Chapter 23

Introduction to Milieu Management

Psychiatric-Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)

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.

Keltners Psychiatric Nursing Philippine edition

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

Keltners Psychiatric Nursing Philippine edition

Therapeutic Milieu
Refers to a formalized treatment modality called milieu therapy.

Keltners Psychiatric Nursing Philippine edition

Nursing and the Therapeutic Environment

Patient benefits from therapeutic environment as it provides opportunities to try new behaviors and solve problems in real life situation. Interactions are opportunities to help the patient learn and adapt to their problem. Distortions, conflicts, and inappropriate behavior are dealt with in the here and now and relate back to the patients treatment plan.

Keltners Psychiatric Nursing Philippine edition

Nursing and the Therapeutic Environment

Paying attention to personal values, reactions, and preconceptions is one aspect of keeping the environment therapeutic. Effective nursepatient interactions and communication skills.

Keltners Psychiatric Nursing Philippine edition

Elements of the Treatment Environment

Safety Structure Norms Limit setting Balance

Keltners Psychiatric Nursing Philippine edition

Safety
Always a priority Includes both physical and psychological protection Environmental intervention (removing harmful items)

Keltners Psychiatric Nursing Philippine edition

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

Keltners Psychiatric Nursing Philippine edition

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.

Keltners Psychiatric Nursing Philippine edition

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.

Keltners Psychiatric Nursing Philippine edition

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.

Keltners Psychiatric Nursing Philippine edition

Balance
Involves the process of gradually allowing independent behaviors in a dependent situation.

Keltners Psychiatric Nursing Philippine edition