"Patient aggression. All nursing assistants frequently reported being subjected to physical and/or verbal aggression by some young persons during manual restraint use. It appeared from their accounts that these young persons were using whatever means they could, to prevent or stop the restraint, in order to stop or avoid nasogastric feeding. Commonly cited verbal aggression included swearing and shouting. Commonly cited physical aggression included spitting, kicking, scratching, biting, punching and head-butting. Some participants reported being subjected to such physical aggression even when nasogastric feeding had been completed: We were starting to leave the restraint . . . I was doing the lower part of the legs and I was kind of tilted over and she actually head-butted me on the head . . . the feed’s finished but she still lashes out at staff. (Participant 4) Being on the receiving end of physical aggression elicited reciprocal urges of aggression for two nursing assistants. These urges were cited in the context of self-defence and the participants in question were clear that they did not reciprocate aggression in any form: One of the patients was trying to dig her nails in my skin and rip whatever I was wearing to protect my arms. . . I hate these moments particularly because I feel I want to hurt the child . . . at that moment you want to hurt them in order to protect yourself. (Participant 1)"