Chapter 7
Milieu
The Therapeutic Environment
Professor Fickley
Introduction
The psychiatric-mental health nurse provides
structures, and maintains a therapeutic environment in
collaboration with the client and other health care clinicians.
Standard Vb of the American Nurses
Association Standards of Psychiatric
Mental Health Nursing Practice
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.
Current
Status
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.
Current
Status (cont.)
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.
Basic Assumptions
The health of
each individual is to be realized and encouraged to grow.
Every interaction
is an opportunity for therapeutic intervention.
The client owns
his or her environment.
Each client owns
his or her behavior.
Peer pressure is
a useful and powerful tool.
Inappropriate
behaviors are dealt with as they occur.
Restrictions and
punishment are to be avoided.
Conditions
Promoting a Therapeutic Community
Basic
physiological needs are fulfilled.
The physical facilities
are conductive to achievement of the goals of therapy.
A democratic form
of self-government exists.
Responsibilities
are assigned according to client capabilities.
A structured
program of social and work-related activities is scheduled as part of the
treatment program.
Community and
family are included in the program of therapy in an effort to facilitate
discharge from the hospital.
The
Program of Therapeutic Community
The treatment
plan is directed by an interdisciplinary 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 chaplains
service.
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
clients physiological and psychological needs are met.
Role
of the Nurse (cont.)
Nurses are also responsible for
Medication
administration
Development of a
one-to-one relationship
Setting limits
on unacceptable behavior
Client education
Goal:
New ways of coping, being, reacting, thinking, living a more satisfying and
productive life!
Questions
1. John came into
the TV room and changed the channel in the middle of a program that several
others were watching. The group reprimanded him loudly and returned the TV to
the channel they had been watching. They told him they would not tolerate that
kind of behavior.
2. The nurse focused on Nancys insight and knowledge to help her
find more adaptive ways of coping.
3. George always started an argument in group
therapy. Each time, the group calmed him down with their discussion. When he
became violent, however, he was placed in isolation for the safety of himself
and others.
a. The health in
each individual
is to be realized
and encouraged
to grow.
b. Every
interaction is an opportunity for therapeutic intervention.
c. The client owns
his/her own
environment.
d. Each client
owns his or her behavior.
e. Peer pressure
is a useful and
powerful tool.
f. Inappropriate
behavior is dealt
with as it occurs.
g. Restrictions
and punishment
are to be avoided.
Fred becomes angry
whenever anyone in the group disagrees with him. Members of the group examine
Freds defensiveness and help him to see how he is coming across to others.
They help him to practice more appropriate
ways of
responding.
5. Lloyd had
always been unable to interact on a personal level with other
people. In the
milieu environment, he learned new communication skills
and had the
opportunity to practice relationship development that helped
him when he left
the hospital.
6. Kevin told the nurse of being arrested for
driving the getaway car in an armed robbery. He stated, I dont know why they
grabbed me. Jack did
the stealing! He
made me drive the car. The nurse responded, Kevin,
no one made you
drive the car. You made that choice yourself. Now you
must own up to
that decision.
a. The health in
each individual
is to be realized
and encouraged
to grow.
b. Every
interaction is an opportunity
for therapeutic
intervention.
c. The client owns
his/her own
environment.
d. Each client
owns his or her behavior.
e. Peer pressure
is a useful and
powerful tool.
f. Inappropriate
behavior is dealt
with as it occurs.
g. Restrictions
and punishment
are to be avoided.