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A qualitative investigation into nurses’ perceptions of factors influencing staff injuries sustained during physical interventions employed in response to service user violence within one secure learning disability serviceAims: The aim of the study was to examine learning disability nurses’ perceptions of incidents involving physical intervention, particularly factors contributing to injuries sustained by this group. Background: This article reports on a qualitative study undertaken within one secure NHS Trust to respond to concerns about staff injuries sustained during physical interventions to prevent incidents of service user violence from escalating out of control. The context of the study relates to increasing debate about the most effective approaches to incidents of violence and aggression. Design: A qualitative research design was utilized for the study. Methods: Semi-structured interviews were undertaken with 20 participants, 2 from each of the 10 incidents involving staff injury sustained during physical intervention. Results: Four themes were produced by the analysis, the first, knowledge and understanding, contextualized the other three, which related to the physical intervention techniques employed, the interpretation of the incident and the impact on staff. Conclusion: Service user violence consistently poses nurses with the challenge of balancing the need to respond in order to maintain the safety of everyone whilst simultaneous supporting and caring for people with complex needs. This study highlights the need for further exploration of the contributory factors to the escalation of potentially violent situations.