Chapter 12: Milieu Therapy

the client is expected to learn...

adaptive coping interaction relationship skills

Milieu therapy creates what?

an environment that is supportive, therapeutic, and safe

chaplain

assesses, identifies, and attends to the spiritual needs of clients and their family members

Which of the following best describes the role of the psychiatric tech as a member of the interdisciplinary treatment team? a)Provides ongoing assessment of client's mental and physical condition b)Functions under the supervision of the psychiatric nurse c)Serves as the leader of the treatment team d)Conducts individual, group, and family therapy

b)Functions under the supervision of the psychiatric nurse

John tells the nurse, "I think lights out at 10 o'clock on a weekend is stupid. We should be able to watch TV until midnight!" Which of the following is the most appropriate response from the nurse on the milieu unit? a. "John, you were told the rules when you were admitted." b. "You may bring it up before the others at the community meeting, John." c. "Some people want to go to bed early, John." d. "You are not the only person on this unit, John. You must think of others besides yourself."

b. "You may bring it up before the others at the community meeting, John."

Which of the following activities would be a responsibility of the psychiatric clinical nurse specialist on the IDT team? a. Manages the therapeutic milieu on a 24-hour basis. b. Conducts group therapies and provides consultation and education to staff nurses. c. Directs a group of clients in acting out a situation that is otherwise too painful for a client to discuss openly. d. Locates halfway house and arranges living conditions for client being discharged from the hospital.

b. Conducts group therapies and provides consultation and education to staff nurses.

recreational activities

include games and community outings

Unstructured, flexible time

includes opportunities for the nurse and other staff to observe clients as they interact spontaneously within the milieu

Milieu

middle, surroundings, or environment

Therapeutic Relationship

focuses on client

countertransference

occurs when a health care team member displaces characteristics of people in her past onto a client

transference

occurs when the client views a member of the health care team as having characteristics of another person who has been significant to the client's personal life

community meetings

on the MH unit should enhance the emotional climate of the therapeutic milieu by promoting

dietician

plans nutrition programs and supervises the preparation and serving of meals

social relationship

primary purpose is for socialization or friendship with a focus on the mutual needs of the individuals involved in the relationship

The psychiatric-mental health nurse provides what?

structures and maintains a safe and therapeutic environment in collaboration with patients, families, and other health-care clinicians

Nurses have the responsibility for meeting what?

the client's physiological and psychological needs

Psychiatric clinical nurse specialist

-Conducts individual, group, and family therapy. -Presents educational programs for nursing staff. -Provides consultation services to nurses who require assistance in the planning and implementation of care for individual clients.

psychiatric social worker

-Conducts therapy. -Concerned with client's social needs. -Conducts in-depth psychosocial history on which the needs assessment is based. -Works with client and family to ensure that requirements for discharge are fulfilled and needs can be met by appropriate community resources.

mental health technician

-Functions under the supervision of the psychiatric nurse. -Provides assistance to clients in the fulfillment of their activities of daily living. -Assists activity therapists as required in conducting their groups.

psychiatric nurse

-Provides ongoing assessment of client condition, both mentally and physically. -Manages on a 24-hour basis. -Administers meds. -Assists clients with all therapeutic activities as required. -Focus on one-to-one relationship development.

a therapeutic nurse-client relationship is:

-Purposeful and goal directed -Well defined with clear boundaries -Structured to meet the client's needs -Characterized by an interpersonal process that is safe, confidential, reliable, and consistent

clinical psychologist

-conducts therapy -psychological tests

psychiatrist

-serves as leader of team -responsible for diagnosis and treatment -prescribes meds

Boundaries in the Therapeutic Relationship

-social relationship -therapeutic relationship

Orient the new client:

-to environment -their rights and responsibilities -their structured activities -any limits or restrictions to maintain safety

Conditions to Promote a Therapeutic Community

1. Basic physiological needs are fulfilled. 2. The physical facilities are conducive to achievement of the goals of therapy. 3. A democratic form of self-government exists. 4. Responsibilities are assigned according to client capabilities. 5. A structured program of social and work-related activities is scheduled as part of the treatment program. 6. Community and family are included in the program of therapy in an effort to facilitate discharge from treatment.

