More recently, the use of ‘de-escalation has been encouraged (Johnson 2001). This, however, is poorly defined and seeks only to prevent further ‘escalation’ (Cowin et al. 2003).
If prevention fails and violence results, the use of breakaway techniques, restraint, rapid tranquillization or isolation is advocated, despite limited research on their outcomes or
value (Cowin et al. 2003). This may be for a number of reasons. First, there are difficulties in gaining access to study vulnerable patients (Valimaki & Leino-Kilpi 1998). Second,
there are methodological problems associated with the investigation of complex areas of communication that involve a number of variables (Nijman et al. 1999). Finally,
research that examines interventions such as seclusion has been self-limiting in that it is difficult to study one approach to the exclusion of others such as restraint or de-escalation,
which are often used conjointly (Meehan et al. 2000).Consequently, perspectives on and approaches used to manage aggression have been poorly researched.