Physical restraint of elderly patients in critical care: historical perspectives and new directions.

The use of physical restraints in health care settings is being examined carefully at all levels. Experience with the elderly in long-term care settings teaches us that in many instances physical restraints are not only unnecessary, they are also not the best available therapy. There can be little doubt that careful evaluation of the use of restraints in the critical care unit is likely to reveal alternatives to their use in many situations. In the American health care system, nurses primarily determine restraint use. Professional nurses are leading the movement to find alternatives to restraints, and critical care nurses can contribute much to the effort. Nurses must recognize restraint application as a serious treatment decision, and must apply risk-to-benefit analysis to each decision. Continuing nursing education and nursing research on restraint reduction will lead to improved care for our elderly patients.