Milieu therapy


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Milieu therapy

  1. 1. NUR 448 Milieu Therapy
  2. 2. What is Milieu Therapy? <ul><li>A healing environment </li></ul><ul><li>Use of the physical and social environment to promote safety, optimal functioning, develop interpersonal skills, and to teach life management skills to use after discharge </li></ul>
  3. 3. Purpose <ul><li>Promote mental health and rehabilitation </li></ul><ul><ul><li>Focus on group process </li></ul></ul><ul><ul><li>Democratic </li></ul></ul><ul><ul><li>Interdisciplinary approach </li></ul></ul>
  4. 4. Functions <ul><li>Containment </li></ul><ul><li>Support </li></ul><ul><li>Structure </li></ul><ul><li>Involvement </li></ul><ul><li>Validation </li></ul>
  5. 5. Nurse as Manager <ul><li>Promotes atmosphere of </li></ul><ul><ul><li>Respect </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><ul><li>Flexibility </li></ul></ul><ul><ul><li>Open communication </li></ul></ul><ul><ul><li>Predictability </li></ul></ul><ul><ul><li>Active involvement </li></ul></ul>
  6. 6. Components of Milieu Therapy <ul><li>Orientation to environment </li></ul><ul><ul><li>Scheduled activities </li></ul></ul><ul><ul><li>Rules for behavior </li></ul></ul><ul><ul><li>Introductions to patients and staff </li></ul></ul><ul><li>Community Meetings </li></ul><ul><ul><li>Welcome new members </li></ul></ul><ul><ul><li>Set expectations </li></ul></ul><ul><ul><li>Share responsibilities </li></ul></ul><ul><ul><li>Plan activities </li></ul></ul><ul><ul><li>Discuss conflicts </li></ul></ul>
  7. 7. Components of Milieu Therapy <ul><li>Limit setting </li></ul><ul><li>System of positive and negative reinforcement </li></ul><ul><ul><li>Privileges </li></ul></ul><ul><li>Seclusion and restraint </li></ul>
  8. 8. Seclusion and Restraint <ul><li>Used primarily to prevent physical injury to client, other clients, staff, and visitors </li></ul><ul><li>Sometimes a quiet area is used to reduce stimulation for a client who is overwhelmed on an open unit </li></ul><ul><li>Sometimes used to prevent major damage to a unit or major interference with a therapeutic environment </li></ul>
  9. 9. Assess the need for seclusion or restraint <ul><li>Assess client needs and needs of others </li></ul><ul><li>Talk to client in a quiet area </li></ul><ul><li>Intervene early to prevent escalation </li></ul><ul><li>Use least restrictive interventions principle </li></ul><ul><li>Never use as punishment </li></ul><ul><li>Document </li></ul><ul><ul><li>Risk for injury </li></ul></ul><ul><ul><li>what was tried before restraint or seclusion was implemented </li></ul></ul><ul><ul><li>Client response to those interventions </li></ul></ul>
  10. 10. Continuum of least restrictive interventions <ul><li>Verbal intervention </li></ul><ul><li>Involve in activities if possible </li></ul><ul><li>PRN Medication </li></ul><ul><li>Seclusion </li></ul><ul><li>Medication given IM without the client ’ s consent (chemical restraint) </li></ul><ul><li>Physical restraint as last resort </li></ul>
  11. 11. Use of Seclusion or Restraint <ul><li>Assure adequate numbers of staff are available </li></ul><ul><li>Give choice to walk to the seclusion area </li></ul><ul><li>Give client a few seconds to decide if he or she will walk to the seclusion area </li></ul><ul><li>If client does not adhere, each staff member grabs a limb and lowers the client to the floor (take down procedure) </li></ul>
  12. 12. Use of Seclusion or Restraint <ul><li>Carry client to seclusion area </li></ul><ul><li>Apply restraints </li></ul><ul><li>Search client for dangerous objects </li></ul><ul><li>Administer IM medication if ordered and appropriate </li></ul>
  13. 13. After Implementing Restraints <ul><li>Consult physician or ARNP or notify as soon as practical </li></ul><ul><li>Have physician or ARNP examine client within 1-3 hours and again every 12 hours </li></ul><ul><li>Explain reasons to client and family </li></ul><ul><li>Offer emotional support </li></ul><ul><li>Document </li></ul>
  14. 14. Nursing Actions for the Client in Restraints <ul><li>Observe at least every 15 minutes and document </li></ul><ul><ul><li>Level of consciousness </li></ul></ul><ul><ul><li>Mental status </li></ul></ul><ul><ul><li>Vital signs </li></ul></ul><ul><li>Every two hours document </li></ul><ul><ul><li>Circulation in restrained extremities </li></ul></ul><ul><ul><ul><li>Pulse </li></ul></ul></ul><ul><ul><ul><li>Color </li></ul></ul></ul><ul><ul><ul><li>Movement </li></ul></ul></ul><ul><ul><ul><li>Sensation </li></ul></ul></ul><ul><ul><ul><li>Edema </li></ul></ul></ul>
  15. 15. Nursing Actions for the Client in Restraints <ul><li>Loosen 4 point restraints one at a time every 2 hours. </li></ul><ul><li>Provide meals (without utensils) </li></ul><ul><li>Offer food and fluids every 2 hours </li></ul><ul><li>Provide for hygiene and toileting every 2 hours </li></ul>
  16. 16. Nursing Actions for the Client in Restraints <ul><li>Release extremities (one at a time) every two hours and perform range of motion </li></ul><ul><li>Evaluate continued need for restriction </li></ul><ul><li>Gradually release client </li></ul><ul><li>“ Debrief ” or discuss the episode with the client when s/he has regained control </li></ul>