milie therapy

زائر

Outlines:-

1/ Milieu therapy:

· Introduction.

· Definition.

· Goals of milieu therapy.

· Characteristics of therapeutic milieu.

· Component of milieu therapy.

· Criteria of selection of recreational and occupational therapy.

· Nursing role.

2/ Recreational therapy:

· Definition.

· Objectives.

· Types of recreational therapy (Definition, Indication &
Nursing role)

3/ Occupational therapy:

· Definition.

· Goals.

· Types of occupational therapy.

· Nursing role.

(1)
Introduction:-

The term milieu in English means
“environment or setting”, in French means “middle place”.

Milieu refers to people, all social
& physical factors in environment which surrounds &interacts with
patient.

(2)
Definition:-

Milieu therapy “a designed
environment provides secure pretreatment for individuals whose capacities for
coping with reality have deteriorated & to provide opportunities to acquire
effective coping strategies for patients & family”.

It provides medical, social, nursing
& psychiatric therapy.

(3)
Goals of therapeutic milieu:-

1-To assist the patient to control
& modify his behavior “Maladaptive behavior”.

2-Promote adaptive psychosocial
skills in coping with self, others & environment.

3-To prepare the patient to adapt
with community {Bridge patient between hospital & community}.

4-Minimize the environmental &
physical stress.

5-Meet patient needs until they are
able to assume responsibilities of themselves.

6-Provide pleasant & attractive
sensory stimulation.

7-Teach patient & their families
about “adaptive coping strategies”:-

It focuses on social relationships
& occupational recreational activities.

To achieve its goal sit use different
therapeutic modalities:

A/ Group therapy.

B/ Different rehabilitative &
activity therapies.

C/ Occupational & recreational
therapy is based on coordinated team word includes {psychiatrists,
psychologists, psychiatric nursing & social workers}.

D/ and can be established in
different setting “psychiatric hospitals, inpatient words, day hospitals &
special houses for geriatric patient}.

(4)
characteristics of therapeutic milieu:-

a.
Individualized
treatment plan:

Every patient has
individualized needs & rights differ from another patient.

But they are equal in the treatment,
social & psychological relationship so individualized treatment & plan
should be apllied.

b.
Self
governance:

Patient develops sense of
responsibility & self control {e.g. gives patient activity & gives him
the chance to act with this activity as he wants}.

c.
Progressive
level of responsibility:

· As to share with activities.

· As to share with decision making.

· By another words, helping the patient to do any activity by
himself to encourage him to take even a small decision.

d.
Variety
of meaningful activities:

· To stimulate variety of senses according to patient needs, ability
& interests the therapy provides.

· Each patient with an individualized activity.

· Such exercise classes, listening & communication.

· Skills work & occupational therapy & a variety of meaningful
activities.

e.
Links
with patient’s family and significant others:

Such as family education
programs that aims to help family members & significant others understand
the client’s problems & learn how they can contribute to client’s recovery
as {how to provide appropriate home care for the patient}.

It includes 24 hrs visiting
{this method will encourage the patient to interact with family & others
step by step}.

f. Links with the community:

Links patient with community
life participation of health team members with milieu activities client
developing the social skills and confidence needed to re-enter community.

g.
Effective
interaction among mental health team member:

The interpersonal conflicts may
occur between the health team members & they must be able to resolve this
conflict effectively & promptly.

The mental health team members
who can resolve conflicts they are effective role models for patient to develop
the sense of trust & co-operation between patients themselves or Mental
health team members.

h.
Humanistic
mental health team member:

They must have the
following characteristics:-

1. Optimistic attitudes toward people in general.

2. Give hope to clients, families & other team members.

3. Do creative working & activities to involve patient with it.

4. They have lack of fear when confront patient with bizarre behavior
(how to be ready to give immediate treatment for any case).

