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Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort.The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions.Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression.Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. What the paper adds to existing knowledge?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil."Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists.Emotions play an important role in decision‐making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups.Staff members consider reflective interventions, such as team supervisions or post‐seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely.Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. What are the implications for practice?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions.Structured post‐seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. Introduction: Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim: The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method: Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results: Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post‐seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion: The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications: The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI. [ABSTRACT FROM AUTHOR]

Aims: To find out which variables may be associated with comfort of patients in an epilepsy monitoring unit. Design: Exploratory, quantitative study design. Methods: Data were collected from October 2018 to November 2019 in Austria and Southern Germany. A total of 267 patients of 10 epilepsy centres completed the Epilepsy Monitoring Unit Comfort Questionnaire which is based on Kolcaba's General Comfort Questionnaire. Secondary data analysis were conducted by using descriptive statistics and an exploratory model building approach, including different linear regression models and several sensitivity analyses. Results: Total comfort scores ranged from 83 to 235 points. Gender, occupation and centre turned out to be possible influential variables. On average, women had a total comfort score 4.69 points higher than men, and retired persons 28.2 points higher than high school students ≥18 years. Comfort scores of younger patients were lower than those of older patients. However, age did not show a statistically significant effect. The same could be observed in marital status and educational levels. Conclusion: When implementing comfort measures, nurses must be aware of variables which could influence the intervention negatively. Especially, high school students ≥18 years should be supported by epilepsy specialist nurses, in order to reduce uncertainty, anxiety and discomfort. But, since the identified variables account only for a small proportion of the inter‐individual variability in comfort scores, further studies are needed to find out additional relevant aspects and to examine centre‐specific effects more closely. Impact: Nurses ensure patient comfort during a hospital stay. However, there are variables that may impair the effectiveness of the nursing measures. Our study showed that the experience of comfort was highly individual and could be explained by sociodemographic variables only to a limited extent. Nurses must be aware that additional factors, such as the situation in the individual setting, may be relevant. [ABSTRACT FROM AUTHOR]

Aims and objectives: To test a mediating effect of compassion satisfaction on the relationship between personality traits (Big Five) and intent to leave. Background: Nursing professionals work in high‐stress environments and exhibit more emotional distress and mental health disorders than other hospital professionals. This translates to increased intention to leave their profession. Evidence suggests that compassion satisfaction reduces intention to leave. Research also indicates that personality factors are associated with compassion satisfaction and intent to leave. Design: Using a cross‐sectional design, we collected data from 536 nurses in a maximum‐care hospital in Germany via questionnaires; the analyses included 518 participants. Method: We applied the structural equation model and followed the STROBE checklist. Results: 30% of our study participants reported high intent to leave. Compassion satisfaction mediated the relationship between agreeableness and intent to leave. Openness to experience and neuroticism had positive direct effects on intent to leave. Conclusions: The results suggest that high compassion satisfaction levels may decrease intention to leave levels. Personality traits impact compassion satisfaction and intention to leave. Relevance to Clinical Practice: Nursing professionals' compassion satisfaction needs to be improved, for example by resilience training. As personality factors remain relatively stable over time, caregivers need to consider them when identifying appropriate areas of work and responsibility. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. Design: A longitudinal design with two data collections points (pre‐ and post‐graduate). Methods: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. Results: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. Conclusion: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. Impact: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. Background: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. Design: Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. Methods: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. Results: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. Conclusion: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. Relevance to clinical practice: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to investigate whether selective optimization with compensation constitutes an individualized action strategy for nurses wanting to maintain job performance under high workload. Background High workload is a major threat to healthcare quality and performance. Selective optimization with compensation is considered to enhance the efficient use of intra-individual resources and, therefore, is expected to act as a buffer against the negative effects of high workload. Design The study applied a diary design. Over five consecutive workday shifts, self-report data on workload was collected at three randomized occasions during each shift. Self-reported job performance was assessed in the evening. Self-reported selective optimization with compensation was assessed prior to the diary reporting. Methods Data were collected in 2010. Overall, 136 nurses from 10 German hospitals participated. Selective optimization with compensation was assessed with a nine-item scale that was specifically developed for nursing. The NASA- TLX scale indicating the pace of task accomplishment was used to measure workload. Job performance was assessed with one item each concerning performance quality and forgetting of intentions. Results There was a weaker negative association between workload and both indicators of job performance in nurses with a high level of selective optimization with compensation, compared with nurses with a low level. Considering the separate strategies, selection and compensation turned out to be effective. Conclusion The use of selective optimization with compensation is conducive to nurses' job performance under high workload levels. This finding is in line with calls to empower nurses' individual decision-making. [ABSTRACT FROM AUTHOR]

