The data from the focus group interview also generated information regarding the positive practices that were already in place on the forensic unit in relation to reducing Metabolic Syndrome in patients prior to the focus group interview taking place. These relate to diet and smoking cessation which reflect two of the risk factors for Metabolic Syndrome as outlined in Chapter Two under smoking and obesity. Following excerpts from the RNs highlight how these two positive inclusions came about on the forensic unit.
Diet
RN 4 We are providing a healthy supper and afternoon tea for all of the patients on the unit which is going very well. The patients are involved in choosing what they want for supper and they are very good at what not to have. It has definitely stopped patients from having toast and spreads at night time and that’s pretty good.
RN 5 Some of the patients are involved in preparing the supper in the evening – it is an opportunity for the patients to work with the staff.
RN 3 And that came out of a barrier because we tried for a long time to get the hospital kitchen to supply healthy suppers.
Figure 4.4: Overarching themes, sub-themes and specific examples identifying the Suggested Solutions to the Barriers
Smoking cessation
RN 5 We are working towards targeting smoking cessation in health working areas. We have been slowly increasing the time in between patient’s
Overarching themes Sub-‐themes
Education
Role of the RN Documentation Improving Resources
Education for patients Education for RNs Education for untrained staff
Manage staff resources New exercise equipment
Exercise/activity programmes for patients
Individual patient care plans Improves consistency of care
Good role modelling Assessing readiness to learn
Creative nursing
Examples
Study: Mental Health Course Metabolic Syndrome education
Patient discussion groups Employ a Diversional Therapist Budget for new sports equipment
Structured activities for patients
Medication care plans Clear & concise documentation
Running competitions Nursing role of assessment Being consistent in delivery of care
smoking breaks and this has being going well. There are posters around the unit regarding smoking cessation and there have been discussions around it. Patients are offered nicotine patches and now as part of the admission process we inform patients about the different choices regarding smoking cessation.
RN 2 We did some work late last year which involved educating the staff around smoking cessation. The pharmacist did two education sessions on nicotine replacement therapy and these education sessions will probably be repeated again soon.
Summary
This chapter has presented the data analysis and results from the focus group
interview. The results have highlighted a number of barriers and suggested solutions to these barriers for RNs in helping to reduce Metabolic Syndrome in patients in a forensic unit in New Zealand. The results emphasise the need for a holistic approach to nursing practice on this forensic unit and offer rich insights for RNs in how they can improve the overall health and wellbeing of patients with SMI. The focus group interview data has also highlighted the positive solutions that have already been put in place on the forensic unit to help prevent the risk factors of Metabolic Syndrome in patients. The results in relation to each of the overarching themes as seen in Figures 4.3 and 4.4 will be explored further and discussed in depth in Chapter Five.
CHAPTER FIVE: DISCUSSION
Introduction
In this chapter, I will discuss the findings that emerged from the data analysis and their relationship to the literature for literature control purposes. I will discuss the main overarching themes and sub-themes (Figure 4.3) that emerged from the focus group interview in relation to Category One, the perceived barriers for RNs. I will the discuss the findings in relation to the main overarching themes and sub-themes (Figure 4.4) in relation to Category Two, the suggested solutions to the barriers. The chapter concludes with a reflection on the methodology used in this study and
explores the limitations and recommendations for further research.
Category One: perceived barriers for Registered Nurses
I conducted this research as I have a strong interest in the physical health of patients with SMI. It was evident to me that in an in-patient fornesic unit, the physical health needs of these patients were not being met adequately and that a holistic nursing approach is required to improve the quality of life, health and wellbeing of patients with SMI. After a thorough review of the literature within the search parameters for this research project, it was evident that there was a paucity of literature available indicating the incidence of Metabolic Syndrome in patients with SMI on forensic psychiatric units. Despite the wealth of literature produced globally involving Metabolic Syndrome, this demonstrates an evident gap in research.
The literature review revealed only one published research article (Prebble, Kidd, O’Brien et al, 2011) relating to the physical health care needs of patients with SMI on a forensic unit in New Zealand. O’Brien et al did not explore the barriers that RNs are confronted with in helping to reduce Metabolic Syndrome; however the research did aim to improve the physical health status of individuals with SMI through the