Chapter 12: the therapeutic environment
Use of the Inpatient Setting
provided for 3 groups of people: • Those who are experiencing crises • Those with acute mental or emotional problems • Those with chronic mental illness
Limit setting in facilities , such as rules for television use in the recreation room or visiting hours, aids in the clients feelings of :
safety and security
Variables of the Therapeutic Environment
• every staff member assists Patient's with ADL's and monitors each step towards treatment goals • Admission and discharge >clients are expected to follow Rules > Appropriate activities engagement > Support the patient with environment > Discharge always begins upon admission > Compliance- clients who follow prescribed treatments are said to be in in-complience , noncompliance refers to not cooperating with the treatment plan 40-80% of clients do not comply with their prescribed therapeutic course , genuine concern is a powerful in helping clients with compliance As therapeutic relationship ends, a client can use ones own resources to deal with difficult situations and the clients independent in therapy and compliment with medications are the expectations in the end from the provider
Goals of a Therapeutic Environment
-Goals are: provide protection, support, and education. -in the Therapeutic environment: • Meeting Patient needs • clients can Learn to replace maladaptive behavior with more effective actions
It is estimated that what percentage of clients with mental and physical health disorders do not comply with their prescribed treatment plan
40 to 80%
Which of the following terms is used to describe whether a client's environment is relaxing and pleasing to the eye and communicates a sense of belonging?
Aesthetics- Aesthetics refers to the condition of the environment and whether it makes a person want to stay and relax, or leave quickly.
The process of preparing for client discharge should begin during which of the following?
Admission- The process of preparing for discharge begins on admission in order to facilitate client reintegration into the community.
A hospitalized client who is paranoid believes that all food served in the hospital is poisoned. An appropriate intervention by the nurse is which of the following?
Allow client to observe other clients eating the same food. Observation of other clients eating the same food would be most convincing for the client.
The nurse enters the room of a male client who demonstrated suspicious tendencies. As the nurse walks through the room, the client yells "get away from my closet" what is the nurses most appropriate action ?
Avoid getting close to the closet
The Therapeutic Environment and Client Needs
Basic physical needs must be met first before higher level needs can be met -Physiologic needs- patient needs to be able to breath, need nourishment , good hygiene , and safe environment -Safety and security -Love and belonging- need to be accepted -Self-esteem needs- love and respect yourself before others can love and respect you -Self-actualization needs- needs to fulfill ones potential
A client is emotionally distraught over an impending divorce and is unable to cope effectively. Which of the following interventions would be most appropriate for this client?
Crisis stabilization- Crisis stabilization interventions are provided by placing clients in 1-day or 2-day treatment settings where balance can be reestablished.
Which of the following is a goal of a therapeutic environment?
Educate- The goals of a therapeutic environment are to provide protection, support, and education.
A depressed client threatens to kill himself and tells a friend his plan. The client should be admitted to which of the following?
Inpatient unit- The client's behavior is a threat to himself; therefore, his behavior meets the criteria for an inpatient mental health admission.
During the night shift, several staff members are being loud at the nurses station if an inpatient mental health unit. The nurse asks them to hold down the noise. The nurse has asked this if the staff most likely because she knows that excessive noise can
Interfere with clients thinking process and perceptions
The Therapeutic Environment
More effective settings -In 1953, Maxwell Jones published book -Published in the United States as The Therapeutic Community -Environments designed to help clients replace inappropriate behavior
A client is actively sharing experiences and making an effort to modify his ineffective behaviors within his environment. This is an example of __.
Orientation- Orientation to time, place, and person and level of consciousness are included in the admission assessment.
Use of the Inpatient Setting cont'd.
Recidivism-is repeated inpatient admissions -it is a Revolving-doorsyndrome -Way of life -Frustrating aspects of inpatient mental health care for both patient's and providers -patients refusal to take prescribed medication - so basically they are Noncompliant and end up coming back to inpatient setting
A 30 year old man is brought to the mental health inpatient unit with the diagnoses of schizophrenia. His clothes are dirty , his hair is uncombed, he has not shaved for several days, and his teeth are chipped with several cavities evident. He is having hallucinations and delusions . What is the priority nursing diagnoses at this time ?
Self care deficit: bathing , hygiene
Which of the following is a lower-order need that must be fulfilled before self-esteem needs can be met?
Sleep- According to Maslow, sleep, air, food, and elimination are lower-order needs.
A certain setting, or environment, designed to help clients replace inappropriate behaviors with more effective personal and psychosocial skills defines which of the following?
Therapeutic environment- In a therapeutic environment, physical surroundings are pleasant but safe, activities are structured, and clients are expected to participate in their treatments.
The nurse wants to help improve his clients compliance with treatment. In order to do this , the nurse must:
Understand the clients unwillingness to follow treatment plan