5. They have willing to maintain frequent daily personal with
patients.

6.
Ability
to provide effective mental health education to patients & their families.

7. Beliefs that control the patient are by therapeutic relationship
not physical or chemical restraining.

8.
Can
help the patient to solve the problem.

(5)
Components of milieu therapy:-

The essential components
of therapeutic milieu are:

1/ Comfortable
& secure physical facilities:

Safety & proper structural security “locked door, non
breakable glass, & silent alarms seclusion room”.

e.g.: unprotected wires, sharp
objects & unprotected electrical sources must be eliminated.

-Elimination the sources of
noise & interruption.

-Special percussion &
immediate treatment for emergency situation must be present.

Emotional climate:-

*Should be warm, friendly,
acceptance, optimistic & cheerful.

*Staff availability to guide
and monitor patient activities.

*Promotion of opportunities for
self decision making and activities that prepare for relation to community.

*Orientation the patient &
the family to steps and process of inpatient psychiatric treatment.

*Emphasis is placed on
socialization and group interaction.

*The focus is on communication
as an opportunity for living and learning.

2/ Qualified
mental health team:

Community
meeting is held at regularly scheduled intervals and it is done to:

a.
Deal
with social and behavioral problems.

b. Discussing administrative matters, activity planning.

c.
Learn
about therapeutic community practices.

3/ An
effective therapeutic milieu program:

a.
According to patient cultural background: therapeutic milieu should match the
client’s cultural background to decrease moving great cognitive conflict or
inner conflict within the client.

b.
According to the client’s needs: to apply certain activities to certain group
which need the same approaches.

c.
According to client diagnosis: we should collect patient that diagnosis and
health status match with each other like “manic state and depression patients”.

4/
Unit norm:

-Rules
and policy of the hospital must be applied “visiting time, breakfast, lunch,
dinner”.

-Patient
takes permission to perform the therapy in the time that allowed.

-Any
change in the hospital routine should be informed.

(6)
Criteria of selection:-

ü According to
the patient :-

1.Age:

· For children we use play therapy & story telling.

· For adult we use role of teacher working.

· For geriatric we use social activities as card games & pet therapy.

2.
Sex:

· For male we use strong activities as chair repair carpenter
working & helping.

· For female we use simple or easy tasks as craft making.

3.Education:

· As “poetry therapy is not used with illiterate patient”.

4.Physical abilities
& degree of handicapped.

5.Capacity of
participation:

· As isolated patient can not tolerate the activity therapy.

6.previous
experience:

· If the patient has got any problems or accident occurred to him
during previous therapy will impact in the patient involvement in the next
activity.

7.Power of
attention:

· Poor concentrates patient can share in the simple activity as
simple painting & drawing.

8.Desires, interests
& patient hobbies.

9.Diagnosis &
it’s effect on patient as:

1.
Manic patient: must not involved in
competent activity as he has over grandeur but he has over energy for that he
may involved in activities requires patient energy as physical exercise &
helping exercises.

2.
Anxiety
disorders patient: involved in simple concrete activity due to his poor concentration
as aerobics & physical exercises.

3.
Social
withdrawal & depressed patient: need easily activity
& simple task to increase self-esteem, confidence & decrease level of
anxiety {e.g. sensory motor stimulation as painting, drawing & pet therapy.

4.
Schizophrenic
“paranoid type”: as manic patient increased
grandeur & has over delusion he needs to increased his concentration &
distracting from his delusion, may involved in simple & meaningful tasks
{e.g. puzzle & chess}.

5.
Catatonic
type: needs
activities enhance & encourage their movement as physical activities &
exercises.

6.
Antisocial
personal: needs
activities enhance self-esteem, social working & relationship; need self
expression of feeling but tasks must be completed according to patient needs.

7.
Mental
retarded patient: according to level IQ {play is painting, drawing & musical
chairs}.

8.
Dementia: need group activity and
increase sense of belonging as their hobbies.

9.
Substances
abuse patient:
needs planed group & social activities to encourage for
co-operation and learning how to differentiate between right & wrong to
avoid the bad relationship.

