analysis indicated a two-cluster solution for ICUs and a three-cluster solution for non-ICUs. ICU cluster assignment varied within 16% of hospitals in which more than one ICU was studied. Non-ICU cluster assignment varied within 20% of hospitals. Physical restraint use was best explained by patient characteristics, not resource clusters or individual resources.

CONCLUSIONS - Studies of outcomes that are the product of a single unit must include measurement of resources at the unit level, assuming equal resources among units of similar types within a hospital is unwarranted. Further research regarding the effect of resource clusters on nurse sensitive outcomes is suggested.

MeSH Terms (23)

Acute Disease Adult Capital Expenditures Cluster Analysis Data Collection Data Interpretation, Statistical Health Resources Hospital Units Humans Intensive Care Units Interior Design and Furnishings Multivariate Analysis Needs Assessment Nursing Administration Research Nursing Staff, Hospital Outcome and Process Assessment (Health Care) Personnel Staffing and Scheduling Practice Patterns, Physicians' Regression Analysis Restraint, Physical Sensitivity and Specificity Surveys and Questionnaires United States

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