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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.

A small but significant number of people die during restraint by hospital staff, police or prison officers. One possible mechanism for this has been termed ‘positional asphyxia’. There is literature to suggest that deaths that occur in circumstances involving restraint may be related to certain positions, but early research has been contested. This article presents a balanced review of the literature and findings and concludes that the evidence remains unclear. However the literature does point to practical measures that should be adopted by those whose work is likely to require restraint of extreme violence, to avoid risk of death. These are summarised.

There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices, there is very limited literature looking at the impact the use of mechanical restraints has upon service users and support staff using them. The aim of this study was to ascertain the experiences of support staff who apply the restraints to the people they support.

Qualitative methodology was utilised. A semi-structured interview was conducted with nine support workers who: directly worked with a client with intellectual disabilities who engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and they had to have been directly involved in the application and removal of the mechanical restraints in the last week. Content analysis utilising emergent coding was used to analyse the data.

All participants described using mechanical restraints as having a negative impact upon them. Participants said they manage the negative impact by reframing, inhibiting their emotions, following support plans closely and gaining support from other staff. Participants described concerns and unmet needs regarding whether they were applying the restraints correctly, the responsibility of teaching others to use restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints is not talked about. Recommendations for practice are made.

This is the first study to explore the views of care staff who are required to use mechanical restraint. It provides insight on the impact of this on them.

The purpose of this paper is to improve the quality of care of patients presenting with challenging behaviour.

Current guidelines are described, and adherence to the standards is audited, with a particular emphasis on physical restraint.

The results of the clinical audit revealed that in the substantial majority of episodes of challenging behaviour, non-physical techniques were used prior to the need to intervene with physical restraint; however, when physical restraint was used, there was limited use of staff debriefs to facilitate reflection- and work-based learning. A potential diagnostic link to the likelihood of use of prone position restraint was also a finding. The results of a quality improvement project undertaken in response to the findings of the clinical audit demonstrated significant and sustained improvements in adherence to most standards.

Continuous improvements to the safety of both patients and staff when managing acute challenging behaviour requires ongoing quality improvement interventions underpinned by the application of human factors principles.

The completion of this audit cycle suggests that it is useful to measure specific points of care processes, however, continuous improvement interventions are indicated to lead to sustained improvement – in this paper this is demonstrated by the safer management of challenging behaviour.

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.

This study aims to investigate motivations and human values of everyday consumers who participate in the annual day of consumption restraint known as Buy Nothing Day (BND). In addition, this study demonstrates a hybrid content analysis method in which artificial intelligence and human contributions are used in the data analysis.

This research uses a hybrid method of content analysis of a large Twitter data set spanning three years.

Consumer motivations are categorized as relating to consumerism, personal welfare, wastefulness, environment, inequality, anti-capitalism, financial responsibility, financial necessity, health, ethics and resistance to American culture. Of these, consumerism and personal welfare are the most common. Moreover, human values related to “openness to change” and “self-transcendence” were prominent in the BND tweets.

This research demonstrates the effectiveness of a hybrid content analysis methodology and uncovers the motivations and human values that average consumers (as opposed to consumer activists) have to restrain their consumption. This research also provides insight for firms wishing to better understand and respond to consumption restraint.

This research provides insight for firms wishing to better understand and respond to consumption restraint.

The question of why everyday consumers engage in consumption restraint has received little attention in the scholarly discourse; this research provides insight into “everyday” consumer motivations for engaging in restraint using a hybrid content analysis of a large data set spanning over three years.

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.

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.

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.