ABSTRACT
With the reforms of 2011 and 2013 relating to psychiatric hospitalisation, raises the question of the suitability of modern psychiatric practice with regard to a person's recognised principles and basic rights. Achieving a balance is difficult and the Constitutional Council has joined the debate, bringing to an end any idea of compromise between safety and freedom. A decision which was made as a result of a clarification of certain regulations which have proved controversial from the point of view of individual liberties.
Subject(s)
Critical Pathways/legislation & jurisprudence , Mental Disorders/nursing , Nurse-Patient Relations , Patient Advocacy/legislation & jurisprudence , Patient Isolation/legislation & jurisprudence , Personal Autonomy , Psychiatric Nursing/legislation & jurisprudence , Restraint, Physical/legislation & jurisprudence , Dangerous Behavior , France , Humans , Mental Disorders/psychology , Milieu Therapy/legislation & jurisprudence , Milieu Therapy/organization & administration , Nursing, Team/legislation & jurisprudence , Nursing, Team/organization & administration , Patient Isolation/psychology , Patient Safety/legislation & jurisprudence , Restraint, Physical/psychologySubject(s)
Alzheimer Disease/therapy , Geriatric Psychiatry/organization & administration , Psychiatric Department, Hospital/organization & administration , Specialization , Aged , Alzheimer Disease/diagnosis , Combined Modality Therapy , Cooperative Behavior , Germany , Health Services Needs and Demand/organization & administration , Hospitals, Psychiatric/organization & administration , Humans , Interdisciplinary Communication , Milieu Therapy/organization & administration , Quality Assurance, Health Care/organization & administration , Social EnvironmentABSTRACT
PURPOSE: The purpose of this study was to compare the effects of enhanced milieu teaching (EMT) implemented by parents and therapists versus therapists only on the language skills of preschool children with intellectual disabilities (IDs), including children with Down syndrome and children with autism spectrum disorders. METHOD: Seventy-seven children were randomly assigned to 2 treatments (parent + therapist EMT or therapist-only EMT) and received 36 intervention sessions. Children were assessed before, immediately after, 6 months after, and 12 months after intervention. Separate linear regressions were conducted for each standardized and observational measure at each time point. RESULTS: Parents in the parent + therapist group demonstrated greater use of EMT strategies at home than untrained parents in the therapist-only group, and these effects maintained over time. Effect sizes for observational measures ranged from d = 0.10 to d = 1.32 favoring the parent + therapist group, with the largest effect sizes found 12 months after intervention. CONCLUSION: Findings from this study indicate generally that there are benefits to training parents to implement naturalistic language intervention strategies with preschool children who have ID and significant language impairments.
Subject(s)
Education, Special/methods , Intellectual Disability/rehabilitation , Language Development Disorders/rehabilitation , Language Therapy/methods , Milieu Therapy/methods , Adult , Child Development Disorders, Pervasive/rehabilitation , Child, Preschool , Down Syndrome/rehabilitation , Early Intervention, Educational/methods , Early Intervention, Educational/organization & administration , Education, Special/organization & administration , Female , Humans , Language Therapy/organization & administration , Male , Milieu Therapy/organization & administration , Parent-Child Relations , Parents , Program EvaluationABSTRACT
The day hospital of Abbeville is a building located in the town center, where the atmosphere is more important than prescriptions. The case of a patient in his thirties shows the role of this place, at the meeting point of other psychiatric care structures. This organization is permitted by the specific organization of the French psychiatrical sector, with a work orientation aimed towards care and shared by a team.
Subject(s)
Community Mental Health Centers , Cooperative Behavior , Day Care, Medical/organization & administration , Interdisciplinary Communication , Mental Disorders/nursing , Mental Healing , Female , France , Humans , Length of Stay , Male , Milieu Therapy/organization & administration , Patient Care Team/organization & administration , Psychotherapy, Group , Psychotic Disorders/nursing , Psychotic Disorders/psychology , Social Environment , Stress, Psychological/psychologyABSTRACT
AIM: This paper is a report of a study to develop milieu therapists' acknowledging communication in their relationships with patients. BACKGROUND: Gunderson's therapeutic processes in milieu therapy have come into use in a broad range of mental health contexts in many countries. Research in nursing indicates that validation needs a more concrete development for use in clinical work. METHODS: Schibbye's theory, 'Intersubjective relational understanding', formed the theoretical foundation for a participatory action research project in 2004-2005. The data comprised the researcher's process notes written during participation in the group of group leaders every second week over a period of 18 months, clinical narratives presented by participants in the same group, and eight qualitative interviews of members of the reflection group. FINDINGS: The core concept in acknowledging communication, mutuality, was described as inter-subjective sharing of feelings and beliefs in a respectful way. Participants presented their process of development as a movement from knowing what was best for the patient (acknowledging patients as competent persons, a milieu-therapy culture based on conformity), to appreciating diversity and stubborn talk, to reflective wondering questions. Misunderstanding of acknowledgement occurred, for instance, in the form of always being supportive and affirmative towards patients. CONCLUSION: The concrete approaches in acknowledging communication presented in this article could be a fruitful basis for educating in and developing milieu therapy, both for nursing and in a multi-professional approach in clinical practice and educational institutions. Future research should focus on broader development of various areas of acknowledging communication in practice, and should also include patients' experiences of such approaches.
