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Objective 1
The therapeutic milieu is a scientific structuring of the environment in order to effect behavioral changes and to improve the psychological health and functioning of the individual.
Within this structured environment, the client is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life.
Objective 2
Analyzing the nurses role in maintaining the therapeutic milieu in an inpatient psychiatric/mental health setting
The nurse maintains the therapeutic milieu in the inpatient setting by:
Encouraging health promotion Providing therapeutic interaction Allowing clients to participate in governing the unit Expecting the client to take responsibility for his or her own behavior Utilizing peer pressure or peer support as a tool to bring about acceptable group norms Dealing with inappropriate behaviors as they occur Avoiding restrictions and punishments
Objective 3
Ability to use ones personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions
Therapeutic communication:
Consists of verbal and nonverbal techniques that focus on the clients needs and advance the promotion of healing and change Encourages the exploration of feelings and fosters understanding of behavioral motivation Promotes trust, discourages defensiveness, and is nonjudgmental
Active listening:
Being attentive to what the client is saying both verbally and nonverbally Facilitative skills include facing the client squarely observing an open posture leaning toward the client establishing eye contact maintaining a relaxed demeanor
Feedback:
Therapeutic relationship:
Interaction between two people in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention Goal-oriented goal of the relationship determined jointly by nurse and client goal is most often directed at learning and growth promotion in an effort to bring about some type of change in the clients life may be based on a problem-solving model
Genuineness
the ability to be open, honest, and real in interactions
confidence in another persons presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested
providing a blanket when the client is cold providing food when the client is hungry keeping promises being consistent ensuring confidentiality
Empathy
process in which one is able to see beyond outward behavior and accurately sense anothers inner experience
Objective 4
Exploring the phases of the therapeutic relationship
Preinteraction phase
Preparation for the first encounter with the client
Working phase
Accomplishment of the therapeutic work of the relationship
Termination phase
Bringing a therapeutic conclusion to the relationship
Countertransference
The nurses behavioral and emotional response to the client which may be related to unresolved feelings toward significant others from the nurses past, or may be generated in response to transference feelings on the part of the client
Self-disclosure
May be appropriate when the information to be shared is judged to be therapeutically beneficial to the client Never used for the purpose of meeting the nurses own needs
Gift-giving
Professional judgment Institutional policy Never financial
suggest a donation elsewhere
Touch
Caring touch with no associated physical need can be therapeutically appropriate Beware of situations in which touch may be misinterpreted, culturally unacceptable, or dangerous paranoid patient psychotic client
Warning signs that may indicate a potential breech in professional boundaries in the nurse-client relationship include: Favoring one clients care over anothers Swapping assignments with another nurse to care for a particular client Giving special attention or treatment to one client over others Spending free time with one particular client Sharing personal information or work concerns with a client Continuing contact/communication with a client after discharge
Objective 5
Using silence
Accepting
gives the client the opportunity to collect and organize thoughts conveys an attitude of reception and regard acknowledging
Giving recognition
offers the client encouragement to continue verbalizing what is observed or perceived repeating the main idea of what the client has said
Reflecting Focusing
referring questions and feelings back to the client so that they may be recognized and accepted taking notice of a single idea or a single word works well with the client who is moving rapidly from one thought to another not to be used with a client who is anxious when a client has a misperception of the environment, the nurse defines reality expressing uncertainty as to the reality of percpetions
Objective 6
Exploring the concept of therapeutic community
The therapeutic community holds that everything that happens to the client or within the clients environment is considered to be part of the treatment program. Community factors, such as social interactions, the physical structure of the treatment setting, and schedule of activities may generate negative responses which are used as examples to help the client learn how to manage stress more adaptively in real-life situations.
Conditions that promote the therapeutic community include: The fulfillment of basic physiological needs The conduciveness of the physical facilities to achievement of the goals of therapy The existence of a democratic form of self-governance The assignment of responsibilities based on each clients capabilities The scheduling of a structured program of social and work-related activities The inclusion of community and family with regards to discharge planning
Objective 7
Group:
Collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose Membership is generally
by chance (born into the group) by choice (voluntary affiliation) by circumstance (the result of life-cycle events over which an individual may or may not have control)
Instillation of hope Universality Imparting of information Altruism Corrective recapitulation of the primary family group Development of socializing techniques Imitative behavior Interpersonal learning Group cohesiveness Catharsis Existential factors
Objective 8
Functions of a group:
Empowerment Governance
rules committees
Types of groups:
Task Groups
accomplishing a specific outcome or task focus on problem-solving and decision-making
Teaching Groups
exist to convey knowledge and information to a number of individuals
Supportive/Therapeutic Groups
concerned with preventing future upsets by teaching effective ways of dealing with emotional distress
Self-Help Groups
allow clients to talk about their fears and relieve feelings of isolation while receiving comfort and advise from others undergoing similar experiences