Therapeutic Settings: Exam 1 Flashcards
In 1954 chlorpromazine (Thorazine®) was introduced and found to decrease many symptoms of psychosis. Other psychotropic drugs would soon follow. In the following years, a massive number of clients were discharged. This mass exodus is called _____________.
deinstitutionalization
Economic forces have limited the length of inpatient hospital stays. Inpatient units typically receive clients who are very ill and must discharge them before they are completely recovered. In addition, outpatient support may not be fully addressed. These issues have led to the “revolving _______” phenomenon in which patients are repeatedly discharged and readmitted.
Door
During hospitalization, treatment focuses on _______ _________ (more on that in a moment), talk/group therapy, and medication management. Case workers help establish community support. Also, much attention is focused on safety. The inpatient setting can provide a safe, supportive environment for clients.
Milieu Therapy
These programs provide treatment during the day (or evening) and enable clients to go home afterwards. Such programs are a good bridge to help clients after discharge from an inpatient stay. Also, a timely referral to one of these programs may prevent an in-patient hospitalization.
Partial Hospitalization Programs
The services and features of these facilities vary. Typically clients’ basic needs are provided (e.g., bed, bathroom, laundry, and some meals). Onsite staff may also assist with various needs (e.g., crisis intervention, case management, etc.). Examples of these residential settings include group homes, supervised apartments, and adult foster care (Videbeck, 2019).
Residential Settings
A major goal of any psychiatric treatment programs is to provide a therapeutic environment. The technical term for this is milieu therapy. For those of us who are fortunate to live in a healthy milieu (i.e., a safe environment, warm bed, nutritious meals, supportive relationships, etc.), we must not forget the profound impact this has on a person’s mental wellbeing.
Milieu Therapy
Characteristics of a Therapeutic Milieu
-Basic physiological needs are met (i.e., Maslow’s hierarchy of needs).
-Space is provided for privacy and socializing.
-As much as possible, clients participate in decision making, problem-solving, etc.
-Clients are given responsibilities (consistent with ability level).
-Clients have a structured schedule of activities that are tailored to their needs.
-Community and family are included as much as possible.
Milieu therapy is difficult to implement today. There are two major reasons for this.
- The average length of hospitalization is much shorter today (usually just 2-3 days).
- Biologically-based treatment (i.e,. medication) is the primary focus.
Psychiatric nurses must be mindful of ___________ hierarchy of human needs. Recall that at the basic, most fundamental level, people require physiological needs (food, water, shelter) and safety. For this reason, safety is a top priority. So aggressive, hostile behavior must be addressed right away. Also, searching newly admitted clients for prohibited items is a top priority.
Maslow’s
Nurses perform _______ ___________ of the milieu. They proactively address issues. Nurses also regularly assess each client’s physical and mental status. A mental status assessment requires a different set of skills. You’ll learn many of these skills and concepts later in this course.
Ongoing Assessments
Nurses orient clients to the mental health unit. This includes:
-The physical environment (e.g., room, bathrooms, medication room).
-Prohibited items (e.g., sharp objects, shoestrings, etc.).
-Rules and expectations.
-The schedule of activities.
Nurses set limits on unacceptable behavior. They do this by:
-Using a calm, matter-of-fact tone.
-Using clear, understandable terminology.
-Explaining what the consequence will be if the behavior is continued.
-Ensuring consistency among staff in explaining and enforcing these limits.
Nurses should promote as much independent functioning as possible. Examples include having clients independently:
-Line up at the medication window at the appropriate times.
-Care for their own hygiene needs, including laundry.
-Participate in treatment team meetings.
Nurses provide formal and informal teaching. Important topics include:
-Psychiatric and medical diagnoses.
-Medication side effects.
-Importance of adhering to the medication regimen.
-Coping skills (e.g., stress management, anger management, social support).
A common feature of many severe psychiatric illnesses is a breakdown of supportive relationships. As noted above, a key benefit of a therapeutic milieu is that it can help clients develop healthy interpersonal skills. Such clients often need practice and support in developing these skills:
Interaction skills.
Relationship skills.
Conflict resolution skills.
Healthy coping mechanisms.
