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.