Exam 1 Mental Health Chapter 20

Chapter 20 Intro to Milieu Management Therapeutic environment: growth promoting atmosphere created in treatment setting; influence by relat among staff, patients, & visitors; physical structure Therapeutic milieu: beneficial aspects of the treatment setting Milieu!Management - The nurse’s involvement in creating a therapeutic environment determines the overall atmosphere of se Recovery oriented care is a goal for mental health care system Person can improve their health & wellness and live a self directed life striving to reach full potential Goal is to ensure protection of patients from potentially harmful effects & maximize opportunities to le self & difficulties in everyday living Therapeutic environment = therapeutic milieu = milieu therapy Historical!Overview - p - -Custodial care: patient care focused on the patient’s ADLs such as hygiene, nutrition, elimination, safe >paternalistic system in which the staff knew what was best for the patient; no structured tx activitie -Maxwell Jones wrote The Therapeutic Community in 1953, discussing the benefit of a therapeutic env -Proposed patient involvement in decision making through therapeutic community meetings -Current inpatient acute families: >fewer beds >reduced length of stay >higher acuity of psychotic & detained patients >increased risk of violence >purpose of hospitalization is to contain & resolve crises >rapid stabilization of symptoms & return to community treatment programs The!Joint!Comission!Environment!of!care Environmental safety: >ongoing assessment & maintenance of all equipment >hazard surveillance >reporting & investigation of safety issues >monitor safety management techniques & procedures >orientation programs that address safety issues Ensures security of all people: >mechanisms for addressing security issues >provision of appropriate identification >security orientation programs >door locks >closet & drawer space >telephones for private conversations Nursing!&!the!Therapeutic!Environment! Florence Nightingale recognized the importance of the environment on patient recovery Nurses traditionally are responsible for activities to manage environment Therapeutic relationships promotes corrective learning experiences to help the patient learn & adapt to roblems in daily living Deals with issues “here & now” interaction as part of treatment plan Nurses take an active role to ensure the therapeutic environment Nurse must pay attention to personal values, reactions, and preconceptions Alter the environment to be therapeutic Elements!of!Treatment!Environment! -Involves physical & psychological protection -Prevent suicide -Prevent verbal or physical aggression -Safety observations, observe patients in a. frequency determined by the unit & patient needs -Environmental care to prevent intrusive behavior such as getting into people’s private space or bullying -Post patient rights -Control aggression -Provide emotional safety; be there for your patient -Expectations of behavior that permeate the treatment environment; intended to promote safety & trust -Socially acceptable behavior and consistency about what to expect -Creates an environment that is predictable & applicable to all patients -Many behavioral norms are r/t ADLs or focused on personal responsibility -Offers a sense of control & avert power struggles -How nurses establish boundaries & clarify expectations about appropriate behavior -Verbal & nonverbal nurse communications -Fast acting sedating medications -Purpose is to maintain safety & security -Environmental modalities such as restraints & seclusion -Facilitate patient growth and development -Refers to physical environment, daily sche of treatment activites, and informal rule interacting between patients & staff -Nurses lead activities such as patient education and social skills training groups -Teach about medications, SE, & aftercare support for both patients & families is an important function -Psychosocial groups led by social workers or trained therapists; individual and/or family therapy -Art therapy, occupational therapy -Group exercise programs -Recreational activities -Physical design of unit -The process of gradually allowing independ behaviors in a dependent situation -Weigh the needs of the patient involved as w as the needs of the other patients and staff on the unit -Proactive stance based on patient needs Nurse!As!Manager!of!the! Treatment!Environment -Creating an atmosphere in which patients can lear new behaviors or become aware of personal strengths -Flexibility based on ongoing evaluation of effectiv