ü According to
environment:

1.Policy &
routines of environment.

2.Rules &
limitations of environment.

3.Safety &
hazards of environment.

4.Resources &
abilities.

(7) Nursing Role:-

1.
Assess
the extent to which the client displacing destruction.

2.
Destructive
clients must require supervision 24 hrs hospitalization.

3.
Ensure
that the physical environment is safe.

4.
Ensure
conduct periodic safety includes community area with milieu and external area.

5.
Protective
measurement during these activities should be applied.

6.
Provide
comprehensive teaching for patients about activities he will do, its benefits
& its manner to do it.

7.
reduce
stressors that client perceives such as loud voices, violent TV programs or
video game, unsightly visual stimuli, unpleasant odors and crowded places.

8.
Encouraging
client to identity his problem to attempt to understand and handling problems
using informal group intervention.

9.
Time
productively for free time to work.

10.
Provide
good motivation to patient when doing something good.

11.
Provide
spiritual support to patient.

12.
Maintain
pain management techniques.

(1)
Definition:-

Effective
use in leisure time& it is the integral part of rehabilitation and
therapeutic activity including variety of sports, social function.

(2) Objectives of recreational therapy:-

A.
Express
thought and feeling by non verbal way.

B.
Help to
control feeling.

C.
Develop
social relationship.

D.
Develop
tasks, skills & abilities.

E.
Consider
as an outlet for energy of patient.

F.
Develop
self-esteem.

G.
Assists
client in bridging the gab between hospital and community.

H.
Decrease
client aggression.

(3) Types of recreational therapy:-

1)
Art therapy:-

§ Non verbal means of expression of feeling and communication.

§ The use of artistic activities such as drawing and painting in
psychotherapy and rehabilitation.

§ It is used in assessment, diagnosis & treatment of patient who
had difficulty in describing image and thought.

§ Its goal to help patient to express feeling, thought &
emotional through his painting & drawing and help patient to relief his
tension & anxiety.

§ Used with children patients, depressed, mutism, anger,
frustration, low self-esteem patients.

2)
Music
therapy:-

§ Non verbal way of communication.

§ Def.: is the functional application of music toward the attention
of specific therapeutic goal.

§ Expression of self through music such as singing or playing an
instrument or composing songs.

§ Sound and rhythm stimulate patient who may listen quietly, sing a
keep time.

§ For depressed, poor concentration &isolated patients.

§ Vary according to age of patients.

Ø Aims:

§ Facilitate emotional expression.

§ Improve cognitive skills & concentration.

§ Exercises through body movement maintain circulation & muscle
tone.

§ Stimulate social interaction & listening.

3)
Dance:-

§ It means to do aerobics exercises.

§ Body movement help patient express thoughts and feelings in nonverbal,
no threatening ways.

§ For adult and child which integrate the emotional & physical
experience.

§ Used with children, depressed, mutism, nihilistic delusion &
hypoactive patients.

Ø Aims:

1.
Help to
develop body awareness.

2.
Facilitate
expression of feeling.

3.
Improve
interaction & communication.

4.
Increase
sense of self-confidence.

4)
Pet therapy:-

§ Animal one used with lonely withdrawn &old patient who fear
human relationships but can respond on an animal need for love and attention.

5)
Plant
therapy:-

§ The using of growing living objects to achieve therapeutic goals
used as to teach patient the core of living thing that allow patient experience
the result of coping with something outside themselves.

§ Used with suicidal, geriatric, depressed & loss of appetite
patients.

Ø Aims:-

§ Help patient to be more interactive with surrounding environment.

6)
Video
therapy:-

§ Means using of videotape of other patient during therapy “under
his consent” to show to patient to encourage him to do the activities.

Ø Use of role playing & video to:

1. Facilitate interaction between patient and environment.

2. Teach patient how to express feeling.

3. It gives a position patient feedback who depressed.

§ Not accepted to patient who have “paranoid or delusion” because it
fixed the dilution hallucination.

