A nurse is admitting a client with severe anxiety and a history of self-directed violence to an inpatient psychiatric unit. Which actions by the nurse support the establishment and maintenance of a safe and therapeutic environment? (Select all that apply.)
- Removing belts, shoelaces, glass items, and personal medications from the client's luggage during the admission searchAnswer
- Assigning the client to a semi-private room located in direct view of the central nurses' stationAnswer
- Explaining the unit's behavioral expectations and providing a written schedule of daily therapeutic activitiesAnswer
- DDelegating the initial assessment of the client's self-harm risk to an experienced unlicensed assistive personnel (UAP)
- EInitiating physical restraints as a preventative measure while the client acclimates to the new unit
- FReassuring the client by stating, "There is nothing to worry about here; we will fix everything that is bothering you"
Answer
The appropriate actions to establish a therapeutic environment are removing potentially hazardous items during the admission search, assigning the client to a highly visible room near the nurses' station, and providing a structured daily schedule to reduce anxiety.
A therapeutic environment (milieu) provides physical and emotional safety, structure, and support. Removing contraband such as glass, belts, and shoelaces eliminates immediate hazards for a client with a history of self-directed violence. Assigning the client to a room near the nurses' station ensures continuous monitoring. Orienting the client to the daily schedule and behavioral expectations provides predictability, which is a fundamental intervention for reducing severe anxiety and establishing a therapeutic routine.
Step-by-Step Solution
Key Concept
Therapeutic Milieu and Environmental Safety