title: Implementing and maintaining nurse-led healthy living programs in forensic inpatient settings: an illustrative case study.
abstract: BACKGROUND
  Healthy living programs (HLPs) within the context of mental health units are an applied response to the concerns of metabolic syndrome and the associated physical illnesses to which people with serious mental illness are susceptible.
  
  
  OBJECTIVE
  To illustrate how nurses, with other health professionals and service users, have established and maintained HLPs in two locked forensic mental health units in New Zealand.
  
  
  METHODS
  This illustrative case study adopts a multimodal approach to data collection and analysis. Across two programs, interviews were undertaken with service users (n = 15) and staff (n = 17), minutes of meetings were analyzed for major decision points, and clinical notes were reviewed to identify which service-user health status measures (body mass index, glucose tolerance test results, blood pressure, and medication use) were recorded.
  
  
  RESULTS
  Similarities were identified in the way the HLPs were implemented and maintained by champions who advocated for change, challenged staff attitudes, secured funding, and established new systems and protocols. Successful implementation depended on involvement of the multidisciplinary team. Each program operated within a different physical environment and adopted its own philosophical approach that shaped the style of the program. The HLPs had an impact on nurses, other staff, and on the culture of the institutions. The programs raised dilemmas about restrictions and risk versus autonomy and self-management.
  
  
  CONCLUSIONS
  Understanding the effects of the clinical and philosophical contexts in which HLPs are established and the way challenges and benefits are affected by context has practical significance for the future development of health programs in forensic settings, prisons, and general mental health units.
authors.affiliation: School of Nursing, Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand. k.prebble@auckland.ac.nz
authors.forename: Kate
authors.initials: K
authors.lastname: Prebble
authors.forename: Jacquie
authors.initials: J
authors.lastname: Kidd
authors.forename: Anthony
authors.initials: A
authors.lastname: O'Brien
authors.forename: Dave
authors.initials: D
authors.lastname: Carlyle
authors.forename: Brian
authors.initials: B
authors.lastname: McKenna
authors.forename: Marie
authors.initials: M
authors.lastname: Crowe
authors.forename: Daryle
authors.initials: D
authors.lastname: Deering
authors.forename: Claire
authors.initials: C
authors.lastname: Gooder
mesh_terms: D000328:Adult; D000368:Aged; D015400:Clinical Nursing Research; D003134:Commitment of Persons with Psychiatric Disorders; D003299:Cooperative Behavior; D005260:Female; D053604:Forensic Nursing / Q000458:organization & administration*; D015438:Health Behavior; D006284:Health Plan Implementation / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D006778:Hospitals, Psychiatric; D006801:Humans; D033183:Interdisciplinary Communication; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000451:nursing*; D024821:Metabolic Syndrome / Q000451:nursing* / Q000517:prevention & control*; D008875:Middle Aged; D009520:New Zealand; D010348:Patient Care Team / Q000458:organization & administration; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D011329:Prisoners / Q000523:psychology*; D011568:Psychiatric Nursing / Q000458:organization & administration*