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Keltner: Psychiatric Nursing, 5th Edition

Chapter 2: Psychotherapeutic Management in the Continuum of Care
Chapter Focus
Psychotherapeutic management is proposed as a model to answer the question, “What do
psychiatric nurses do that is different from other mental health professionals?” This
model acknowledges the interdependence of mental health professionals and emphasizes
the unique strengths of psychiatric nurses. Emphasis is placed on the balance of three
components of psychiatric treatment—the therapeutic nurse-patient relationship (words),
psychopharmacology (drugs), and milieu management (environment)—all of which must
be supported by a sound understanding of psychopathology. Neglect of any component
compromises the therapeutic benefits of nursing intervention. The domain of the
psychiatric nurse includes the art of being therapeutic (as opposed to the practice of
therapy), management of the prescribed medication regimen (dispensing, monitoring,
evaluating, and decision making), and modulation of environmental elements to produce
therapeutic benefits (safety, structure, norms, limit setting, balance, and unit

Key Terms
behavior therapy
continuum of care
psychotherapeutic management
psychotropic drugs

Learning Objectives
After reading this chapter, you should be able to:
1. Describe the components of psychotherapeutic management.
2. Explain the way in which the balancing of psychotherapeutic management
components combines to form a powerful therapeutic model of care.
3. Recognize the relationship between the continuum of care and the psychotherapeutic
management model.
Chapter Outline

Teaching Strategies

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

and home care.  All nurses should understand basic principles of therapeutic communication and use same in nurse-patient interactions. Structured to provide services based on the changing needs of the individual Services include:  Health promotion  Prevention  Treatment  Rehabilitation Initial contact of patient with system should provide assessment and referral to services that are:  Least restrictive  Most effective  Most cost-conscious Risk assessment phase: refers to decisions formerly made at discharge to provide ongoing guidance to an appropriate level of care Providing therapy versus being therapeutic:  All nurses can be therapeutic. nurses:  Administer medications. however. one component can take precedence at a given point in time.  Providing formal therapy is the domain of the advanced practice psychiatric nurse. Additionally. All rights reserved.  Evaluate for desired results.Instructor's Manual Psychotherapeutic Management Application of Psychotherapeutic Management Interventions Continuum of Care Therapeutic Nurse-Patient Relationship Psychopharmacology Milieu Management 2-2 A model proposed to clarify and distinguish the role of the psychiatric nurse.  Plan responses to side effects.  Implement plans. . Inc. residential services.  Make decisions regarding use of prn medications. Maximal benefit to patients occurs when all components are applied.. an affiliate of Elsevier Inc. The three distinct dimensions are:  Therapeutic nurse-patient relationship (use of self/words)  Psychopharmacology (use of drugs)  Milieu management (use of environment) Extend beyond inpatient settings into a variety of settings— for example. Nurses use nursing process to:  Assess patient responses to medication. Proactive approach to care that provides therapeutic Copyright © 2007 by Mosby. outpatient programs.

and biology associated with specific behavior. All rights reserved. Refers to therapies that are effective treatments. mechanisms. an affiliate of Elsevier Inc.  Provide guidance to other staff members toward being therapeutic. This is the study of the processes.Instructor's Manual Psychopathology Special Therapies 2-3 benefits from the environment of the care setting.. but that do not have the universal clinical applications of other categories of psychiatric treatment emphasized in the text:  Behavior therapy  Somatic therapies (electroconvulsive therapy)  Alternative and complementary therapies Copyright © 2007 by Mosby. Inc. Six environmental elements considered:  Safety  Structure  Norms  Limit setting  Balance  Environmental modification Nurses:  Are consistent forces in the milieu. . Knowledge of psychopathology serves as a foundation for the three components of psychotherapeutic management.