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Milieu therapy

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milieu therapy

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Milieu therapy

  1. 1. MILIEU THERAPY To:T.ngla abualzahb by: Jamla bejad Nawal galed Rana tamimi Awatif mobark
  2. 2. Objectives  Define milieu therapy  Basic assumptions  Conditions That Promote a Therapeutic Community  Therapeutic community  Nursing role  Nursing care plan
  3. 3. Introduction  “The psychiatric-mental health nurse provide structures, and maintain a therapeutic environment in collaboration with the patient, families, and other health care clinicians. “
  4. 4. Milieu therapy Defin 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
  5. 5. Basic assumptions 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
  6. 6. Condition that promote a therapeutic community 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.
  7. 7. Conditions That Promote a Therapeutic Community 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.
  8. 8. Cont…..  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 treatment.
  9. 9. Therapeutic community Promotion  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 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 form
  10. 10.  Program  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 needed.  Disciplines may include psychiatry, psychology, nursing, social work, occupation therapy, recreational therapy, art therapy, music therapy, dietetics, and chaplains service .
  11. 11. Nursing role  Thorough use of the nursing process, nursing manage the therapeutic environment on a 24- hours.  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.  Client education
  13. 13. Assessment data related factors(etiology)  Impaired ability to process/synthesize internal /external stimuli.  Disintegration of boundaries between self and others and self and the environment .  Biologic factors (neurophysiologic, genetic, structural)  Sensory – perceptual alterations  Psychosocial /environmental stressors
  14. 14. Defining characteristics  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 and fantasy.
  15. 15. Cont…. 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
  16. 16. Cont… o I know they are planning to capture me and use my brain for science.  Inappropriate reactions to others communication behavior and environmental events. 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 calculate. o Interprets the proverb a stitch in time saves nine as it takes nine stitches to save time
  17. 17. RationalNursing intervention 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 facility policies. 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 processes.. 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 perceptions. Approach the client in a slow calm matter of fact manner 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 persecutory type. Maintain facial expressions and behaviors that are consistent with verbal statements.
  18. 18. rationaleNursing intervention 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 clients behavior 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 abilities. 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 other clients
  19. 19. Nursing intervention 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?”
  20. 20. Reference  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 Fifth education
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