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Ch12 milieu therapy(3) (1)

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Ch12 milieu therapy(3) (1)

  1. 1. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Chapter 12 Milieu Therapy ― The Therapeutic Community
  2. 2. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 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 health-care clinicians.” * To provide the # 1 Priority of a nurse on newly admitted is to search the client for contraband or hazardous stuff.   Standard 5c of the American Nurses’ Association Standards of Psychiatric– Mental Health Nursing Practice, 2007
  3. 3. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 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, interaction, and relationship skills that can be generalized to other aspects of his or her life.
  4. 4. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Current Status of Milieu Therapy  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.
  5. 5. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Current Status of Milieu Therapy (cont’d)  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.
  6. 6. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Basic Assumptions of Milieu Therapy  The health in each individual is to be realized and encouraged to grow.*A newly admitted client was given a unit schedule and refuses to attend groups. Client stated I am here to rest. The best response of a nurse is group therapy provides the opportunity to learn and practice new coping skills  Every interaction is an opportunity for therapeutic intervention.*AN CLIENT WAS ANGRY BECAUSE SOMEBODY STOLE HIS FAVORITE SHAMPOO. STATING TO THE NURSE YOU NEED TO DO SOMETHING ABOUT THIS NOW.  The client owns his or her own environment.  Each client owns his or her own behavior.-*A CLIENT WAS ANGRY AND TELL THE NURSE THE OTHER CLIENT IS NOT DOING HIS SHARE OF CLEANING AFTER HIMSELF. THE NURSE SHOULD RECOGNIZE THIS BEHAVIOR AND GIVE HIM THE CHANCE TO DSICUSS CONCERS.  Peer pressure is a useful and powerful tool.  Inappropriate behaviors are dealt with as they occur.  Restrictions and punishment are to be avoided.
  7. 7. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Conditions That Promote a Therapeutic Community  Basic physiological needs are fulfilled.  The physical facilities are conducive to achievement of the goals of therapy.  *A democratic form of self-government exists.-*Treating all clients equally.  *Responsibilities are assigned according to client capabilities.  A structured program of social and work-related activities is scheduled as part of the treatment program. *A client with schizophrenia decompensate after discharge. The client needs a structured programming which is not available in the home setting.  *Community and family are included in the program of therapy in an effort to facilitate discharge from treatment.
  8. 8. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 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.  *Psychological testing result are review by Psychologist.
  9. 9. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company The Program of Therapeutic Community (cont’d) 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) Conducts individual, group, and family therapy D) Serves as the leader of the treatment team
  10. 10. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company The Program of Therapeutic Community (cont’d) Correct answer: D  The psychiatric social worker is a member of the interdisciplinary treatment team and conducts individual, group, and family therapy.
  11. 11. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company 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 client’s physiological and psychological needs are met.
  12. 12. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Role of the Nurse (cont’d)  Nurses are also responsible for  Medication administration- * Nurses should promote self –reliance on medication administration by encouraging clients to request their medication at the appropriate time  Development of a one-to-one relationship  Setting limits on unacceptable behavior  Client education-* The best topic is stress management.
  13. 13. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Role of the Nurse (cont’d) 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
  14. 14. Psychiatric Mental Health NursingPsychiatric Mental Health Nursing 77thth EditionEdition Copyright © 2012 F.A. Davis Company Role of the Nurse (cont’d) 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.
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