Perceived social climate factors and self-esteem among residents of nursing homes with differing restraint practices.

摘要

An indicator of quality of life and quality of care in nursing homes has been the prevalence rate of physical restraint. Intensified by federal mandates, restraint reduction occurs through policy change and environmental redesign. While the effect of restraints on individuals has been studied extensively, the relationship between restraint use and the psychosocial milieu or social climate of nursing homes had not been investigated. In this research, restraint practices are considered to be a contextual organizational factor that impacts the social climate. The social climate includes three dimensions: Social relationships among residents and staff, resident self-sufficiency, and system maintenance factors. The social climate in turn impacts behavioral and psychological outcomes, such as morale, life satisfaction and self-esteem. Self-esteem is particularly pertinent in a study of institutional environment since institutionalization is often associated with stigmatization, decreased social interaction, and loss of control. A correlational design was used to examine the relationships among the social climate variables (cohesion, independence, and resident influence), resident self-esteem, and type of residence (restraint practices). Forty-seven residents of a restraint-free nursing home and 36 residents of a restraint-limited (15% prevalence) nursing home were interviewed using the Sheltered Care Environment Scale (SCES) and the Rosenberg Self-esteem Scale (SES). Pearson's correlation was used to determine which social climate variables impacted self-esteem once type of residence, perceived affective status, and perceived health and functional status were controlled. The social climate factor of resident influence was found to be positively related to self-esteem (p .01). No differences in the social climate factors or self-esteem were found by type of residence. It may be that other contextual factors not measured moderate the effect of restraint practices.