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Psychiatric-Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)
Chapter 23 Introduction to Milieu
Management
Keltner’s Psychiatric Nursing – Philippine edition
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.
Keltner’s 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
Keltner’s Psychiatric Nursing – Philippine edition
Therapeutic Milieu
• Refers to a formalized treatment modality called milieu therapy.
Keltner’s 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 patient’s treatment plan.
Keltner’s 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 nurse–patient interactions and communication skills.
Keltner’s Psychiatric Nursing – Philippine edition
Elements of the Treatment Environment
• Safety • Structure • Norms • Limit setting • Balance
Keltner’s Psychiatric Nursing – Philippine edition
Safety
• Always a priority • Includes both physical and psychological protection • Environmental intervention (removing harmful items)
Keltner’s 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
Keltner’s 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.
Keltner’s 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.
Keltner’s 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.
Keltner’s Psychiatric Nursing – Philippine edition
Balance
• Involves the process of gradually allowing independent behaviors in a dependent situation.