Explain elements and methods of fostering a therapeutic milieu.


Case Study, Mohr

CHAPTER 19, Inpatient Care Settings

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In completing the case study, students will be addressing the following learning objectives:

Define the various levels of care within inpatient treatment settings.

Explain elements and methods of fostering a therapeutic milieu.

1. Robert Woods has been admitted to an inpatient psychiatric facility due to a resurgence of his manic symptoms because he has not been taking his psychiatric medications. His sister has been trying to supervise Robert, who lives in a small apartment a few miles away. The sister is very frustrated and feels she cannot continue to monitor Robert successfully any longer. She asks what kinds of inpatient care options are available to assist in caring for Robert and voices concern about Robert’s noncompliance with his psychiatric medications.

(Learning Objectives: 1, 4)

a. Review the levels of inpatient care and offer some suggestions to Robert’s sister concerning ongoing psychiatric care.

b. The nurse is responsible for medication administration for Robert. How can a therapeutic environment and strategies assist the nurse in ensuring that Robert takes his psychiatric medications?


Inpatient Psychiatric Care: Levels of Care and Strategies for Medication Compliance


Inpatient psychiatric care provides a structured and supportive environment for individuals experiencing acute mental health symptoms. This essay discusses the levels of care within inpatient treatment settings and explores strategies for fostering a therapeutic milieu and ensuring medication compliance. Specifically, it addresses the case of Robert Woods, who has been admitted to an inpatient facility due to a resurgence of manic symptoms and noncompliance with his psychiatric medications.

Levels of Inpatient Care

Acute Inpatient Care: Acute inpatient care is suitable for individuals requiring immediate and intensive treatment for acute psychiatric symptoms. This level of care offers round-the-clock supervision, medication management, group therapy, individual counseling, and a structured environment (Treatment, 1997). It focuses on stabilizing acute symptoms and ensuring patient safety.

Subacute Inpatient Care: Subacute care is appropriate for individuals who require a longer duration of treatment but do not need 24-hour supervision. It provides a less restrictive environment while still offering structured programming, medication management, individual and group therapy, and a supportive milieu.

Residential Treatment: Residential treatment programs cater to individuals who need ongoing support and treatment but do not require 24-hour medical care. These programs offer a therapeutic environment with a focus on recovery, independent living skills, medication management, and various therapeutic interventions.

Partial Hospitalization Program (PHP) or Day Treatment: PHPs are structured programs that provide comprehensive treatment during the day, allowing individuals to return home in the evenings. They involve group therapy, medication management, psychoeducation, and other therapeutic activities. PHPs are suitable for individuals who require intensive treatment but do not need constant supervision.

Suggestions for Ongoing Psychiatric Care for Robert’s Sister

Given Robert’s current situation and noncompliance with medications, an acute inpatient care setting may be the most appropriate option. This level of care would provide the necessary structure, supervision, and medication management to stabilize his acute symptoms and ensure compliance with his psychiatric medications (Chien et al., 2013). It would also allow for close monitoring and adjustment of his medication regimen as needed.

Fostering a Therapeutic Milieu and Strategies for Medication Compliance

Creating a therapeutic environment within the inpatient setting is crucial for promoting medication compliance. Here are strategies that can assist nurses in optimizing the therapeutic milieu and ensuring medication compliance for patients like Robert:

Establishing a Collaborative Treatment Plan: Involve the patient in developing their treatment plan, including the medication regimen. Collaboratively set treatment goals and discuss the benefits and potential side effects of the medications. This empowers the patient and increases their sense of ownership over their treatment.

Education and Psychoeducation: Provide comprehensive education about the importance of medication adherence, specific medications prescribed, their mechanisms of action, and potential side effects. Ensure that the patient understands the consequences of noncompliance and the benefits of adhering to the medication regimen.

Individualized Approach: Recognize that each patient has unique needs and preferences. Tailor the medication administration process to suit the patient’s preferences as much as possible (Kim, 2023). Consider factors such as medication schedules, preferred routes of administration, and involving the patient in decision-making regarding their treatment.

Therapeutic Communication: Establish a trusting and therapeutic nurse-patient relationship. Encourage open and honest communication, actively listen to the patient’s concerns, and address any fears or misconceptions they may have about their medications. Provide emotional support and reassurance throughout the treatment process.

Behavioral Interventions: Implement behavioral strategies to reinforce medication compliance. This may involve positive reinforcement techniques, such as rewards or incentives for taking medications as prescribed. Additionally, utilize cognitive-behavioral interventions to address underlying reasons for noncompliance and develop coping skills to overcome barriers to medication adherence.

Multidisciplinary Collaboration: Work collaboratively with the healthcare team, including psychiatrists, psychologists, social workers, and occupational therapists, to ensure a comprehensive approach to patient care. Regular interdisciplinary meetings can help address challenges, adjust the treatment plan if needed, and ensure continuity of care.


Inpatient psychiatric care offers various levels of care to address the unique needs of individuals experiencing acute mental health symptoms. For patients like Robert Woods, who are noncompliant with psychiatric medications, acute inpatient care may be the most appropriate option. Fostering a therapeutic milieu and utilizing strategies such as establishing a collaborative treatment plan, providing education, individualizing the approach, promoting therapeutic communication, implementing behavioral interventions, and encouraging multidisciplinary collaboration can optimize the therapeutic environment and support medication compliance. By incorporating these strategies, healthcare professionals can enhance patient outcomes and contribute to effective inpatient psychiatric care


Chien, W. T., Leung, S. F., Yeung, F. K. C., & Wong, W. Y. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment, 1463. https://doi.org/10.2147/ndt.s49263 

Kim, J. (2023, February 12). Medication Routes of Administration. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK568677/ 

Treatment, C. F. S. A. (1997). Chapter 5—Specialized Substance Abuse Treatment Programs. A Guide to Substance Abuse Services for Primary Care Clinicians – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64815/ 

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