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This study examines the experiences of physical restraint procedures reported by in‐patients of a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Patients had differential experiences of similar physical procedures. Most reported some negative psychological experience of restraint. Anger and anxiety were two major themes. Some respondents held the perception that restraint was used to punish patients and several suggested that restraint incited further violence and aggression. Some female service users reported that restraint evoked flashbacks of previous sexual trauma.A subset of female respondents gave contrasting accounts of restraint, suggesting that they purposely brought about the restraint to gain a sense of containment or as a way to release feelings.Possible implications of these responses for clinical practice are discussed.

There are considerable differences between the USA and the UK in terms of the practice of in‐patient care, particularly in the use of restraint. The American legal system defines restraint in terms of physical, mechanical, and chemical restraints, of which only physical and chemical restraints are routinely used in the UK. There is a need to agree a standard definition of restraint as it is used in the UK, which may be valuable as one proxy for quality. Such information would enable nurses to make appropriate use of the published literature, make valid comparisons within and between institutions, and provide evidence about the kind of nursing education and nursing practice development needed to produce quality patient care.

The study examines the experiences of physical restraint procedures reported by nursing staff in a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Nursing staff reported a range of emotional responses to the use of restraint procedures. They included anxiety, anger, boredom, distress and crying. In some cases these responses were confirmed by descriptions from patients.Staff coped with the emotional responses to restraint in a variety of ways. Some staff discussed the ‘stigma’ attached to showing feelings to other staff. They described how laughter was used to reduce stress following an incident and how distressing emotions had to be taken home. Some staff described how they had become ‘hardened’ to the experience of restraint. A substantial proportion of staff suggested that they had ‘no’ emotional reactions and many reported ‘automatic’ responding during a restraint event in which they did not feel any emotion.Possible implications of these responses and clinical practice are discussed.

Tackling the problem of aggression and violence in health care is high on the agenda for healthcare professionals. In an endeavour to protect both patients and staff alike when managing aggressive behaviour, the use of physical restraint is under scrutiny, particularly as a result of the reported deaths of a number of patients whilst being restrained. The challenges of employing this type of intervention, implications for safe and effective practices and the need for the suitable training of staff are explored in this paper.

Despite the controversy surrounding physical restraint and seclusion in the care of vulnerable adults, the views of service users have had little impact on current practice. This paper reviews the literature documenting the personal views and experience of people with learning disabilities and severe mental health problems following these procedures.

The historian can provide quite a different explanation, other than the currently held views, for the emergence of the Red Terror in 1918.

This paper proposes a complementary strategy that works in conjunction with physical restraint and which seeks to address dysfunctional thinking patterns thought to be contributory to the maintenance of the emotion of anger during an incident of aggression. The paper also includes a clinical case example to illustrate a variety of techniques that are designed to engage, challenge and dispute negative automatic thoughts and expressed verbal dialogue in an individual who requires restraint due to his aggressive and potentially harmful behaviour, which is driven by anger.

The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and international literature to ascertain any common findings in order to provide guidance for staff on safe and effective restraint techniques where there is no other resort in the management of violent and aggressive individuals.

The researchers undertook a review of the literature on the medical theories relating to restraint‐related deaths and an analysis of deaths in custody in the UK for the time period 1 Jan 1999 to 1 Jan 2010.

Findings showed that certain groups are particularly vulnerable to risks while being restrained. There are also biophysiological mechanisms which staff need to be aware of when restraining an aggressive or violent individual.

It is evident that those in vulnerable groups when restrained in a prone position, or in a basket hold, for a prolonged period and who are agitated and resistive, are most at risk of death in custody. Consistency in reporting relevant deaths locally and nationally is necessary to facilitate analysis of key information and prevent deaths in custody in the future. Staff training and awareness are also key factors.

The use of physical interventions in the management of aggressive and violent behaviour continues to divide opinion and practice. In learning disability services, it is acknowledged that any physical intervention must be non‐aversive and considered as part of an overall programme which emphasises positive alternative behaviours. The author considers this understanding in the light of recent research and experience.

Traditional methods of addressing workplace violence have relied almost solely on reactive measures. Methods of de‐escalation, strategies to calm the already distressed person down by means of positive communication, or responding to an actual or potential act of violence by means of physical control have formed the focus of training initiatives provided for staff. This approach has suggested an acceptance of the premise that violence in certain services is an inevitable problem that must be managed. This paper proposes that many incidents can be prevented and outlines the emerging evidence to support a structured, holistic approach. Additionally, it provides an overview of the recent policy agenda, the evidence base and examples of some recent and ongoing development work that attempts to change practice.