Skip to main content Accessibility help

Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints?

  • Bernadette M. Willemse (a1) (a2), Jan de Jonge (a3) (a4), Dieneke Smit (a1) (a2), Wouter Dasselaar (a1), Marja F. I. A. Depla (a5) and Anne Margriet Pot (a1) (a2) (a6)...



Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints.


Data were derived from the first wave (2008–2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ).


Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints.


Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making – especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.


Corresponding author

Correspondence should be addressed to: B. M. Willemse, Program on Aging, Netherlands Institute of Mental Health and Addiction, Utrecht, P.O Box 725, 3500 AS Utrecht, the Netherlands. Phone: +31 30 2959210; Fax: +31-30-2971111. Email:


Hide All
Aiken, L. H. et al. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ (Clinical Research Ed.), 344, e1717.
Castle, N. G. and Engberg, J. (2009). The health consequences of using physical restraints in nursing homes. Medical Care, 47, 11641173.
Cornege-Blokland, E., Kleijer, B. C., Hertogh, C. M. P. M. and van Marum, R. J. (2012). Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers. Journal of The American Medical Directors Association, 13, 80.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
de Casterlé, B. D., Goethals, S. and Gastmans, C. (2014). Contextual influences on nurses' decision-making in cases of physical restraint. Nursing Ethics, 22, 642651.
Eggermont, L. H. P., de Vries, K. and Scherder, E. J. A. (2009). Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. International Psychogeriatrics, 21, 286294.
Evans, D. and FitzGerald, M. (2002). Reasons for physically restraining patients and residents: a systematic review and content analysis. International Journal of Nursing Studies, 39, 735743.
Feng, Z. et al. (2009). Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study. International Journal of Geriatric Psychiatry, 24, 11101118.
Goethals, S., Dierckx de Casterl+®, B. and Gastmans, C. (2012). Nurses' decision-making in cases of physical restraint: a synthesis of qualitative evidence. Journal of Advanced Nursing, 68, 11981210.
Goethals, S., Dierckx de Casterl+®, B. and Gastmans, C. (2013). Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study. International Journal of Nursing Studies, 50, 603612.
Gulpers, M. J. M., Bleijlevens, M. H. C., Ambergen, T., Capezuti, E., van Rossum, E. and Hamers, J. P. H. (2011). Belt restraint reduction in nursing homes: effects of a multicomponent intervention program. Journal of The American Geriatrics Society, 59, 20292036.
Hamers, J. P. H. and Huizing, A. R. (2005). Why do we use physical restraints in the elderly?. Zeitschrift F++r Gerontologie Und Geriatrie, 38, 1925.
Haüsser, J. A., Mojzisch, A., Niesel, M. and Schulz-Hardt, S. (2010). Ten years on: a review of recent research on the job demand-control (-support) model and psychological well-being. Work & Stress, 24, 135.
Huizing, A. R., Hamers, J. P. H., de Jonge, J., Candel, M. and Berger, M. P. F. (2007). Organisational determinants of the use of physical restraints: a multilevel approach. Social Science & Medicine, 65, 924933.
International Psychogeriatric Association (2002). Behavioral and Psychological Symptoms of Dementia (BPSD) Education Pack. Northfield, MN: International Psychogeriatric Assocation.
Johnson, J. V. and Hall, E. M. (1988). Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. American Journal of Public Health, 78, 13361342.
Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly, 24, 285307.
Karlsson, S., Bucht, G.+., Eriksson, S. and Sandman, P. O. (2001). Factors relating to the use of physical restraints in geriatric care settings. Journal Of The American Geriatrics Society, 49, 17221728.
Katz, S., Downs, T. D., Cash, H. R. and Grotz, R. C. (1970). Progress in development of the index of ADL. The Gerontologist, 10, 2030.
