Chapter 23
Chapter 23
Chapter 23
Learning Objectives
Define the terms therapeutic mileu, therapeutic environment, and therapeutic community. Describe the goal of managing the therapeutic environment for the care of psychiatric patients. Identify the elements of the therapeutic environment. Discuss several ways in which nurses can influence the therapeutic environment.
Therapeutic Environment
Vital ingredient in facilitating the journey of recovery of patients. Functions are as follows: to protect the patient from potentially harmful effects to maximize opportunities for patients to learn something about themselves and their difficulties in everyday living
Therapeutic Milieu
Refers to a formalized treatment modality called milieu therapy.
Safety
Always a priority Includes both physical and psychological protection Environmental intervention (removing harmful items)
Structure
An essential component of a therapeutic milieu Refers to the physical environment, daily schedules of treatment activities, and informal rules of interacting between patients and staff Nurses lead activities such as patient education and social skills training group Recreation and art are an important aspect of the structured treatment environment
Norms
Specific expectations of behavior that permeate the treatment environment Intended to promote safety and trust in the environment through the sanctioning of socially acceptable behaviors ad consistency about what to expect Many of the behavioral norms are related to the activities of daily living.
Norms
Other types of norms are focused on personal responsibility, such as the expectations are: 1. Patient will not harm themselves. 2. Patient will attend and participate in group meetings. 3. Patient will focus on their personal treatment plan.
Limit Setting
Includes approaches for regulating patients behavior through the use of verbal and nonverbal nurse communications, fast-acting sedating medications, and environmental modalities. Purpose of limit setting is to: 1. Maintain and/or create security for patients and health care personnel. 2. Facilitate patients growth and development.
Balance
Involves the process of gradually allowing independent behaviors in a dependent situation.
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