ATI Ch 5, Creating and Maintaining a Therapeutic and Safe Environment Flashcards
What is a therapeutic nurse-client relationship?
A purposeful and goal-directed relationship
This relationship aims to achieve specific health-related outcomes.
How is a therapeutic nurse-client relationship structured?
It is structured to meet the client’s needs
This structure ensures that the focus remains on the client’s health and well-being.
What are the defining characteristics of a therapeutic nurse-client relationship?
It is well-defined with clear boundaries
Clear boundaries help to maintain professionalism and trust.
List the key aspects of a therapeutic nurse-client relationship.
- Safe
- Confidential
- Reliable
- Consistent
These aspects contribute to a supportive environment for the client.
True or False: A therapeutic nurse-client relationship is characterized by an interpersonal process.
True
The interpersonal process is essential for building rapport and trust.
What is milieu therapy?
An environment that is supportive, therapeutic, and safe
Also known as therapeutic community or therapeutic environment.
What does the management of the milieu involve?
Management of the total environment, physical and psychosocial, of the mental health unit
Aims to provide the least amount of stress, ensure client and staff safety, manage behavioral crisis, and promote recovery.
What are the goals of milieu therapy?
Learn tools to cope adaptively, interact effectively, and strengthen relationship skills
Clients are encouraged to use these tools in all aspects of their life.
Who is responsible for structuring the therapeutic milieu?
The nurse, as manager of care
Responsible for implementing aspects of the therapeutic milieu within the mental health facility.
What is one structure of the therapeutic milieu?
Regular community meetings
These meetings include both the clients and the nursing staff.
What should the physical setting of a therapeutic milieu be like?
Clean and orderly
A therapeutic milieu should promote a safe and inviting atmosphere for clients.
What types of spaces should be included in a therapeutic setting?
Comfortable furniture, solitary spaces, meal areas, quiet sleeping areas
These spaces help facilitate interaction, personal reflection, and relaxation.
How should the color scheme and overall design of a therapeutic milieu be determined?
Appropriate for the client’s age
This consideration helps in making the environment more relatable and comforting for clients.
What qualities should materials in a therapeutic milieu have?
Attractive, easy to clean, and safe
Materials should ensure a hygienic and pleasing environment.
What traffic-flow considerations are important in a therapeutic milieu?
Conducive to client and staff movement
A well-planned layout enhances accessibility and safety.
What is a key responsibility of health care team members in a therapeutic milieu?
Promote independence for self-care
Encouraging clients to take charge of their own care fosters growth.
How should clients be treated within a therapeutic milieu?
As individuals
Recognizing individuality promotes respect and tailored care.
What should clients be allowed concerning their daily routine?
Choices
Allowing choices empowers clients and enhances their sense of control.
What should be applied to ensure fairness among clients?
Rules of fair treatment
Fair treatment helps build trust and a sense of community.
What behavior should health care team members model for clients?
Good social behavior, such as respect for the rights of others
Modeling behavior sets a standard for clients to follow.
What is important for team dynamics in a therapeutic milieu?
Cooperative teamwork
Working together ensures comprehensive care and support.
What boundaries should be maintained in a therapeutic setting?
Boundaries with clients
Maintaining boundaries is crucial for professional relationships.
What appearance and demeanor should health care team members maintain?
Professional
A professional appearance fosters trust and respect.
What types of interactions should be promoted among clients?
Safe and satisfying peer interactions
Positive interactions contribute to a supportive community.
What communication techniques should be practiced with clients?
Open communication techniques
Open communication is essential for building rapport and understanding.
What feelings should be promoted in clients within a therapeutic milieu?
Self-worth and hope for the future
Fostering positive feelings enhances overall mental health.
What emotional safety should clients feel in a therapeutic milieu?
Safe from harm, including self-harm and disruptive behaviors of others
Emotional safety is critical for effective therapy and healing.
What should clients feel from the staff and others in a therapeutic setting?
Cared for and accepted
A caring environment is fundamental to client well-being.
What is a key role of the nurse in the therapeutic nurse-client relationship?
Ensure self-awareness and evaluation of their own beliefs, values, and behaviors.
What should the nurse consistently focus on during interactions with clients?
The client’s ideas, experiences, and feelings.
What is one responsibility of the nurse regarding client needs?
Identify and explore the client’s needs and problems.
What type of communication does the nurse facilitate?
Therapeutic communication.