7)
Poetry
therapy:-

§ When patient talk he raise his voice in apart of poetry, we know
he has defect or he want to express feeling.

§ Used with all patients except manic patients.

Ø N.B.:-

§ The aim of recreational therapy to keep the patient in realistic
activity.

Play therapy:-

§ Natural growth & development {e.g. through play the child
learn to express emotions.

§ Used with children patients & social withdrawal patients.

Ø Aims:-

1. It allows comparison between loss & failure.

2. Improves the emotional growth.

3. Provide opportunity to child to act out his conflict.

Ø Diagnostic function:-

1. It gives to therapist chance to explore the family relationship of
child & discover child problems.

2. Allow to study the hidden aspect of the child personality.

3. Obtain the good ideas of intelligence level of child.

4. The relationship can be studied there.

Ø Types:-

1. Individualized or group play.

2. Free play {child given freedom with toy he want} & controlled
play {child involved into situation already stabled}.

3. Structured or un structured {involvement of organized situation to
obtain more information or non organization}.

9)
Biblotherapy:-

Reading
in library (books-text). The benefits to increase patient creativity &
distract his attention by reading.

a.
Definitions:-

Occupation:-

Goal
directed use of time, energy, interest and attention to foster adaptation and
productivity to minimize pathology and to promote the maintenance of health.

Occupational
therapy:-

The
application of goal directed in the assessment and treatment of individuals
with psychological, physical, developmental disabilities.

b.
Goals of
occupational therapy:-

1.
Encourages
clients to develop interests which may either reestablish old skills and
knowledge or initiate new learning.

2.
Develop
self-esteem and self-confidence.

3.
Provide
suitable outlets for aggression and excess energy for disturbance patient.

4.
Reduction
of tension and easing emotional stress by providing constructive outlet.

5.
Improve
concentration ability of wandering mind.

6.
Improve
communication with others through the creation of social atmosphere.

7.
Encourage
feeling of acceptance.

8.
Provide
useful living experience by establishing normal work and play habits.

c.
Types of
occupational therapy:-

Educational
therapy:

ü It involves formal instruction which is giving by qualified
person.

ü The instruction is given by qualified teacher in specific subject
to enhance patient self-esteem and to help to adjust the treatment setting.

ü For children with school phobia, educational therapy is more
essential and immediate therapy.

Vocational
rehabilitation:

Definition: It is
a process by which clients are evaluated, trained and placed in jobs that are
meaningful and satisfying.

ü It is based upon the belief that work provides an outlet for
creativity and satisfying relationships with other colleagues and increases the
sense of self-esteem.

People
for selection:

1.
Clients
with poor work record.

2.
Clients
with occupational maladjustment.

3.
Clients
whose former jobs have been very stressful.

4.
Clients
are evaluated by means of series attitude tests, interviews and tests of manual
skills that provide the therapist by the basic data.

5.
Clients
are generally encouraged to observe or try practical or skill prior to
commencing the training program for it.

ü When the education is completed the vocational rehabilitation
therapist generally facilitates placement job that is money producing.

Creative
media:

ü Clay, painting.

ü To express creative weeds or feelings and conflict that person is
unable to express in health.

Activities:

1.
E.g.
rug, weaving and sanding.

2.
To
provide outlet for releasing anger and frustration.

3. Other activities: grocery shopping & self care.

d.
Nursing care:-

1.Encourage
the patient to learn activity that is money producing to earn his life.

2.Assessment
of the patient needs and qualifies {the nurse should carry out the plan which
is prepared with the occupational therapist}.

3.The
nurse should guide, encourage, and support these who participate in this
activity.

4.The
nurse should keep the environmental safety during the occupational therapy.

5.The
nurse should perform psychological preparation before the occupational therapy.

6.Health
teaching about the method which will be used and its benefits.

7.Try
with therapist to facilitate placement of the patient in a job that is money
producing.

8.Treat
the patient as human being.

9.Facilitate
team work and leadership abilities.

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