Mental Health Chapter 7 PDF

Chapter 7 Milieu Therapy—The Therapeutic Community Copyright ©2019 F.A. Davis Company Introduction § The psychiatric-mental health nurse provides structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians. Copyright ©2019 F....

Chapter 7 Milieu Therapy—The Therapeutic Community Copyright ©2019 F.A. Davis Company Introduction § The psychiatric-mental health nurse provides structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians. Copyright ©2019 F.A. Davis Company 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, as well as interaction and relationship skills, that can be generalized to other aspects of his or her life. Copyright ©2019 F.A. Davis Company Current Status of Milieu Therapy § Milieu therapy came into its own during the 1960’s, 1970’s, and early 1980’s, when psychiatric inpatient treatment provided sufficient time to implement programs of therapy aimed at social rehabilitation. Copyright ©2019 F.A. Davis Company Current Status of Milieu Therapy (continued) § 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. Copyright ©2019 F.A. Davis Company Basic Assumptions of Milieu Therapy § The health in each individual is to be realized and encouraged to grow. § Every interaction is an opportunity for therapeutic intervention. § The individual owns his or her own environment. § Each individual owns his or her own behavior. § Peer pressure is a useful and powerful tool. Copyright ©2019 F.A. Davis Company Basic Assumptions of Milieu Therapy (continued) § Inappropriate behaviors are dealt with as they occur. § Restrictions and punishment are to be avoided. Copyright ©2019 F.A. Davis Company Conditions That Promote a Therapeutic Community § § § § §. Containment. The environment is contained to create a sense of safety and security. Patients who are struggling with strong suicidal intentions, for example, often find that locked doors and lack of access to easy methods of self-harm provide the containment they need to resist self-destructive impulses. 2. Structure. The environment needs to have a structure that promotes the goals of treatment. This includes a schedule of activities so that patients know what, when, and where activities are taking place. Group therapies, for example, are scheduled at specific times so the patient can structure their day to attend. Knowing to whom they should go (perhaps a primary nurse or team leader) to express concerns, ask for medication, or contact other team members is another aspect of unit structure that promotes therapeutic outcomes. 3. Involvement. The environment must encourage involvement so that patients develop a sense of social community. Common dining areas, small group seating arrangements, and community meetings to discuss aspects of community living are examples of elements that promote involvement. 4. Support. The environment must be supportive and affirming rather than rigid or punitive. The nurse plays an active role offering emotional support, reinforcing the expectations within the community environment to promote supportive interaction, and redirecting patients who are struggling to accomplish therapeutic interaction with others. Support also includes creating a sense that patients are not only involved in treatment but are empowered in decision making and direction around their care. 5. Validation. The environment must support and affirm the needs of the individual both within and separate from the community. Active, empathic listening to the patient’s perceptions and concerns and promoting autonomy are examples of validation. Copyright ©2019 F.A. Davis Company 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. Copyright ©2019 F.A. Davis Company Clicker Question 1 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. Serves as the leader of the treatment team D. Conducts individual, group, and family therapy Copyright ©2019 F.A. Davis Company Clicker Question Answer 1 Correct Answer: D The psychiatric social worker is a member of the interdisciplinary treatment team and conducts individual, group, and family therapy. Copyright ©2019 F.A. Davis Company Role of the Nurse in Milieu Therapy § 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. Copyright ©2019 F.A. Davis Company Role of the Nurse in Milieu Therapy (continued) § Nurses are also responsible for: Medication administration Development of a one-to-one relationship Setting limits on unacceptable behavior Client education Copyright ©2019 F.A. Davis Company Clicker Question 2 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 Copyright ©2019 F.A. Davis Company Clicker Question Answer 2 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. Copyright ©2019 F.A. Davis Company