7 basic assumptions of a therapeutic community

1. The health in each individual is to be realized and encouraged to grow. 2. Every interaction is an opportunity for therapeutic intervention. 3. Each client owns his or her own environment. 4. Each client owns his or her own behavior. 5. Peer pressure is a useful and powerful tool. 6. Inappropriate behaviors are dealt with as they occur. 7. Restrictions and punishment are to be avoided.

transference example

A client may see a nurse as being like his mother and thus may demonstrate some of the same behaviors with the nurse as he demonstrated with his mother.

countertransference example

A nurse may feel defensive and angry with a client for no apparent reason if the client reminds her of a friend who often elicited those feelings.

Milieu therapy or therapeutic community

A scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the individual

individual therapy

characterized by scheduled sessions with a mental health provider to address specific mental health concerns, such as depression

Countertransference

HCT member displaces characteristics of people in her past onto a client

Therapeutic Community is also called what?

Milieu Therapy

therapeutic relationship

Primary purpose is to identify the client's problems or needs and then focus on assisting the client in meeting or resolving those issues

Which nursing action demonstrates the role of the teacher in a therapeutic milieu? a) The nurse holds a group meeting to present common side effects of psychiatric meds. b) The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit. c) The nurse implements a self-affirmation exercise during a one-to-one client interaction. d) The nurse introduces the concept of fair play while playing cards with a group of clients.

a) The nurse holds a group meeting to present common side effects of psychiatric meds.

Which of the following best describes the role of the nurse as a member of the interdisciplinary treatment team? a)Provides ongoing assessment of client's mental and physical condition b)Functions under the supervision of the psychiatric nurse c)Serves as the leader of the treatment team d)Conducts individual, group, and family therapy

a)Provides ongoing assessment of client's mental and physical condition

A nurse is planning care for the termination phase of a nurse-client relationship. Which of the following actions should the nurse include in the plan of care? a. Discussing ways to use new behaviors. b. Practicing new problem-solving skills. c. Developing goals d. Establishing boundaries

a. Discussing ways to use new behaviors.

One of the goals of therapeutic community is for clients to become more independent and accept self-responsibility. Which of the following approaches by staff best encourages fulfillment of this goal? a. Including client input and decisions into the treatment plan. b. Insisting that each client take a turn as "president" of the community meeting. c. Making decisions for the client regarding plans for treatment. d. Requiring that the client be bathed, dressed and attend breakfast on time each morning.

a. Including client input and decisions into the treatment plan.

On the milieu unit, duties of the staff psychiatric nurse include which of the following? (Select all that apply.) a. Medication administration b. Client teaching c. Medical diagnosis d. Reality orientation e. Relationship development f. Group therapy

a. Medication administration b. Client teaching d. Reality orientation e. Relationship development

Sally was sexually abused as a child. She is a client on the milieu unit with a diagnosis of borderline personality disorder. She has refused to talk to anyone. Which of the following therapies might the IDT team choose for Sally? (Select all that apply.) a. Music therapy b. Art therapy c. Psychodrama d. Electroconvulsive therapy

a. Music therapy b. Art therapy c. Psychodrama

Which of the following are basic assumptions of milieu therapy? (Select all that apply.) a. The client owns his or her own environment. b. Each client owns his or her behavior. c. Peer pressure is a useful and powerful tool. d. Inappropriate behaviors are punished immediately.

a. The client owns his or her own environment. b. Each client owns his or her behavior. c. Peer pressure is a useful and powerful tool.

In the community meeting, which of the following actions is most important for reinforcing the democratic posture of the therapy setting? a. Allowing each person a specific and equal amount of time to talk. b. Reviewing group rules and behavioral limits that apply to all clients. c. Reading the minutes from yesterday's meeting. d. Waiting until all clients are present before initiating the meeting.

b. Reviewing group rules and behavioral limits that apply to all clients.

A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following actions indicates transference behavior? a. The client asks the nurse whether she will go out to dinner with him. b. The client accuses the nurse of telling him what to do just like his ex-girlfriend. c. The client reminds the nurse of a friend who died from a substance overdose. d. The client becomes angry and threatens harm to himself.

b. The client accuses the nurse of telling him what to do just like his ex-girlfriend.

Psychoeducational groups

based on a client's level of functioning and personal needs, such as adverse effects of medication

A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements should the nurse make? a) "You and a group of other clients will meet to discuss your treatment plans." b) "Community meetings have a specific agenda that is established by the staff." c) "You and the other clients will meet with staff to discuss common problems." d) "Community meetings are an excellent opportunity to explore your personal mental health issues."

c) "You and the other clients will meet with staff to discuss common problems."

