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Define milieu therapy
Conditions That Promote a Therapeutic
Nursing care plan
“The psychiatric-mental health
nurse provide structures, and
maintain a therapeutic
environment in collaboration with
the patient, families, and other
health care clinicians. “
e• A scientific structuring of the
environment to effect behavioral charges
and to improve the psychological health
and functioning of the individual
• Within the therapeutic
community stetting the client is
expected to learn adaptive
coping and interaction and
relationship skills that can be
generalized to other aspects of
The health in each individual is to be realized and encourage to grow .
Every interaction in an opportunity for therapeutic intervention.
The client owns his or her own environment .
Each client own his or her behavior.
Peer pressure is s useful and powerful tool.
Inappropriate behaviors are dealt with as they occur.
Restrictions and punishment are to be avoided
Condition that promote a therapeutic
In a therapeutic community setting,
everything that happens to the client, or
within the clients environment, is
considered to be part of the treatment
program. the community setting is the
foundation for program of treatment.
Conditions That Promote a
Under what conditions, then, is a hospital
environment considered therapeutic? A
number of criteria have been identified:
• Basic physiological needs are fulfilled.
• The physical facilities are conducive to
achievement of the goals of therapy.
• A democratic form of self-government exists.
Responsibilities are assigned according to
A structured program of social and work-
related activities is scheduled as part of the
Community and family are included in the
program of therapy in an effort to facilitate
discharge from treatment.
Basic physiologic needs are fulfilled.
The physical facilities are condition to
achievement of the goals of therapy.
A democratic form of self-government exists.
Responsibilities are assigned according to client
A structured program of social and work-related
activities is scheduled as part of the treatment
Community and family are included in the
Therapy in an effort to facilitate discharge form
Care is directed by an interdisciplinary team.
A comprehensive treatment plan is formulated
by the team
Team members of ail disciplines signs the plan
and meet regularly to update the plan as
Disciplines may include psychiatry, psychology,
nursing, social work, occupation therapy,
recreational therapy, art therapy, music therapy,
dietetics, and chaplains service .
Thorough use of the nursing process, nursing
manage the therapeutic environment on a 24-
Nurses have the responsibility for ensuring that the
clients psychological needs are met
Nursing are also responsible for
Medication of administration
development of a one-to-one relationship.
Setting limits on unacceptable behavior.
Assessment data related
Impaired ability to process/synthesize internal /external
Disintegration of boundaries between self and others
and self and the environment .
Biologic factors (neurophysiologic, genetic, structural)
Sensory – perceptual alterations
Psychosocial /environmental stressors
Client inaccurately interprets incoming information .
o Thinks others in the environment are spies or demons.
o Believes the psychiatric intensive care unit is a prison.
o Perceives others benign statements or gestures as
hostile or sexual overtures.
Demonstrates inability to distinguish internally
stimulated thoughts from facts or actual events; the
clients statements reflects combined segments of realty
o The president is our leader. he is the ruler of the universal life and death .
Perceives that others in the environment can hear the cline's thoughts .
Demonstrates neologisms, word salad thought blocking thought insertions
,thought withdrawal ,poverty of speech or mutism(see glossary).
Believes that his or her thoughts are responsible for world events or disasters
o My thoughts are causing all those fires they are burning up the world .
Thinks that he or she is omnipotent and capable of superhuman powers
o I am a messenger for the devil and can destroy the universe.
Believes that others in the environment are plotting evil deeds against the client
o I know they are planning to capture me and use my brain for science.
Inappropriate reactions to others communication behavior and
o Laughs in response to sad or despondent content .
Incites fear or confusion in other clients.
Demonstrates inability to follow or comprehend others communication
or simple instructions, unrelated to language or cultural differences.
Demonstrates impaired ability to abstract conceptualize reason or
o Interprets the proverb a stitch in time saves nine as it takes nine stitches
to save time
The nurses firs priority is to protect the client
and others if the clients delusion or though
disorder contains paranoid or grandiose
content that may result in harm or injury.
Quiet time /seclusion or restraint may be
used along with medication according to
Anxiety is transferable and clients
experiencing psychosis are extremely
sensitive to extremely sensitive to external
stimuli.the nurse anxiety can increase the
clients anxiety and foster disturbed thought
Maintain the safety of client and others in
the environment from possible harmful
effects of the client,s thought
disorder.(client may need quiet time
seclusion or behavioral restraint if other less
restrictive measures such as orientation if
other less restrictive measures such as
orientation or re-direction do not help to
control clients behaviors).
Monitor own level of anxiety and use anxiety
reducing strategies to reduce anxiety to
tolerable level (see appendix g)
A calm approach helps to avoid distorting
the client sensory –perceptual field which
could promote disturbed thoughts and
Approach the client in a slow calm matter of
Clients who are suspicious hostile or
paranoid may perceive touch as a
threatening gesture and react aggressively.
Refrain form touching a client who is
experiencing a delusion especially if it is
Maintain facial expressions and behaviors
that are consistent with verbal statements.
The client with disturbed thought
processes may have difficulty
interpreting correct meanings if the
nurse misrepresents intent with a
conflicting or “double” massages
Nontherapeutic or “double” massages
The nursing smiles while discussing a
serious matter with the client.
The nurse frowns and appears
impatient while telling the client that
the nurse accepts and understand the
Establishing the clients functioning and
determining the extent of cognitive
impairment and progress mad in use of
logical thinking help the nurse facilitate
treatment strategies and maintain
Establish on a continued basis the
clients ability to think logically and to use
realistic judgment and problem –solving
Keen listening helps to elicit problem
areas, promotes the clients willingness
to relate to another person, and helps
meet the clines needs.
Listen attentively for key themes and
realty-oriented phrases or thoughts in
the clients communication with staff and
Clients with disturbed thought processes
interpret abstraction concretely and may
misunderstand or misinterpret the
meaning of the message
Use simple, concrete, or literal
explanations, and avoid use of
abstractions of metaphors.
Therapeutic response(concrete): “its 10
o'clock and time for you to go to bed.”
Nontherapeutic response (abstract): “its
10 o'clock and time to hit the hay.”
Focusing on the intent or feeling versus
the content or words helps meet the
clients needs, reinforce reality, and
discourage the false belief without
challenging the client.
Therapeutic response: “ I know that’s
troubling for you. I'm not frightened
because don't believe the end of the
world is here.”
This Nontherapeutic response feeds into
the clients delusion by reinforcing the
belief that “these people” are real, which
could further confuse the client.
Nontherapeutic response : “describe
those people who out to get you. What do
they look like?”
Townsend “M”((2014). Essentials of psychiatric
mental health nursing :
Concepts of care in Evidence-Based practice, 6th
Edition. F.A. Davis ; Philadelphia PA
Fortinash holoday worret
Psychiatric nursing care plan
Fifth edition 2007
Psyciatric mental health nursing
Concept of care in evidence-based practic
MARY C. TOWONSEND