Subject(s)
Delivery of Health Care/organization & administration , Mental Health Services/organization & administration , Milieu Therapy/organization & administration , Adult , Attitude of Health Personnel , Humans , Middle Aged , Milieu Therapy/methods , Professional-Patient RelationsABSTRACT
We describe the results of a survey about therapeutic standards in German and Swiss depression treatment units.
Subject(s)
Depressive Disorder/therapy , Milieu Therapy/organization & administration , Psychiatric Department, Hospital/organization & administration , Quality Assurance, Health Care/organization & administration , Combined Modality Therapy/psychology , Depressive Disorder/psychology , Germany , Hospitals, Psychiatric , Humans , Patient Care Team/organization & administration , SwitzerlandABSTRACT
As part of a continuous quality improvement program, a hospital implements a nurse-driven milieu therapy plan for substance abuse patients.
Subject(s)
Milieu Therapy/organization & administration , Psychotherapy, Group/organization & administration , Substance-Related Disorders/nursing , Total Quality Management/organization & administration , Humans , Patient Care Team/organization & administration , Patient Satisfaction , Professional Staff Committees/organization & administration , Substance-Related Disorders/psychology , Substance-Related Disorders/rehabilitationABSTRACT
The author provides a concise overview of how the milieu functions of structure, involvement, containment, support, and validation can be used to create a positive treatment environment. Examples of an unhealthy milieu are contrasted with these therapeutic principles.
Subject(s)
Milieu Therapy , Humans , Milieu Therapy/organization & administration , Organizational Objectives , Psychiatric NursingABSTRACT
Multiple changes in the authors' inpatient adolescent unit--including unit mergers, increased patient acuity, and shorter length of stay--created the need and opportunity to implement a new Behavioral Milieu Program with two significant components: A positive Behavioral Points System and 15 nurse-led groups. The authors describe this new program, which provides a safe and effective treatment modality and promotes each adolescent's sense of responsibility for his own behavior and life. Dramatic outcomes include decreased use of mechanical restraints by 56% in the first three months of implementation and by 82% in the second three months. This program has applications for inpatient units, community residences, and schools, and can even be adapted for home use by parents.
Subject(s)
Adolescent Psychiatry/organization & administration , Behavior Therapy/organization & administration , Hospital Units/organization & administration , Milieu Therapy/organization & administration , Adolescent , Humans , Internal-External Control , Organizational Innovation , Restraint, PhysicalABSTRACT
The deinstitutionalization movement has left a legacy of need for appropriate care for inpatients with chronic refractory mental illness. This article describes a nurse managed program for such patients based on the principles of a therapeutic milieu. The program was formally defined for a 6-month period with an effort to include outcome measures for program evaluation. Multidisciplinary treatment team planning with a psychiatric nursing clinical specialist as team leader provided a format for putting therapeutic concepts into practice. The nurse clinical specialist and two nurse practitioners served as case managers as well as primary care providers. Program evaluation showed that cost-effective quality care could be achieved with a reduction in polypharmacy and overall neuroleptic usage. The notion of a restraint appropriate environment, with the goal of minimizing restraint use, was introduced and put into practice.
Subject(s)
Inpatients , Managed Care Programs/organization & administration , Mental Disorders/therapy , Milieu Therapy/organization & administration , Patient Care Planning , Patient Care Team/organization & administration , Psychiatric Nursing/organization & administration , Adult , Aged , Aged, 80 and over , Chronic Disease , Cost-Benefit Analysis , Deinstitutionalization , Drug Utilization , Health Services Needs and Demand , Humans , Male , Middle Aged , Models, Nursing , Nurse Clinicians , Nurse Practitioners , Outcome Assessment, Health Care , Program EvaluationABSTRACT
Milieu therapy has long existed as an effective treatment modality for the mentally ill. It has also been a significant aspect of psychiatric-mental health nursing practice for several decades. This article reviews the history of milieu therapy and the role that psychiatric-mental health nursing staffs have in its implementation. The authors suggest strategies for milieu management and future implications for milieu therapy.
Subject(s)
Milieu Therapy/methods , Psychiatric Nursing/methods , Forecasting , Humans , Milieu Therapy/organization & administration , Milieu Therapy/trends , Nursing Staff , Nursing, Supervisory , Psychiatric Nursing/organization & administration , Psychiatric Nursing/trends , RoleABSTRACT
A number of clinical and financial advantages exist when clients diagnosed with borderline personality disorder are placed in an unlocked milieu-oriented treatment unit during hospitalization. The author describes the transition from a locked inpatient unit to an unlocked unit, the effects of this change on staff and clients' attitudes toward treatment, and the impact of this transition on client functioning.
