The safety and effectiveness of interventions for aggression in mental health nursing

  • Johnathan Parkes

Student thesis: Doctoral ThesisPhD by Publication


This document presents five published journal articles all of which investigate the safety and effectiveness of interventions for aggression in mental health nursing. Early work focuses upon studies of the safety and effectiveness of interventions in the clinical setting. In the first article the research project examined the safety and effectiveness of a course of training in ‗control and restraint‘ (C&R) at a medium secure mental health unit. Mixed findings are reported, with some aspects of the study showing an increase in injuries whilst the overall outcome showed no significant change. The second article reports the pattern of incidents, and staff interventions, over a three year period in a different medium secure unit. A low threshold of reporting was encouraged and substantial numbers of incidents are described. Later work narrows the focus of the study onto a specific area of the safety of physical interventions for aggression: sudden death related to restraint. A published review of the literature on 'positional asphyxia' is presented, discussing the key literature and developing the concept of 'positional asphyxia.' Two research publications are also presented. In the first article the effect of body position on the rate of recovery from exercise is studied using pulse oximetry as a proxy measure of respiration. Equivocal results are reported. The second study shows a development of the methodology, following a similar design but using computer assisted pneumotachography to provide direct measurement of lung function. A clear pattern is demonstrated showing significant changes in lung function in prone restraint positions where the participant is flexed and/or body weight is applied. The development of the concept of positional asphyxia and the contribution of the articles, academic and professional, is discussed. It is suggested that positional asphyxia should be viewed as one factor in a multi-factorial model of risk. The body of work is presented as having clear implications for practice. Early work examining the pattern of incidents in clinical settings has relevance to staff training, particularly in terms of a clearer understanding of the potential risks which need to be addressed by training. Later work has considerable implication for both policy and training by identifying those restraint positions which present less risk to the restrained person. Directions for future research are discussed.
Date of Award2010
Original languageEnglish
Awarding Institution
  • Coventry University


  • mental health nursing
  • positional asphyxia
  • aggression
  • patient restraint
  • violence
  • patient intervention

Cite this