Nursing staff’s experiences of using manual physical restraint within inpatient adolescent mental health care: A descriptive phenomenological study

Background: Manual restraint is a ‘hands on’ type of physical restraint used by staff in inpatient mental health care and beyond to maintain patient and staff safety. However, its use has been linked to adverse physical and psychological patient and staff outcomes, and a recognised need to minimise manual restraint use globally has arisen. Despite the high reported rates of manual restraint use within inpatient child and/or adolescent mental health care, little research has been undertaken exploring the manual restraint experiences and perspectives of staff and young people in this setting. Objective: The purpose of this qualitative study was to explore nursing staff’s experiences of using manual restraint within inpatient adolescent mental health care. Methods: Individual in-depth videoconference interviews were conducted with 12 nursing staff recruited from four inpatient adolescent mental health hospitals across three National Health Service Trusts in England. Interviews were transcribed verbatim and data analysis was undertaken through a descriptive phenomenological methodology using reflexive thematic analysis. Results: Four themes were generated from the analysis which captured the essences of participants’ experiences: It needs to be done . . . sometimes; It’s not a nice thing to do; It doesn’t really damage the therapeutic relationship; and Importance of team support. Whilst reporting that it was sometimes necessary to manually restrain young people for substantial safety reasons, participants spoke with dislike about its use, and described consequential aversive experiences of emotional distress, patient aggression, pain and injury, and exhaustion. Participants reported relying on each other for emotional and practical support. Conclusion: The findings provide unique insights into the manual restraint experiences of nursing staff working within inpatient adolescent mental health care. Implications for practice and research are discussed in relation to the inclusion of temporary nursing staff and young people, and recommendations for manual restraint minimisation programmes are made.