1. Therapeutic Milieu Assumption: the social milieu itself is an instrument of treatment How cooks, Nurses, Techs, Psychiatrists Social Workers treat the client is important Milieu refers to the structure a unit provides: the context of treatment, both physical and social.

2. Definitions Therapeutic Milieu - “conceptual approach in which all aspects of the environment are channeled to make a therapeutic environment for the patients” A microcosm of society. Therapeutic Community-Has patient government- Patient decision making Milieu Management- “Purposeful manipulation of the environment to promote a therapeutic atmosphere.”

3. Defining characteristics Physical setting Social culture How problems are handled A variety of settings Psychotherapeutic atmosphere

4. Basic Guidelines Health in each individual is acknowledged and cultivated Every interaction is an opportunity for therapeutic intervention The clients “own” the environment – Daily ward (unit) meetings Each client is accountable for themselves and their own behavior

5. Guidelines Cont. Peer pressure is fostered – Especially on adolescent unit Issues handled immediately restriction and punishment avoided – Pt. safety is issue, ALWAYS

6. Elements of the Effective Milieu 1. Safety (examples) Psychological and physical Restraint and seclusion No contraband (cans, glass, lighters) 2. Structure (examples) Unit schedules, meals, bedtime Groups Visiting hours 3. Norms (examples) Individual responsibility Rules 4. Limit setting (examples) cannot harm to self or others; cannot smoke 5. Balance (examples) Rights of one person to talk loud –VS- rights of others to quiet Nursing judgment and critical thinking Environmental Modification- bending rules when necessary to be therapeutic.

7. Role of the Nurse Sets the TONE of the Milieu; Organizer of supportive social environment – Group leader – Coordinator /supervisor of unit – Therapeutic milieu is core function of nursing – Therapeutic use of self Direct care and treatment responsibilities