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Although the use of verbal de-escalation in nursing has been shown to be an effective tool for controlling agitation and avoiding mechanical restraint, there is scarce evidence supporting the use of de-escalation by nurses and factors related to the patients who ultimately receive mechanical restraint. This retrospective study sought to examine the relationship between the use of verbal de-escalation by nurses and the clinical profile of patients who had received mechanical restraint at an acute mental health unit. This study analysed the records of patients who had received mechanical restraint between the years 2012 and 2019. A bivariate analysis was initially performed, followed by multiple logistic regression analysis. A total of 493 episodes of restraint were recorded. Of these, in almost 40% of cases, no prior use of verbal de-escalation was noted. The factors associated with the use of verbal de-escalation by nurses were patients with a history of restraint episodes and patients who previously had been administered medication. Furthermore, episodes of mechanical restraint that occurred later during the admission were also associated with the use of de-escalation. These findings confirm the relevance of early nurse interventions. Consequently, it is important to establish an adequate therapeutic relationship from

Aims and Objectives To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse–patient therapeutic relationship. Design Participatory Action Research. Methods Ninety‐six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. Results The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. Conclusions This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. Relevance to Clinical Practice The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. No Patient or Public Contribution Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.

Accessible Summary What is known on the subject? Mechanical restraint is a common practice in mental healthcare settings in Spain, despite controversy. Mechanical restraint is perceived as a negative experience for nurses and service users. Mechanical restraint damages the nurse–patient therapeutic relationship, which is essential in providing quality care and promoting recovery. What the paper adds to existing knowledge? The negative experiences of service users and mental health nurses arising from use of mechanical restraint affects both parties involved and results in trauma. Using mechanical restraint can provoke a moral injury in mental health nurses which can negatively impact on the establishment of trust within the therapeutic nurse–patient relationship. What are the implications for practice? Nurses must be aware of the negative effects that mechanical restraint use has on both their practice and their day‐to‐day lives. Post‐mechanical restraint debriefing is required to repair the damage to the trust aspect of the nurse–patient relationship. Involving service users in co‐producing a debriefing framework may be a way to rebuild trust through constructive dialogue. Abstract Introduction Mechanical restraint is an intervention that causes harm to service users and nurses, yet continues to be used in many countries, including Spain. However, there is a lack of research exploring Spanish mental health nurses' experiences of using mechanical restraint. Aim To describe the experiences of mental health nurses who have used mechanical restraint in practice. Methods A qualitative descriptive methodology was used and a purposive sample of 10 Spanish mental health nurses were interviewed about their experiences of using mechanical restraint. Thematic analysis was then employed to analyse interview data. Results Participants' experiences of using mechanical restraint were mostly negative. Three main themes arose from the analysis of interview transcripts, (i) symmetrical trauma, (ii) moral injury and (iii) broken trust. Discussion The use of restrictive practices, which can be perceived as counter‐therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention. Implications for practice Reducing or eliminating use of mechanical restraints should be a policy and practice priority due to the symmetrical harms it causes both nurses and service users. The trust aspect of the therapeutic nurse–patient relationship is a significant casualty when mechanical restraint is used, therefore involving service users in co‐production of post‐mechanical restraint debriefing can be an avenue for restoring this trust through dialogue.

Introducción: la contención mecánica (CM) es una práctica actualmente permitida en España para su uso en centros sanitarios. Es una medida terapéutica excepcional de uso controvertido. Las investigaciones relacionadas con la CM describen experiencias traumáticas para el paciente y el personal, por lo que puede comportar un dilema ético para los profesionales sanitarios y favorecer el comportamiento regresivo del paciente.Objetivo: recopilar las recomendaciones y la evidencia científica en relación con el manejo de las agitaciones para reducir el uso de la CM y los problemas secundarios del abordaje.Material y métodos: revisión bibliográfica mediante la consulta de las siguientes bases de datos: CINAHL, PubMed/ Medline y Google Scholar. Se utilizó el siguiente vocabulario controlado: «agitación», «contención mecánica», «desescalada verbal», «intervención enfermera» y «salud mental» con un lenguaje libre, combinándolos con los operadores booleanos AND y OR.Resultados: se analizaron un total de 46 artículos. Se identificaron y aclararon los siguientes conceptos relacionados con alternativas a la CM en los entornos de salud mental: 1) contención cero, 2) legalidad de la CM, 3) prevención, fundamental para evitar la CM, 4) gestión/manipulación ambiental y organizativa, 5) intervención farmacológica, 6) desescalada verbal, 7) CM y 8) relación terapéutica.Discusión y recomendaciones: la CM sigue formando parte de la práctica psiquiátrica cotidiana. Los efectos adversos graves están asociados al uso de la reclusión y la contención; de ahí la necesidad de encontrar estrategias de tratamiento alternativas. Es útil recordar que ciertas reformas -que, al principio, pueden crear inquietud entre el personal-pueden ser bastante exitosas.