Objective: To gain insights into the experience, and impact, of using security staff to facilitate physical restraints for nasogastric tube feeding.

Design
A cross-sectional design using 39 individual interviews, three online focus groups and three written submissions involving young people with lived experience (PWLE), parents/carers, paediatric staff, and security staff involved in nasogastric feeding under restraint in paediatric settings in England. Qualitative semi-structured interviews were transcribed, and thematically analysed.

Participants
53 individuals participated: seven security staff (all male); nine PWLE who experienced the intervention between the ages of 9 and 17 (all female); twenty parents (15 mothers, 5 fathers) and twenty paediatric staff (5 male, 15 female).

Results
Regarding the involvement of security staff, participants spoke in relation to two primary themes (a) short-term impact, (b) long-term impact. Short term themes included that the intervention felt inappropriate and traumatic whilst also recognising its live saving nature and the fact that involving security guards preserved positive relationships with nursing staff. Longer term themes included development of trauma symptoms, whilst also acknowledging the skill development and improved professional relationships that could result from delivering the intervention.

Conclusions:
This lifesaving clinical intervention can negatively impact security staff as much as the patient, parents/carers, and paediatric staff. A pre- and de-brief should be seen as part of the ‘process’. Further research is needed to better understand what else can mitigate negative impacts.

Strengths and limitations

• This is the first study to qualitatively explore the experiences of people with lived experience, parents/carers, paediatric staff and security staff regarding naso-gastric tube feeding under physical restraint in English paediatric wards.

• Those with lived experience did not only include people with Anorexia Nervosa, which is the primary population previously studied.

• Due to the large total sample size (53 respondents, across 4 groups) we have a good range of views with multiple perspectives.

• However, the seven security guards from five NHS Trusts represented the smallest group in the sample and therefore data saturation may not have been achieved as research suggests that a minimum of 9 participants is needed [1]