Week 3: Ch 23,24

Question 1

Define therapeutic environment

Answer 1

• Growth-promoting atmosphere created in treatment setting
• Influenced by relationships among staff, patients, and visitors
• Physical structure

Question 2

Define therapeutic milieu

Answer 2

• Strictly speaking, refers to a formalized treatment modality called milieu therapy (as opposed to custodial care)
• The challenge to is apply principles of milieu therapy in a very much reduced time frame, with patients who are more acutely ill.

Question 3

What are the JCAHO Environment of Care Issues?

Answer 3

Safety: ongoing assessment and maintenance of all equipment, hazard surveillance, reporting and investigation of safety issues, monitoring of safety management techniques and procedures, orientation programs that address safety issues.
Security: mechanisms for addressing security issues, provision of appropriate id for all staff, patients, and staff; security orientation programs, mechanisms for handling emergencies, mechanisms for interacting with the media.
Social environment: space for storage of grooming and hygiene articles; closet and drawer space for personal property; clothing that is suitable for clinical conditions.
Physical setting: adequate privacy to ensure respect for patients, door locks consistent with program goals; availability of telephones that allows for private conversations; sleeping rooms with doors for privacy; furnishings suitable to the population served; access to the outdoors.

Question 4

What are the elements of the treatment environment?

Answer 4

Safety: both physical and psychological protection
Structure: physical environment, daily schedules of treatment activities, and informal rules of interacting between patients and staff.
Norms: specific expectations of behavior that permeate the treatment environment.
Limit setting: approaches for regulating patients’ behavior through the use of verbal and nonverbal nurse communications.
Balance: represents the value of developing expertise in nursing.

Question 5

What is the role of nurses?

Answer 5

Psychiatric nurses actively manage the treatment environment by modification of:
Safety
Structure
Norms
Limit setting
Balance

Question 6

What are the current trends?

Answer 6

Rapid patient turnover
High acuity
Little improvement in patient functioning at discharge
Overreliance on medications
Inadequate time to assess and diagnose patients
Difficult to develop therapeutic relationship
Crisis mode of treatment

Question 7

Name some variables affecting the therapeutic environment

Answer 7

Aggression and violence
Inpatient suicidal behavior
Staff relationships
Burnout and secondary traumatization
Clinical supervision
Management practices and organizational structure
Nursing’s influence

Question 8

Define burnout

Answer 8

State of physical, emotional, and mental exhaustion
-Caused by long-term involvement in emotionally demanding situations
-Results in:
Emotional distancing Feeling emotionally burdened
Feeling to blame for patient care failures Lowered effectiveness in nurse-patient interactions
Low morale Passivity, disinterest, complaining
`Negative, hostile reactions to others

Question 9

Define secondary traumatization

Answer 9

Cumulative effect of working with survivors of traumatic life events
Influence nurses’ personal sense of safety and views of others’ trustworthiness.
May experience disillusionment, cynicism, and despair

Question 10

What are nursing’s influence?

Answer 10

Nurses spend little time interacting with patients.
Patient dissatisfaction with nursing care is related to quality and time that nurses spend with them.
Focus on interpersonal care needs to be priority.