restraint also contribute to the NG couch’s effectiveness. By giving staff better support during the restraint process, the NG couch helps to make the insertion process more controlled, reducing the risk of tube misplacement and injury to the patient. An angled back and seat for staff mean a more comfortable seating position for staff, with increased back support. Staff face towards the user without having to twist, reducing potential injuries and strains, and improving strength of hold. This inward seated position allows staff to provide natural positive posture to reassure patients that require eye contact and continuous positive engagement support. The back of the centre seat is at an 8 degree angle, which allows the patient’s head to be in a natural position to receive the NG feed. This also allows patients’ heads to be positioned closer to the staff standing behind the couch in order to administer feeding and head restraint protocols.

Recessed bottom edge A recessed bottom edge creates an ergonomic leg support for staff, while also leaving room for patient and staff feet to be placed comfortably and with stability. It retains space for staff to approach with a feeding tube without being obstructed, and allows extra leg room for dealing with resisting patients and space for implementing leg-on-leg techniques. Overall, the patient seat has been lowered, improving access to the user, and creating improved ergonomic posture and comfort for staff performing leg restraints. Benefits include a safer process, lower costs, less time consumed in NG feed under restraints, a reduction in the risk of back injuries, less sick leave, improved infection control, and fewer staff members needed per feed. Live service evaluations have ensured that every angle of the NG couch has been optimised to achieve ergonomic integrity and a safer clinical procedure on a stable and safe platform that supports both staff and patients throughout a prolonged NG feed process, ergonomically designed to promote back care. The soft padded upholstery and bright colours of the couch aim to avoid a clinical aesthetic, and

Design and production Every angle of the products has been optimised to ensure that ergonomic integrity is maintained to support safer processes for patients and staff alike. The design process was an iterative one, starting with a full-size prototype made from supportive foam. Physical intervention specialists from Andy Johnston Associates tested the ergonomics of the design through role- play evaluations, and provided feedback to the design team. Each round of testing resulted in subtle refinements, and after nine stages, the optimal design was achieved, taking into account the variations of shape and size of the general population.

Andy Johnston is a former clinical director and independent mental health consultant, with over 32 years’ experience in mental health services. His team of mental health professionals collaborated in designing the JAK De-escalation couch, and tested prototypes throughout the design process.

instead evoke more of a sense of wellness and rehabilitation. Often the patient is aligning feeding time with moments of distress, and previous furniture may not be designed for purpose, and may causes further distress and potential injury.

Hygienic, single-skin finish Infection control is paramount in medical intervention, and during the NG feeding procedure there is a likelihood of spillages and purged food coming into contact with the furniture. The NG couch has a hygienic single-skin finish, with no stitching or seams, to eliminate dirt-traps, which also allows it to be thoroughly cleaned, maintaining high standards of infection control.

Using the latest developments in surface technology, the PU foam used has been designed to adapt to the contours of the couch, creating a seamless design. The double-coated foam finish with a water-based top coat is moisture-resistant, comfortable, and has proven durability. A versatile palette of colours is available to help soften the environment, creating a less unsettling atmosphere.

The final prototype of the NG feeding couch was tested in four live service evaluations, with 50 clinical professionals. The team also invited an ergonomic specialist and six physical intervention specialist instructors to observe and test its use.

Feedback from clinical professionals

included: l ‘Made the restraint easier and safe.’ l ‘[The] back is just at the right angle to provide safe feed.’

l ‘Good support for back and legs of staff in prolonged seated intervention.’

l ‘Very appropriate for every level of intervention.’

l ‘Surprisingly comfortable’ l ‘Feels safe.’

Comments from physical intervention experts included: l ‘Staff body positions are supported throughout a seated intervention.’

l ‘Allows staff to engage and see what is going on rather than flat back.’

l ‘I can see that it will support both staff and patients in preventing back strains.’

Patients and families said: l ‘It’s much more comfortable and safer than the chairs being used at the moment.’

l ‘Thank you for thinking of my daughter’s safety.’

The Ellern Mede NG Couch has been designed alongside a bespoke EDRIST (Eating Disorder Restrictive Intervention Support Training) programme developed by Andy Johnston Associates in partnership with Ellern Mede. The programme is the first evidence-based training to be developed for services required to carry out the NG feeding process using physical interventions.


References 1 Ford S. Injuries to mental health staff during restraint on the increase. Nursing Times, 16 November 2017.

The final prototype of the NG feeding couch was tested in four live service evaluations, with 50 clinical professionals.


2 Mental health crisis care: physical restraint in crisis. A report on physical restraint in hospital settings in England. Mind, June 2013.


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