"Participants were recruited from a private 25-bed locked inpatient specialist child and adolescent eating disorder service in the UK which provides inpatient treatment to young persons aged 9-18 years with eating disorders. In addition to providing multidisciplinary input from a number of professionals including psychiatrists, paediatricians, psychologists, family therapists and dieticians, the eating disorder service, under the powers of the Mental Health Act 1983 (Department of Health, 2015), and occasionally parental consent, also provides CNF under manual restraint as an intervention to young persons with AN presenting with ongoing food and/or fluid refusal and subsequent non-compliance with nasogastric feeding. A standard CNF intervention under manual restraint within the eating disorder service could typically last between 10 and 30 minutes, and involve up to five nursing assistants restraining the young person in the seated position, and up to two registered mental health nurses inserting the nasogastric tube, checking the tube’s placement, and delivering subsequent dietary nutrition through the tube via syringe. As reported by participants, up to 12 CNF interventions under manual restraint could occur per shift within the eating disorder service. This was owing to the fact that some young persons had care plans in place for pre-planned CNF interventions under manual restraint to be implemented multiple times per day (e.g., at specific times during the mornings, afternoons and evenings) due to their global and ongoing refusal of all foods and fluids, and their non-compliance with nasogastric feeding. Chemical restraint was not routinely used within the eating disorder service, and there was a service policy in place for CNF interventions under manual restraint to be aborted and reattempted at a later time in circumstances where it was not possible to safely administer nasogastric feeding within 30 minutes of manual restraint holds being applied."
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