Physical restraint training for nurses in English and Welsh psychiatric intensive care and regional secure units

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Abstract
Background: The physical management of violence in psychiatric in-patient settings is of great concern and interest. However, there are no guidelines concerning training providers, course content, or course length, and little is known about injuries to staff during training. Aim: To investigate training in physical restraint in Psychiatric Intensive Care Units (PICUs) and Regional Secure Units (RSUs) in England and Wales, with a view to comparing course content and length, and injuries in training across the training providers cited by respondents. Method: Questionnaires were completed by randomly selected PICU and RSU nursing staff on 63 participating wards (of a total of 112 such wards in England and Wales). Results: 338 nurses (47% response rate) replied. Training in a wide variety of techniques was reported, although in practice a core curriculum can be identified. Few respondents were able to state which provider conducted their initial training. The reported length of initial training courses and required frequency of refresher training was variable, and refresher training had not always been conducted within the previous year. Less frequently used techniques were reported as taught to a large number of respondents that were infrequently used in practice. Some key aspects of patient safety (e.g. positional asphyxia) were reported as not covered by some respondents. Nearly a third of respondents reported being hurt in training, although injuries requiring medical treatment were rare. Discussion: It appears that in practice a core curriculum is taught despite a lack of course standardisation. When these core elements are taught, training is also more likely to include theoretical aspects of the prevention and management of violence, as well as safety and ethical aspects. Reported confidence in the respondents' ability to use in practice the techniques that they have been taught was found to be related to whether they had been trained in the core curriculum and not to duration of training. Conclusion: Further research needs to be conducted on a wider range of adult inpatient nursing staff, preferably of a prospective nature, before a sufficient evidence base will be available to guide purchasers and upon which national guidance and standards can be based.