where possible, whether they are environmental or human factors. Research from the mental health charity, Mind,2 highlighted the importance of communication in particular for mitigating the negative effects of physical restraint, engendering compassion and respect. For staff too, restraining a patient in distress can be mentally and physically demanding, and poses significant risk of injury. Data collected from 22 mental health Trusts in England in 2016-2017 found 1,847 injuries to staff during instances of restraint.1

The de-escalation couch Existing furniture designed for de- escalation tends to focus on soft surfaces and edges which reduce the likelihood of patients and staff being injured by their immediate environment. While this is a legitimate concern, these products generally do not address the physical demands and postural stress associated with extended periods of high-intensity restraint and the potential risk of injury. The seated position in traditional de- escalation couches only allows staff to sit facing the same direction as the patient. This seated position for staff contradicts the basic rule of engagement with patients in de-escalation processes unless the staff ‘twist’ their position. As well as causing potential back injuries, this position also makes verbal communication more difficult, to the detriment of therapeutic approaches.

From the outset, the JAK De-escalation couch was designed to address these issues. The couch allows two staff members to sit either side of the patient, rotated towards the centre at a 33 degree angle. The inward angle of the couch allows staff to sit ‘naturally’ – by placing their feet with a wide, stable base, maintaining the principles of biomechanics, and provides essential back support for staff who would otherwise be in a twisted position, reducing the effectiveness of their techniques and risking back injuries. It also provides support for staff from lateral forces, which may otherwise cause them to be pushed towards the side of the couch. The lower part of the couch is angled inwards towards the floor, creating a supportive footwell, and extra space for staff seated on each side, and staff approaching from the front – for relieves, transfer, and the feeding process. This also enables staff to secure patient ankles and place them back against the sofa footwell. This naturally discourages the ergonomic efforts of the patient to stand.

A downward gradient

The centre seat is lower than the other side seats, and provides a slight downward gradient towards the back of the couch, thus reducing the ability to slide forwards off the couch. The lower patient seat position design provides three supportive features to both staff and patients: l A patient seated lower than staff will have less ability to move side to side.


The restraint couch allows two staff members to sit either side of the patient, rotated towards the centre at a 33 degree angle.

l A patient seated lower will have their knees slightly raised above the normal 90-degree position. Ergonomically, this reduces the ability to stand during high resistive situations.

l A lower seated position also benefits staff in terms of enabling them to apply safer techniques in relation to securing legs.

In addition to reducing the risks of positional asphyxiation (as found in prone restraint), the upright sitting position makes communication easier between patients and staff, which helps to develop co-productive relationships that aid verbal de-escalation and reduce the level of physical restraint required.

Nasogastric tube feeding Nasogastric tube feeding (NG feeding) is a form of enteral nutrition which provides vital fluids, medicines, and nutrition, directly into the patient’s stomach via a nasal tube. The method of insertion is a ‘blind’ procedure (i.e. without fluoroscopic guidance), which requires care and dexterity to complete safely. Even in non-resistive situations, the natural reflexes caused by an object passing through the nasal passage can cause patient distress, and there are inherent health risks associated with the procedure. Under

normal conditions, the NG-tube insertion procedure usually takes 20-30 minutes. Insertion requires the patient to sit upright and face forward to allow the fine bore feeding tube to be passed safely and correctly.

Patient and staff impact For patients living with severe eating disorders, NG-tube feeding may be used as a last resort if insufficient nutrition is gained from oral feeding. In such circumstances, the patient may resist treatment, making the procedure more dangerous, and requiring physical restraint to administer safely. Risks relating to enteral tube misplacement can cause discomfort and injuries. In the worst-case scenario, the tube may be accidentally inserted into the respiratory tract, resulting in serious consequences if not rectified quickly. Further NG-tube feeding procedures may evoke powerful feelings of anxiety and stress. Clinical environments filled with hard surfaces and utilitarian equipment may serve to compound these feelings, establishing a resistive atmosphere before the process has begun.

The NG couch

Many of the features which make the de- escalation couch beneficial for physical

The soft padded upholstery and bright colours of the NG couch aim to avoid a clinical aesthetic, and instead evoke more of a sense of wellness and rehabilitation.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32