Therapeutic Milieu

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