Predictors of pressure ulcer and physical restraint prevalence in Japanese acute care units

Abstract Aim: To investigate the predictors of pressure ulcer and physical restraint prevalence in Japanese acute care units and their relationship to the nursing hours, skill mix, and Nursing Need Scores (NNS). Methods: In this descriptive study, quantitative methods were employed to determine if pressure ulcers and physical restraint prevalence, as outcomes of nursing care, were related to the nursing hours, skill mix, and intensity of nursing‐care needs. The sample included 87 acute care units in 42 hospitals in Tokyo and its surrounding prefectures in Japan. The NNS was used as the instrument to measure the intensity of nursing‐care needs. The data were analyzed with descriptive statistics, correlations, and multiple regression analyses. Results: Pressure ulcer prevalence was positively correlated with the NNS‐A and NNS‐B. Physical restraint use was positively correlated with the NNS‐B and negatively correlated with the NNS‐A. However, the total nursing hours per patient day was positively related with both pressure ulcer and physical restraint prevalence. Conclusions: The nursing hours and NNS are predictors of pressure ulcer development and physical restraint use. The results also suggest that we should revise our process of nursing care. Many functions that might be shared with other personnel are performed by nurses, which results in longer total nursing hours but shorter direct nursing hours, used in order to observe and care for patients. Japan's aging population will result in higher NNS, requiring more direct nursing hours and other personnel to participate in our process of nursing care.