Can An Exercise Program Be Effectively Implemented For Severely Mentally Ill Patients In A Locked Down Forensic Psychiatric Facility?

It is widely reported that exercise can have positive cardiovascular health benefits for the general public. In reviewing information on the Internet, studies indicate that exercise is now recommended for all overweight and obese patients that are taking antipsychotics. Exercise may also have the potential to decrease hallucinations, improve self-esteem, and improve sleep (Faulkner & Sparks, 1999). Most psychiatric nurses would feel that with these potential benefits, it may be important to incorporate exercise as part of patient treatment. The first question that comes to mind is “how would I get my patients to comply?”  Tetlie, et al. 1999 conducted a study using exercise on fifteen severely mentally ill patients in a locked down psychiatric hospital. The data revealed four themes that were most important to patients and staff for an effective exercise program.  These themes include therapeutic relationships, mandatory participation in the exercise program, positive reinforcement by staff, and qualified instructors. The staff actually exercised with the patients one to one, and were able to build a therapeutic relationship in this manner. It was also deemed necessary by both staff and the patients that the exercise program be mandatory. For the most part, the patients stated that many times they would have not participated if it were not required. After the fact, most patients were glad that they did. According to the patients and staff, it was also necessary to have a staff member to exercise with that could balance his authoritarian leadership role with the ability to give positive feedback. The last requirement was to have a staff member that was familiar with the necessary techniques for each exercise. The most important of the four themes was the establishment of a therapeutic relationship.  It will serve us well as psychiatric nurses to keep the value of a therapeutic relationship in mind as we work with our patients on a daily basis.

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