A client, diagnosed with borderline personality disorder, approaches the nursing station often with various requests. The nurse intervenes by stating, "You may approach the nurse's station only once an hour." Which nursing intervention has been employed? a) Providing reality orientation b) Ensuring physical need fulfillment c) Setting limits on behavior d) Providing client education

c) Setting limits on behavior

Which of the following best describes the role of the psychologist as a member of the interdisciplinary treatment team? a)Provides ongoing assessment of client's mental and physical condition b)Functions under the supervision of the psychiatric nurse c)Serves as the leader of the treatment team d)Conducts individual, group, and family therapy

c)Serves as the leader of the treatment team

A nurse is talking with a client who is at risk for suicide following the death of his spouse. Which of the following statements should the nurse make? a. "I feel very sorry for the loneliness you must be experiencing." b. "Suicide is not the appropriate way to cope with loss." c. "Losing someone close to you must be very upsetting." d. "I know how difficult it is to lose a loved one."

c. "Losing someone close to you must be very upsetting."

A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements by the nurse is appropriate? a. "You and a group of other clients will meet to discuss your treatment plans." b. "Community meetings have a specific agenda that is established by staff." c. "You and the other clients will meet with staff to discuss common problems." d. "Community meetings are an excellent opportunity to explore your MH issues."

c. "You and the other clients will meet with staff to discuss common problems."

Which of the following activities would be a responsibility of the clinical psychologist member of the IDT? a. Locates halfway house and arranges living conditions for client being discharged from the hospital. b. Manages the therapeutic milieu on a 24-hour basis. c. Administers and evaluates psychological tests that assist in diagnosis. d. Conducts psychotherapy and administers electroconvulsive therapy treatments.

c. Administers and evaluates psychological tests that assist in diagnosis.

In prioritizing care within the therapeutic environment, which of the following nursing interventions would receive the highest priority? a. Ensuring that the physical facilities are conducive to achievement of the goals of therapy. b. Scheduling a community meeting for 8:30 each morning. c. Attending to the nutritional and comfort needs of all clients. d. Establishing contacts with community resources.

c. Attending to the nutritional and comfort needs of all clients.

A charge nurse is discussing the characteristics of a nurse-client relationship with a newly licensed nurse. Which of the following characteristics should the nurse include in the discussion? a. The needs of both participants are met. b. An emotional commitment exists between the participants. c. It is goal-directed. d. Behavioral change is encouraged. e. A termination date is established.

c. It is goal-directed. d. Behavioral change is encouraged. e. A termination date is established.

group therapy

characterized by scheduled sessions for a group of clients to address common MH issues, such as substance use disorder

Transference

client views member of the HCT as having characteristics of another person who has been significant to the client's personal life

Which of the following best describes the role of the psychiatric social worker as a member of the interdisciplinary treatment team? a)Provides ongoing assessment of client's mental and physical condition b)Functions under the supervision of the psychiatric nurse c)Serves as the leader of the treatment team d)Conducts individual, group, and family therapy

d)Conducts individual, group, and family therapy

Client teaching is an important nursing function in milieu therapy. Which of the following statements by the client indicates the need for knowledge and a readiness to learn? a. "Get away from me with that medicine! I'm not sick!" b. "I don't need psychiatric treatment. It's my migraine headaches that I need help with." c. "I've taken Valium every day of my life for the last 20 years. I'll stop when I'm good and ready!" d. "The doctor says I have bipolar disorder. What does that really mean?"

d. "The doctor says I have bipolar disorder. What does that really mean?"

Psychodramatist

directs clients in the creation of a "drama" that portrays real-life situations

Community meetings are an opportunity for clients to do what?

discuss common problems/issues affecting all members of the unit

Music Therapist

encourages clients in self-expression through music

One of the first nursing interventions is what?

establishing a foundation for trust and maintaining a therapeutic milieu

nurses manage the what?

therapeutic environment on a 24-hour basis

Therapeutic Community

this approach strives to manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic

Recreational Therapist

uses recreational and leisure activities as form of treatment

art therapist

uses the client's creative abilities to encourage expression of emotions and feelings through artwork

occupational therapist

works with client to help develop independence in performance of ADLs

The most important thing to consider in MH is what?

your safety and the safety of the client