Chapter 12 Milieu The Therapeutic Environment

Introduction
The psychiatric-mental health nurse provides
structures, and maintains a therapeutic environment in collaboration with the client and other health care clinicians.
Standard Vb of the American Nurses

Association Standards of Psychiatric Mental Health Nursing Practice

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.

Current Status
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.

Current Status (cont.)

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.

Basic Assumptions
The health of each individual is to be realized and encouraged to grow. Every interaction is an opportunity for therapeutic intervention. The client owns his or her environment. Each client owns his or her behavior. Peer pressure is a useful and powerful tool. Inappropriate behaviors are dealt with as they occur. Restrictions and punishment are to be avoided.

Conditions Promoting a Therapeutic Community

Basic physiological needs are fulfilled. The physical facilities are conductive 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 from the hospital.

The Program of Therapeutic Community

The treatment plan is directed by an interdisciplinary team. The 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 chaplains service.

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 clients physiological and psychological needs are met.

Role of the Nurse (cont.)

Nurses are also responsible for
Medication administration

Development of a one-to-one relationship Setting limits on unacceptable behavior Client education