Aims To identify job-related resources which strengthen nurses' expectation of remaining in the same job until retirement age. Background The dramatic shortage of qualified nurses in industrialized countries makes it necessary to take steps to retain nurses at work at all career stages. The study introduces to the nursing literature the construct 'expectation of remaining in the same job until retirement age' as an early indicator of attitudes responsible for employees leaving the job prematurely. Design Longitudinal questionnaire survey. Methods In 2010, a longitudinal study was carried out and data were collected from 387 nurses aged 21-63 years. To ensure predictive validity, the dependent variable was assessed again in 2011 after a time lag of 6 months. Data were analysed applying multiple regression analyses. Findings The expectation of remaining in the same job until retirement age is positively related to work-time control, role clarity and colleague support. Supervisor support exerts an indirect effect via job resources. Vitality partially mediates the relationship between job resources and the expectation of remaining in the same job until retirement age. Most importantly, as hypothesized, the analysed relationships are different for younger (<30 years), middle-aged (30-50 years) and older (>50 years) nurses. Conclusion Our findings suggest that interventions that seek to retain nurses should promote different job resources along the working life span to strengthen nurses' vitality in all age groups. Future research should apply age-differentiated measures to unveil work conditions that improve the retention of nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effects of a nurse-led, hospital-based heart failure specific education session with a three-month telephone follow-up on self-care behaviour, care dependency and quality of life for patients with chronic heart failure. Background Patient education in patients with heart failure is able to promote heart failure-specific self-care, to reduce mortality, morbidity and rehospitalisation rates and to enhance quality of life, especially if heart failure education is embedded in a multidisciplinary approach. Evidence of the effect of a nurse-led self-care education, quality of life and care dependency in addition to standard medical treatment in Germany is lacking. Design Nonblinded, prospective, single-centre, randomised controlled trial. Method Sixty-four patients were allocated either to the intervention group or to the control group. Patients in the intervention group received education about heart failure self-care with a consecutive telephone follow-up over three months in addition to standard medical treatment. Patients in the control group received standard medical treatment only. Results Data of 110 patients (58 in the intervention group and 52 in the control group) with a mean age of 62 years and mean left ventricular ejection fraction of 28·2% could be analysed. Self-care education had a significant influence on overall heart failure self-care but not on quality of life and care dependency. Conclusion A single education session with a consecutive telephone follow-up is able to improve overall self-care behaviours but not quality of life. Care dependency was not influenced by the education session. Relevance to clinical practice The easy to implement and short educational intervention has a positive effect on self-care behaviour for patients with heart failure. However, there was no effect on quality of life and care dependency. To improve quality of life and to influence care dependency, different measures have to be applied. [ABSTRACT FROM AUTHOR]

Aims and objectives The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. Background Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. Design A nonparticipant observational descriptive design was used. Methods A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. Results A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were 'cleaning the patients' skin' and 'minimizing exposure to moisture' that were undertaken in more than 90% of all patients. The least frequent measures were 'patient and relative education', 'assessment and recording of nutritional status'. Conclusion This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. Relevance to clinical practice This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed. [ABSTRACT FROM AUTHOR]

Aims and objectives To prevent medication errors in drug handling in a paediatric ward. Background One in five preventable adverse drug events in hospitalised children is caused by medication errors. Errors in drug prescription have been studied frequently, but data regarding drug handling, including drug preparation and administration, are scarce. Design A three-step intervention study including monitoring procedure was used to detect and prevent medication errors in drug handling. Methods After approval by the ethics committee, pharmacists monitored drug handling by nurses on an 18-bed paediatric ward in a university hospital prior to and following each intervention step. They also conducted a questionnaire survey aimed at identifying knowledge deficits. Each intervention step targeted different causes of errors. The handout mainly addressed knowledge deficits, the training course addressed errors caused by rule violations and slips, and the reference book addressed knowledge-, memory- and rule-based errors. Results The number of patients who were subjected to at least one medication error in drug handling decreased from 38/43 (88%) to 25/51 (49%) following the third intervention, and the overall frequency of errors decreased from 527 errors in 581 processes (91%) to 116/441 (26%). The issue of the handout reduced medication errors caused by knowledge deficits regarding, for instance, the correct 'volume of solvent for IV drugs' from 49-25%. Conclusion Paediatric drug handling is prone to errors. A three-step intervention effectively decreased the high frequency of medication errors by addressing the diversity of their causes. Relevance to clinical practice Worldwide, nurses are in charge of drug handling, which constitutes an error-prone but often-neglected step in drug therapy. Detection and prevention of errors in daily routine is necessary for a safe and effective drug therapy. Our three-step intervention reduced errors and is suitable to be tested in other wards and settings. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine the knowledge and use of pressure ulcer preventive measures among nursing staff in Dutch and German nursing homes. Background Studies in the Netherlands and Germany have shown a large discrepancy in pressure ulcer prevalence rates among nursing homes in both countries and concluded that some of this variance could be explained by differences in pressure ulcer prevention. Design A cross-sectional questionnaire survey nested in a prospective multicenter cohort study. Methods A questionnaire was distributed to nursing staff employed in 10 Dutch nursing homes ( n = 600) and 11 German nursing homes ( n = 578). Data were collected in January 2009. Results The response rate was 75·7% in the Netherlands ( n = 454) and 48·4% in Germany ( n = 283). Knowledge about useful pressure ulcer preventive measures was moderate in both countries, while nonuseful preventive measures were poorly known. On average, only 19·2% (the Netherlands) and 24·6% ( Germany) of preventive measures were judged correctly as nonuseful. The same pattern could be seen with regard to the use of preventive measures, because nonuseful preventive measures were still commonly used according to the respondents. Conclusions The results indicate that the respondents' knowledge and use of pressure ulcer preventive measures could be improved in both countries, especially for nonuseful measures. Changes and improvements can be achieved by providing sufficient education and refresher courses for nurses and nursing assistants employed within Dutch and German nursing homes. Relevance to clinical practice Recurring education about pressure ulcer prevention is required among nursing staff employed in Dutch and German nursing homes, particularly in relation to the use of ineffective and outdated preventive measures. Obstacles regarding the implementation of preventive measures should be addressed to achieve a change in practice. [ABSTRACT FROM AUTHOR]