What should the nurse discuss with the client to aid in problem-solving?
Problem-solving alternatives.
How does the nurse assist in the development of the client?
Help to develop the client’s strengths and new coping skills.
What behavior does the nurse encourage in the client?
Positive behavior change.
What aspect of the client’s development is the nurse responsible for promoting?
A sense of autonomy and self-reliance.
What type of education does the nurse provide to the client and family?
Education about the environment, expectations, disorders, medications, symptom management, and rights of the client.
What does the nurse do to orient the client and family?
Orient them to the care environment, treatments, and expectations regarding safety.
What type of environment should the nurse establish for clients?
A welcoming trauma-informed environment.
How does the nurse enable health promotion?
Through education.
What should the nurse select and advocate for to support client recovery?
Activities that promote participation, recovery, and healing.
What qualities should the nurse portray towards the client?
Genuineness, empathy, and a positive regard.
How does the nurse practice empathy?
By remaining nonjudgmental and attempting to understand the client’s actions and feelings.
True or False: Sympathy involves feeling the way the client does.
True
Fill in the blank: The nurse should help the client develop a sense of _______.
autonomy and self-reliance.
What must be established to maintain a safe and professional nurse-client relationship?
Boundaries
Boundaries help ensure the relationship remains therapeutic rather than social.
What occurs when the nurse-client relationship begins to meet the needs of the nurse rather than those of the client?
Blurred boundaries
Blurred boundaries can lead to a loss of therapeutic focus.
What is the primary purpose of a social relationship?
Socialization or friendship
Focus is on the mutual needs of the individuals involved.
What is the primary purpose of a therapeutic relationship?
Identify the client’s problems or needs
Focus on assisting the client in resolving issues and improving quality of life.
What should the nurse maintain with the client to ensure effective care?
A consistent level of involvement
This includes reflecting on boundary issues frequently.
What is transference in a therapeutic context?
Client views a health care team member as having characteristics of a significant person from their past
Transference can be positive or negative.
What is a positive form of transference?
Client is motivated to work with the nurse toward recovery
This indicates a productive therapeutic relationship.
What is a negative form of transference?
Client directs anger or painful emotions toward the health care team member
This requires exploration of the client’s response.
What behavior might indicate transference from a client?
Client expects exclusive services from the nurse
This may include demands for extra session time.
What behavior might indicate jealousy or extreme affection from a client?
Client demonstrates anger, hostility, or extreme affection for the nurse
Such behaviors complicate the therapeutic relationship.
What is countertransference?
Health care team member displaces characteristics of people from their past onto a client
This can affect the nurse’s objectivity.
What behavior might indicate countertransference from a nurse?
Nurse overly identifies with client
This may lead to loss of professional boundaries.
What is a potential nursing implication when experiencing countertransference?
Seek supervision or peers for support
This helps ensure objective responses to the client.
Fill in the blank: Transference may be _______ if the client directs anger toward the health care team member.
negative
Understanding the nature of transference is crucial for effective intervention.
True or False: A therapeutic relationship focuses on the mutual needs of the individuals involved.
False
A therapeutic relationship focuses on the client’s needs rather than mutual needs.
What is the purpose of community meetings on a mental health unit?
To enhance the emotional climate of the therapeutic milieu by promoting:
* Interaction and communication between staff and clients
* Decision making skills of clients
* A feeling of self-worth among clients
* Discussions of common unit objectives
* Discussion of issues of concern to all members of the unit
* Client-led meetings with group decisions
What are the characteristics of individual therapy?
Scheduled sessions with a mental health provider to address specific mental health concerns (e.g., depression, trauma)
What defines group therapy?
Scheduled sessions for a group of clients to address common mental health issues (e.g., substance use disorder, anger management)
What is the focus of psychoeducational groups?
Based on clients’ level of functioning and personal needs (e.g., adverse effects of medication, coping skills and strategies)
What activities are included in recreational therapy?
Activities that use leisure time and socializing with others to benefit mental health, such as:
* Activities
* Exercise
* Games
* Community outings
What does unstructured, flexible time in a therapeutic milieu provide?
Opportunities for the nurse and other staff to observe clients as they interact spontaneously within the milieu
True or False: Community meetings on the mental health unit should only focus on administrative matters.
False
Fill in the blank: Group therapy addresses _______ mental health issues.
[common]
What are the main objectives discussed in community meetings?
Encouraging clients to meet treatment goals and plan for discharge
