Chapter 5 - Creating and Maintaining a Therapeutic and Safe Environment

Question 1

Milieu Therapy

Answer 1

environment conducive to tx of children who have mental illness

Question 2

Therapeutic nurse-client relationship

Answer 2

purposeful and goal-directed
well-defined with clear boundaries
structured to meet client’s needs
characterized by interpersonal process that is safe, confidential, reliable, consistent

Question 3

Tasks of Therapeutic Relationship

Orientation

Answer 3

introduction
set contract (and termination date)
discuss HIPAA
build trust - expectations/boundaries
set goals
explore client's ideas/issues/needs
explore meaning of testing behaviors
enforce limits on testing/inappropriate behaviors

Question 4

Tasks of Therapeutic Relationship

Working

Answer 4

maintain relationship according to contract
ongoing assessment
facilitate client’s expression of needs/issues
encourage problem-solving
promote self-esteem
pos. behavioral change
deal with defense mechanisms
recognize transference/countertransference
reassess problems/goals
support new coping skills
remind client of termination

Question 5

Tasks of Therapeutic Relationship

Termination

Answer 5

listen to client’s thoughts about termination and previous experiences with separation/loss
sum up goals/achievements
review memories of work
express own feelings about sessions
discuss incorporating new healthy behaviors
maintain limits of final termination

Question 6

Transference

Answer 6

client views RN as having characteristics of another person of significance in personal life

Question 7

Countertransference

Answer 7

RN displaces characteristics of people in past onto a client

Question 8

Therapeutic Milieu

Physical setting

Answer 8

clean
orderly
comfortable furniture promoting interaction
solitary spaces for reading
place for meals
quiet area for sleep
color scheme for age
proper traffic-flow

Question 9

Therapeutic Milieu

Health care team member responsibilities

Answer 9

promote independence
allow choices
rules for fair tx
work cooperatively
maintain boundaries
professionalism
self-worth and hope

Question 10

Therapeutic Milieu

Emotional climate

Answer 10

feel safe from harm from self and disruptive behaviors from others
feel cared for and accepted

Question 11

Activities within Therapeutic Milieu

Community meetings

Answer 11

interaction/comm
decision-making skills
self-worth
discuss common unit objectives and issues of concern
client-led meetings

Question 12

Activities within Therapeutic Milieu

Individual therapy

Answer 12

scheduled sessions with MHP to address specific mental health concerns (ex. depression)

Question 13

Activities within Therapeutic Milieu

Group therapy

Answer 13

scheduled sessions for a group to address common mental health concerns (ex. substance abuse disorder)

Question 14

Activities within Therapeutic Milieu

Psychoeducational groups

Answer 14

based on client’s level of functioning and personal needs (ex. adverse effects of meds)

Question 15

Activities within Therapeutic Milieu

Other

Answer 15

recreational - community outing

unstructured flex time - opportunities for RN to observe clients spontaneously