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The New Zealand Health Strategy in 2000 highlighted significant health inequalities and the need to improve the health status of individuals with severe mental illness (Ministry of Health, 2000). Mental health users die at 2.5 to 4.3 times the rate of the general population, even when suicide is factored out (Handiside, 2004). It is estimated that one quarter of the world's population have Metabolic Syndrome and that they are twice as likely to die from and have a five-fold greater risk of developing type two diabetes mellitus (International Diabetes Federation, 2009). The time has long past when Registered Nurses can only afford to focus on a patient's mental health and to do so would negatively impact on a patient's quality of life. A patient's quality of life encompasses their physical, functional, emotional, spiritual and social well-being (Cella, 1994). This study highlights that Registered Nurses working in inpatient psychiatric units are well positioned to detect, prevent and manage Metabolic Syndrome in patients with severe mental illness as they spend the greatest amount of time in close patient contact. An exploratory qualitative descriptive approach was used for the study to describe the perceived barriers that Registered Nurses encounter in their practice in the reduction of Metabolic Syndrome in patients with severe mental illness. The study was conducted on a forensic psychiatric unit at one DHB in New Zealand. A sample of five Registered Nurses consented to participate in a focus group interview, which was the main data collection tool used for this study. Thematic analysis was used to establish the major themes that emerged from the focus group interview. The findings of this study revealed that there are significant barriers that Registered Nurses have in helping to reduce Metabolic Syndrome in this patient group. These barriers include a patient's mental illness, knowledge of patients and staff, staff provision of care, diet and insufficient resources on the forensic unit. The focus group interview also encouraged Registered Nurses to suggest possible solutions to these barriers and these are reflected upon in this study.

Reducing Metabolic Syndrome in Patients with a Severe Mental Illness in a Forensic Unit in New Zealand: Perceived Barriers for Registered Nurses