Aims To examine the role of two personal resources (active, problem-focused coping; self-efficacy beliefs) in the relation between job demands and strain. Background Evidence suggests that healthcare staff in general and nurses in particular, are at a high risk of suffering from high levels of job strain. In addition to often examined job-related resources (such as control and social support), personal resources are expected to moderate (i.e. buffer) the relation between job demands and indicators of strain, particularly when there is a functional match between the type of demands and resources. Design Cross-sectional questionnaire survey. Method A cross-sectional questionnaire survey was conducted (February-April 2010) among staff members of three nursing homes of a municipal organization for residential elderly care located in an urban area of Western Germany. A total of 145 of 251 employees responded to the invitation to participate in the study (57·8% participation rate). Data were analysed by hierarchical moderated regression analyses. Results Increasing job demands (quantitative and qualitative workload) had adverse effects on emotional exhaustion, psychosomatic complaints, and turnover intentions, whereas nurses' self-efficacy beliefs exerted beneficial effects on all outcomes. Furthermore, findings revealed that active, problem-focused coping interacts with job demands in the prediction of job strain. Conclusion Both research and practice should focus on a closer match between personal resources and job demands to prevent nurses from being strained. [ABSTRACT FROM AUTHOR]

Aims (1) To explore 'successful ageing' strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship. Background Studies indicate impaired work ability of older nurses. Research is needed to examine if 'successful ageing' strategies can promote the work ability especially in older nurses. Design The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability. Methods Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21-63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1) . Results Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability . The positive relationship was stronger for older nurses. Conclusion Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this research is to investigate the degree of distress experienced by nurses in response to the challenging behaviour of nursing home residents (residents' challenging behaviour) and their impact on nurses individual resources (general health, burnout and work ability). Background Because of the increasing and ageing population of nursing home residents, professional nursing care faces several challenges. One highly prevalent issue among nursing home residents is the so-called 'challenging behaviour'. However, to date, 'challenging behaviour' has not yet been recognised as an occupational stressor, and the extent of the impact of 'challenging behaviour' on nurses' well-being and functioning is not well understood. Design Cross-sectional study. Method Self-report questionnaire data collected from 731 registered nurses and nursing aides in 56 German nursing homes were used in a secondary data analysis. The level of residents' challenging behaviour-related distress that nurses experienced was assessed using a scale consisting of nine questions. Validated instruments were used for the assessment of individual resources. Results The mean score for residents' challenging behaviour-related distress was 41·3 ( SD 21·2). Twenty-seven per cent of all nurses reported over 50 residents' challenging behaviour. Residents' challenging behaviour had a significant impact on all three measures of individual resources. Specifically, nurses exposed to frequent residents' challenging behaviour reported a significantly lower quality of general health, reduced workability and high burnout levels. Conclusion Our findings indicate that residents' challenging behaviour-related distress is a significant work place stressor for nurses in nursing homes with a clear impact on general health, the risk of burnout and work ability. Relevance to clinical practice Our findings suggest that residents' challenging behaviour is a stressor for nurses in nursing homes. Further scientific and practical attention is necessary from the point of view of working conditions for nurses. The development of preventive concepts for nursing staff and residents is recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. Background. Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. Design. A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes ( n = 5521) and 15 hospitals ( n = 2827). For data analysis, a 3-level random intercept logistic model was used. Results. The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. Conclusions. Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. Relevance to clinical practice. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study. [ABSTRACT FROM AUTHOR]