Chapter 5 - Creating and Maintaining a Therapeutic and Safe Environment Flashcards
Milieu Therapy
environment conducive to tx of children who have mental illness
Therapeutic nurse-client relationship
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
Tasks of Therapeutic Relationship
Orientation
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
Tasks of Therapeutic Relationship
Working
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
Tasks of Therapeutic Relationship
Termination
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
Transference
client views RN as having characteristics of another person of significance in personal life
Countertransference
RN displaces characteristics of people in past onto a client
Therapeutic Milieu
Physical setting
clean orderly comfortable furniture promoting interaction solitary spaces for reading place for meals quiet area for sleep color scheme for age proper traffic-flow
Therapeutic Milieu
Health care team member responsibilities
promote independence allow choices rules for fair tx work cooperatively maintain boundaries professionalism self-worth and hope
Therapeutic Milieu
Emotional climate
feel safe from harm from self and disruptive behaviors from others
feel cared for and accepted
Activities within Therapeutic Milieu
Community meetings
interaction/comm decision-making skills self-worth discuss common unit objectives and issues of concern client-led meetings
Activities within Therapeutic Milieu
Individual therapy
scheduled sessions with MHP to address specific mental health concerns (ex. depression)
Activities within Therapeutic Milieu
Group therapy
scheduled sessions for a group to address common mental health concerns (ex. substance abuse disorder)
Activities within Therapeutic Milieu
Psychoeducational groups
based on client’s level of functioning and personal needs (ex. adverse effects of meds)
Activities within Therapeutic Milieu
Other
recreational - community outing
unstructured flex time - opportunities for RN to observe clients spontaneously
