Psychiatric Management and Treatment Modality (I) PDF

Psychiatric Management and Treatment Modality (I) Asst. Prof. Dr. Siriporn Poonruksa, RN Objectives: Students will be able to ⚫ Describe the concept of Milieu therapy ⚫ Explain the important concept of group therapy ⚫ Describe how to arrange group activity to...

Psychiatric Management and Treatment Modality (I) Asst. Prof. Dr. Siriporn Poonruksa, RN Objectives: Students will be able to ⚫ Describe the concept of Milieu therapy ⚫ Explain the important concept of group therapy ⚫ Describe how to arrange group activity to psychiatric client  In your opinion, what “home” means?  Topic 2.1 Milieu Therapy What is milieu therapy? ⚫ It refers to socio-environment therapy in which the attitudes and behaviors of the staff in a treatment service and the activities prescribed for the client are determined by the client’s emotional and interpersonal needs (Shives, 2008). ⚫ The “therapeutic milieu” refers to the environment in which the treatment service is delivered. ⚫ It’s structure to control, stabilize, and improve problematic emotions and behavior and enables the client to use problem-solving skills to cope with self, others, and environmental stressors. Goals of the therapeutic milieu in psychiatric setting ⚫ Providing physically and psychologically safe environment ⚫ Maximizing the highest level of psychological functioning ⚫ Identifying acute and chronic physical illnesses that are affecting symptoms ⚫ Promoting healthy coping behavioral strategies and symptom management ⚫ Helping to provide independent activities of daily living ⚫ Educating clients and their families about medications and other therapeutic modalities ⚫ Establishing collaborative discharge planning between the client or family and the multidisciplinary team (Boyd, 2008). ⚫ Clients are responsible for being active participants in the treatment plan through the following actions: -Attending scheduled activities -Participating in treatment planning and goal setting -Meeting regularly with members of the interdisciplinary team -Acquiring effective problem-solving skills and emotional coping strategies -Performing self-care activities -Adhering to the medication regimen ⚫ Nurses are largely responsible for managing the client’s activities including: -Completing hygiene and grooming -Participating in mealtimes -Taking medications as the prescribed times -Participating in unit assignments (wearing pants, keeping dayroom organized, running community meeting, attending planned activity therapies) -Meeting with multidisciplinary team members www.manarom.com Group therapy ⚫ Group therapy is the method of therapeutic intervention (treatment method) based on the exploration and analysis of both internal (emotion) and external (environment) conflicts and the group process (Lego, 1996 cited in Shives, 2008). Advantages of Group Therapy ⚫ Decreased isolation and dependence ⚫ Opportunities for helping others ⚫ Interpersonal learning and development of coping skills ⚫ Decreased transference of the therapist while developing the ability to listen to other group members Characteristics of Group Therapy ⚫ Group size consists of 8-12 members ⚫ Mental health and psychiatric nurse acts as leader and co-leader while member (client) may be a co-leader for some groups for example therapeutic community group ⚫ There are three phases of group therapy including beginning or orientation, middle or working, and ending or termination phases. Beginning or orientation phase ⚫ It is often one of much stress and anxiety for group members. ⚫ Each person is concerned with how she or he will fit into group as the group norms and acceptable behaviors are identified. What are the tasks in orientation phase? ⚫ Greet the members ⚫ Introduce leader, co-leader, and encourage members to introduce own self to the group ⚫ Orient group members to the purpose or goal (objective) of the group ⚫ Identify group rules to members ⚫ Leader creates small talk to introduce all members to working phase of the group Hi! I’m Adam www.imagine.com What are the tasks in working phase? ⚫ Leader and co-leader use techniques to make members achieve the group goal. ⚫ Members are the center of the group.*** ⚫ Democratic leader is needed to encourage members to explore their conflicts, to identify repetitive behaviors and continually to clarify the group goals and tasks.  What are the tasks in closing phase? ⚫ Encourage members to conclude or summarize “how do they receive benefit” from participating in each group activity. Most common important techniques used in group therapy ⚫ Encouraging: -Direct and Indirect encouraging ⚫ Positive reinforcement ⚫ Active listening ⚫ Talk to the group not talk to individual** ⚫ Use the group rules and regulations beneficially to solve any problem that may happen during group therapy (Fortinash, Kennedy, and Ballard, 2008). Follow me, take a deep breathing www.imagine.com Group, would you tell me how do you manage stress? www.imagine.com  Example of group therapy in Thai Psychiatric Hospital ⚫ Reading group (reading newspaper) -Promote listening skill and update clients’ knowledge -The news should have neutral information. ⚫ Social skill training group -Promote skill normally used in society such as communication skills ⚫ Self-care group -Promote skills related to self-care in daily activities ⚫ Therapeutic community group -Provide opportunity for clients to realize the daily life problem and how do they solve it ⚫ Occupational therapy group -Promote task skills for clients before discharging such as making crafts ⚫ Sport group -Provide opportunity for clients to play their favourite sport ⚫ Discharge planning group -Prepare clients and families for effective discharge planning ⚫ Psycho-education group -Promote psychological skills such as self- esteem, stress relaxation technique ⚫ Psycho-medication group -Empower clients for arranging and taking home medication by themselves effectively to reduce discontinuing medication at home ⚫ Recreation group -Promote clients’ enjoyable experiences and cohesiveness while having recreation Sport group www.imagine.com www.imagine.com Cooking group www.imagine.com Social Skill Training [email protected] [email protected] Tips for group therapy*** ⚫ Stimulated work/activity -increase movement for clients -use hot color -take short time -normally apply for depressed and withdrawal clients ⚫ Repressed work/activity -decrease movement for clients -use cold color -take long time -normally apply for overactive and mania clients Note: All material used for activity must be safe for clients. Stimulated activity www.imagine.com Repressed activity www.imagine.com Assignment ⚫ Make a group work consisting of 2 persons ⚫ Find a news that is appropriate for setting up reading group for psychiatric patients and post in A4 paper ⚫ Write the reasons why you think that this news is appropriate for psychiatric patients ⚫ Write a small talk to introduce members to pay attention in your reading group about this news ⚫ Submit this assignment to me on 15 November 2024, in the classroom Reference Boyd, M. (2008). Psychiatric nursing: Contemporary practice (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Fortinash, P. G., Kennedy, W. Z., and Ballard, K. A. (2008). Psychiatric mental health nursing: An introduction to theory and practice. Massachusetts: Jones and Barlett Publishers. Shives, L. R. (2008). Psychiatric-mental health nursing (7th ed.). Philadelphia: Lippincott Williams & Wilkins. Varcarolis, E. M. & Halter, J. (2014). Foundations of psychiatric mental health nursing: A clinical approach (7th ed.). Philadelphia: W.B. Saunders Company. Videbeck, S.,L. (2014). Psychiatric-mental health nursing (6th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Wheeler, K. (2014). Psychotherapy for the advanced practice nurse: How to guide for evidence-based practice. USA: Springer. Wrycraft, N. (2012). Mental health nursing: case book. Maidenhead : McGraw Hill / Open University Press. http:/www.adamimages.com http://www.imagine.com http://www.manarom.com http://www.psiquiatruras.blogspot.com