Ch12 milieu therapy(3) (1)

Psychiatric Mental Health NursingPsychiatric Mental Health Nursing
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Copyright © 2012 F.A. Davis Company
Chapter 12
Milieu Therapy ―
The Therapeutic Community

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Introduction
 “The psychiatric-mental health nurse provides structures,
and maintains a safe and therapeutic environment in
collaboration with patients, families, and other health-care
clinicians.” * To provide the # 1 Priority of a nurse on newly admitted is to search the client for contraband or
hazardous stuff.

 Standard 5c of the American Nurses’
Association Standards of Psychiatric–
Mental Health Nursing Practice, 2007

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Milieu, Defined
 Milieu therapy, or therapeutic community, is defined as “a
scientific structuring of the environment to effect behavioral
changes and to improve the psychological health and
functioning of the individual.”
 Within the therapeutic community setting, the client is
expected to learn adaptive coping, interaction, and
relationship skills that can be generalized to other aspects of
his or her life.

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Current Status of Milieu Therapy
 Milieu therapy blossomed during the 1960s, 1970s,
and early 1980s, when psychiatric inpatient
treatment provided sufficient time to implement
programs of therapy aimed at social rehabilitation.

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Current Status of Milieu Therapy
(cont’d)
 Although strategies for milieu therapy are still
used, they have been modified to conform to the
current short-term approach to care and to
outpatient treatment programs.

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Basic Assumptions of Milieu Therapy
 The health in each individual is to be realized and
encouraged to grow.*A newly admitted client was given a unit schedule and refuses to attend groups. Client stated
I am here to rest. The best response of a nurse is group therapy provides the opportunity to learn and practice new coping skills
 Every interaction is an opportunity for therapeutic
intervention.*AN CLIENT WAS ANGRY BECAUSE SOMEBODY STOLE HIS FAVORITE SHAMPOO. STATING TO THE NURSE YOU NEED TO
DO SOMETHING ABOUT THIS NOW.
 The client owns his or her own environment.
 Each client owns his or her own behavior.-*A CLIENT WAS ANGRY AND TELL THE
NURSE THE OTHER CLIENT IS NOT DOING HIS SHARE OF CLEANING AFTER HIMSELF. THE NURSE SHOULD RECOGNIZE THIS BEHAVIOR
AND GIVE HIM THE CHANCE TO DSICUSS CONCERS.
 Peer pressure is a useful and powerful tool.
 Inappropriate behaviors are dealt with as they occur.
 Restrictions and punishment are to be avoided.

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Conditions That Promote a
Therapeutic Community
 Basic physiological needs are fulfilled.
 The physical facilities are conducive to achievement of the goals of
therapy.
 *A democratic form of self-government exists.-*Treating all clients equally.
 *Responsibilities are assigned according to client capabilities.
 A structured program of social and work-related activities is
scheduled as part of the treatment program. *A client with schizophrenia
decompensate after discharge. The client needs a structured programming which is not available in the home setting.
 *Community and family are included in the program of therapy in
an effort to facilitate discharge from treatment.

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The Program of Therapeutic Community
 Care is directed by an interdisciplinary team.
 A comprehensive treatment plan is formulated by the team.
 Team members of all disciplines sign the plan and meet
regularly to update the plan as needed.
 Disciplines may include psychiatry, psychology, nursing, social
work, occupational therapy, recreational therapy, art
therapy, music therapy, dietetics, and chaplain’s service.
 *Psychological testing result are review by Psychologist.

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The Program of Therapeutic Community
(cont’d)
1. Which of the following best describes the role of the
psychiatric social worker as a member of the
interdisciplinary treatment team?
A) Provides ongoing assessment of client’s mental and
physical condition
B) Functions under the supervision of the psychiatric nurse
C) Conducts individual, group, and family therapy
D) Serves as the leader of the treatment team

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The Program of Therapeutic
Community (cont’d)
Correct answer: D
 The psychiatric social worker is a member of the
interdisciplinary treatment team and conducts
individual, group, and family therapy.

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Role of the Nurse
 Through use of the nursing process, nurses manage
the therapeutic environment on a 24-hour basis.
 Nurses have the responsibility for ensuring that the
client’s physiological and psychological needs are
met.

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Role of the Nurse (cont’d)
 Nurses are also responsible for
 Medication administration- * Nurses should promote self –reliance on medication
administration by encouraging clients to request their medication at the appropriate time
 Development of a one-to-one relationship
 Setting limits on unacceptable behavior
 Client education-* The best topic is stress management.

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2. A client, diagnosed with borderline personality
disorder, approaches the nursing station often with
various requests. The nurse intervenes by stating,
“You may approach the nurse’s station only once an
hour.” Which nursing intervention has been
employed?
A) Providing reality orientation
B) Ensuring physical need fulfillment
C) Setting limits on behavior
D) Providing client education

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Correct answer: C
 In this situation the nurse is responsible for setting
limits on unacceptable behavior in the therapeutic
milieu. Consistency in carrying out the
consequences of violation of the established limits
is essential if learning is to be reinforced.

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