Lecture 5 Community and Mental Health Nursing-NUR 472 Milieu — The Therapeutic Environment

Milieu, Defined  Milieu is the French word – in English translation, the word milieu means “surroundings, or environment.”  Milieu therapy is the treatment of mental disorder or maladjustment by making substantial changes in a patient's immediate life circumstances and environment in a way that will enhance the effectiveness of other forms of therapy.  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.

Milieu Therapy  Client makes decisions and solves problems related to government of the unit.  Destructive behaviors can usually be controlled with group discussion. However, if an individual requires external controls, temporary isolation is preferred over lengthy restriction or other harsh punishment.

Goals of milieu therapy  Manipulate the environment so that all aspects of client’s hospital experience are considered therapeutic.  Client is expected to learn adaptive coping, interaction and relationship skills that can be generalized to other aspects of his or her life.  Achieving client autonomy

Principles of milieu therapy  To promote a fundamental respect for individuals (both clients and staff).  To use opportunities for communication between client and staff for maximum therapeutic benefit.  To encourage clients to act at a level equal to their ability and to enhance their self esteem( autonomy is reinforced)  To promote socialization.  To provide opportunities for clients to be part of unit management.

Principles of milieu therapy(cont.)  Individuals are held responsible for own actions.  Peer pressure is utilized to reinforce rules and regulations.  Team approach is used.  Group discussions and temporary seclusions are favored approaches for acting out behavior.  The nurses function is to act in ways that consistently promote these goals.

The Program of Therapeutic Community  The treatment plan is directed by an interdisciplinary team.  Disciplines may include psychiatry, psychology, nursing, social work, occupational therapy, recreational therapy, art therapy, music therapy, dietetics, and the clergy.  The plan is formulated by the team.  Team members of all disciplines sign the plan and meet regularly to update the plan as needed.

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 client ’ s physiological and psychological needs are met.  Nurses are also responsible for  Medication administration  Development of a one-to-one relationship  Setting limits on unacceptable behavior  Client education