Kirwan, M., Matthews, A. and Scott, P. A. (2013). The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International Journal of Nursing Studies, 50, 253263.
Kramer, M., Maguire, P. and Brewer, B. B. (2011). Clinical nurses in magnet hospitals confirm productive, healthy unit work environments. Journal of Nursing Management, 19, 517.
Lovheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713726.
Meyer, G., K+Âpke, S., Haastert, B. and M++hlhauser, I. (2009). Restraint use among nursing home residents: cross-sectional study and prospective cohort study. Journal of Clinical Nursing, 18, 981990.
Mohler, R. and Meyer, G. (2014). Attitudes of nurses towards the use of physical restraints in geriatric care: a systematic review of qualitative and quantitative studies. International Journal of Nursing Studies, 51, 274288.
Pekkarinen, L., Elovainio, M., Sinervo, T., Finne-Soveri, H. and Noro, A. (2006). Nursing working conditions in relation to restraint practices in long-term care units. Medical Care, 44, 11141120.
Pekkarinen, L., Sinervo, T., Elovainio, M., Noro, A. and Finne-Soveri, H. (2008). Drug use and pressure ulcers in long-term care units: do nurse time pressure and unfair management increase the prevalence?. Journal of Clinical Nursing, 17, 30673073.
Pellfolk, T. J. E., Gustafson, Y., Bucht, G. +. and Karlsson, S. (2010). Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial. Journal of The American Geriatrics Society, 58, 6269.
Smeets, C. H. W. et al. (2014). Factors related to psychotropic drug prescription for neuropsychiatric symptoms in nursing home residents with dementia. Journal Of The American Medical Directors Association, 15, 835840.
Snowdon, J., Day, S. and Baker, W. (2006). Current use of psychotropic medication in nursing homes. International Psychogeriatrics, 18, 241250.
Stevenson, D. G. et al. (2010). Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 national nursing home survey. The American Journal Of Geriatric Psychiatry: Official Journal Of The American Association For Geriatric Psychiatry, 18, 10781092.
Toles, M. and Anderson, R. A. (2011). State of the science: relationship-oriented management practices in nursing homes. Nursing Outlook, 59, 221227.
van der Doef, M. and Maes, S. (1999). The leiden quality of work questionnaire: its construction, factor structure, and psychometric qualities. Psychological Reports, 85, 954962.
van lersel, M. B., Zuidema, S. U., Koopmans, R. T. C. M., Verhey, F. R. J. and Rikkert, M. G. M. O. (2005). Antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs & Aging, 22, 845858.
Werner, P. and Mendelsson, G. (2001). Nursing staff members' intentions to use physical restraints with older people: testing the theory of reasoned action. Journal of Advanced Nursing, 35, 784791.
Willemse, B. M., Smit, D., de Lange, J. and Pot, A. M. (2011). Nursing home care for people with dementia and residents' quality of life, quality of care and staff well-being: design of the living arrangements for people with dementia (LAD) - study. BMC Geriatrics (Online), 11, 11. doi:10.1186/1471-2318-11-11.
World Health Organization (2012). Dementia: A Public Health Priority. Geneva: World Health Organization.
Zuidema, S. U., Koopmans, R. T., Schols, J. M. G. A., Achterberg, W. P. and Hertogh, C. M. P. M. (2015). Trends in psychofarmacagebruik bij patiënten met dementie. in Nederlandse verpleeghuiszen, periode 2003–2011. [Trends in psychotropic drug use in patients with dementia: In Dutch nursing homes, 2003–2011. Verenso Tijdschrift.
Zwijsen, S. A. et al. (2014). Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. Journal of The American Medical Directors Association, 15, 531.
Zwijsen, S. A., de Lange, J. and Pot, A. M. (2013). [Dealing with uncomprehended behavior of people with dementia: Inventory of guidelines and perceptions] Omgaan met onbegrepen gedrag bij dementie: Inventarisatie richtlijnen en inzichten rondom onbegrepen gedrag bij ouderen met dementie. Utrecht: Trimbos-instituut en Vilans.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed