MILIEU THERAPY

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MILIEU THERAPY

• THE THERAPEUTIC
• COMMUNITY

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DEFINITION / CHARACTERISTICS

• STRUCTURING OF THE ENVIRONMENT TO BRING ABOUT
  BEHAVIORAL CHANGES AND TO IMPROVE THE
  PSYCHOLOGICAL HEALTH AND FUNCTIONING OF
  INDIVIDUALS

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CHARACTERISTICS

• BASIC NEEDS MET
• PHYSICAL FACILITIES ARE CONDUCIVE
• DEMOCRATIC FORM OF SELF-GOVERNANCE
• RULES AND REGULATIONS
• STRUCTURED PROGRAMS
• FAMILY INVOLVEMENT

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TEAM MEMBERS

• PSYCHIATRIST
• CLINICAL PSYCHOLOGIST
• PSYCHIATRIC NURSE
• PSYCHIATRIC TECHS
• OT, REC, MUSIC, ART, DRAMA THERAPISTS
• PSYCHIATRIC SOCIAL WORKER
• DIETITIAN
• CHAPLAIN

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ROLE OF THE NURSE

• 24 HOUR OBSERVATION
• REALITY ORIENTATION
• PHYSICAL CARE
• MEDICATION ADMINISTRATION
• 1 1 RELATIONSHIP
• LIMIT SETTING
• TEACHER

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CRISIS INTERVENTION
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DEFINITION

• AN UNSTABLE OR CRUCIAL TIME OR STATE OF AFFAIRS
  WHOSE OUTCOME WILLMAKE A DECISIVE DIFFERENCE FOR
  BETTER OR WORSE
• ACUTE NOT CHRONIC
• RESOLVED IN ONE WAY OR ANOTHER WITHIN A BRIEF
  PERIOD

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CRISIS THEORY

• BODY OF KNOWLEDGE THAT HAS GROWN UP AROUND THE
  SUBJECT OF ACUTE STRESS IN INDIVIDUALS AND
  GROUPS. IT IS CONCERNED WITH HOW SUCH
  DISTRUBANCES ARISE, THEIR COURSE, THEIR EFFECT ON
  BEHAVIOR AND HOW THERAPY OR GUIDANCE CAN HELP OR
  HINDER

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HISTORICAL PERSPECTIVE

• 1944 STUDYOF THE COCONUT GROVE FIRE OF 1942
• 1964 GERALD CAPLAN WORK ON CRISIS THEROY
• EARLY 60S CONCEPT OF SUICIDE TEAMS
• COMMUNITY MENTAL HEALTH SYSTEM COMPLETE CARE
  AVAILABLE IN THE COMMUNITY

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PHASES OF A CRISIS

• PHASE I PERCIPITATING STRESSOR INCREASE IN
  ANXIETY- TRIES TO USE FAMILIAR COPING MECHANISMS
  TO RESOLVE FEELINGS.
• PHASE II INCREASED ANXIETY DUE TO FAILURE OF
  USUAL COPING TECHNIQUES FEELINGS OF
  HELPLESSNESS AND HOPELESSNESS

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PHASES OF A CRISIS

• PHASE III ANXIETY CONTINUES TO RISE TRIES TO
  USE NEW PROBLEM SOLVING TECHNIQUES MAY REACH
  OUT FOR ASSISTANCE. MAY BE RESOLVED AT THIS LEVEL
  AT HIGHER, LOWER, OR AT THE PREVIOUS LEVEL OF
  FUNCTIONING

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PHASES OF A CRISIS

• PHASE IV ACTIVE STAGE INNER RESOURCES AND
  SUPPORT SYSTEMS ARE INADEQUATE. PRECIPITATING
  EVENT IS NOT RESOLVED- STRESS AND ANXIETY BECOME
  INTOLERABLE. DISORDERED THINKING, EMOTIONAL
  LABILITY, AND PSYCHOTIC THINKING

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PREDICTABILITY OF CRISIS EXPERIENCE

• INDIVIDUALS PERCEPTION OF THE EVENT
• AVAILABILITY OF SUPPORT
• AVAILABILITY OF COPING MECHANISMS

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TYPES MATURATIONAL / DEVELOPMENTAL

• RESPONSE TO TRANSITION BETWEEN DEVELOPMENTAL
  STAGES
• PREDICTABLE EXPECTED GRADUAL PREVENTABLE
• USUALLY DUE TO THE INABILITY TO MASTER THE TASKS
  OF ONE OF THE STAGES OF DEVELOPMENT

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TYPES SITUATIONAL

• RESPONSE TO A TRAUMATIC EVENT
• UNPREDICTABLE UNEXPECTED SUDDEN UNAVOIDABLE
• USUALLY DUE TO THE LOSS OF AN EXTABLISHED SUPPORT

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ADVENTITIOUS CRISES

• SOCIAL CRISES NATURAL DIASTERS TERRORIST
  ATTACKS VIOLENT CRIMES SUCH AS RAPE OR MURDER

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PSYCHOPATHOLOGY PSYCHIATRIC EMERGENCIES

• IMPAIRMENT OF ABILITY TO ADAPT
• FUNCTIONING SEVERELY IMPAIRED OR RENDERED
  INCOMPETENT
• SUICIDAL INDIVIDUALS, ACUTE PSYCHOSES, ALCOHOL
  INTOXICATION.

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GOALS OF INTERVENTION

• ASSIST IN IMMEDIATE RESOLUTION OF PROBLEM
• DONT DWELL ON UNRESOLVED ISSUES
• STRESS HEALTHY ASPECTS OF PERSONALITY
• EVALUATE ON TERMS OF ABILITY

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CHARACTERISTICS OF INTERVENER

• BE DIRECT
• SUPPORTIVE
• ACTIVE PARTICIPANT
• ENCOURAGE TO DO THE BEST THAT HE CAN MANAGE
• UTILIZE EXISTING SOCIAL NETWORK

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CONTINUED

• ASSIST CLENT TO MAKE DECISIONS
• ASSIST TO FIND STRESSOR
• ASSESS COPING SKILLS
• NONJUDGEMENTAL
• CULTURALLY AWARE
• COURAGEOUS
• EMPATHETIC
• CALM / ASTUTE ASSESSOR

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NURSING PROCESS

• ASSESSMENT
• CLIENTS FEELINGS
• PERCEPTIONS
• SUPPORT SYSTEM
• COPING SKILLS
• POTENTIAL FOR SELF HARM

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NURSING PROCESS

• NURSING DIAGNOSIS
• ANXIETY
• INEFFECTIVE INDIVIDUAL COPING
• ALTERED THOUGHT PROCESS
• IMPAIRED SOCIAL INTERACTION
• SOCIAL ISOLATION
• DISTURBED SELF-CONCEPT

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NURSING PROCESS

• PLANNING
• ENCOURAGE CLIENT
• DO WHAT THEY CANT DO FOR THEMSELVES
• OUTLINE THE PROBLEM/RESOURCES
• HELP FIND SOLUTIONS
• TIME FRAME

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