"In light of the findings of this study, it is crucial that eating disorder services providing CNF under manual restraint sufficiently support their frontline nursing staff. Support can include the implementation of policies ensuring that manual restraints are spread out fairly between nursing staff, so that the same staff members are not repeatedly involved in manual restraint incidents. Support can also include, access to adequate manual restraint training and refresher training, access to adequately sized and ventilated ward areas/rooms for administering manual restraint for CNF, and access to sufficient supervision, post-restraint debriefing, reflective sessions, and talking therapy. Under the close working between psychiatrists, physicians and anaesthetists, it would also be reasonable for relevant eating disorder services to consider the supplementary risk-assessed use of chemical restraint (e.g., oral and parenteral benzodiazepines and oral olanzapine) and mechanical restraint (e.g., restraining belts and soft cuffs) in extreme cases where patients present with ongoing extreme levels of physical aggression and resistance to staff during manual restraints for CNF (Ridley & Leitch, 2019; Royal College of Psychiatrists, 2012, 2014). The aforementioned points are particularly important given the risk of burnout, compassion fatigue and physical injury which may lead to high staff turnover and sickness, and poor standards of care if left unresolved."