In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of the therapeutic environment in order to:

  • Identify external factors that may interfere with client recovery (e.g., stressors, family dynamics)
  • Make client room assignments that support the therapeutic milieu
  • Provide a therapeutic environment for clients with emotional/behavioral issues

Identifying External Factors That May Interfere with Client Recovery

Client recovery is negatively and positively impacted by a wide variety of intrinsic and internal client related factors and also with extrinsic and external forces and factors. For example, physical recovery from a biological illness or disease can be delayed, interrupted and otherwise negatively impacted when the client has a comorbidity such as diabetes which is an intrinsic factor; and physical recovery from a biological illness or disease can be facilitated when the patient has the support of the family and resources in the community which are extrinsic factors external to the client. Similarly, psychological recovery can be facilitated and enhanced when the client has a strong support system and psychological recovery can be impeded and interfered with when the patient is not compliant and adherent to their medication regimen.

Other factors that can interfere with the psychological recovery and psychosocial integrity include disrupted family dynamics, the inaccessibility and the lack of affordability of health care services and resources, levels of stress, social stigma, and the lack of culturally competent care.

Psychological recovery is enhanced when patients and significant others participate in group meetings for professional and peer support. For example, community meetings can help the client in terms of socialization skills enhancement, self care promotion groups, group therapy, and psychosocial peer support groups; and community group meetings are available to also facilitate psychological recovery for those affect with a common disease or disorder such as depression, and there are also peer support groups like Alcoholics Anonymous and Narcotics Anonymous meetings.

Making Client Room Assignments that Support the Therapeutic Milieu

As much as possible, client room assignments should support the therapeutic milieu. For example, a client with violent and, or otherwise, disruptive behavior should not share a room with a client who triggers a client's inappropriate and/or violent dangerous behaviors, and a client at risk for suicide should have a room close to nursing station so that the client can be observed and monitored more closely and more frequently than would occur in a less trafficked and remote area.

Providing a Therapeutic Environment for Clients with Emotional/Behavioral Issues

Nurses establish, provide and maintain a therapeutically safe and supportive environment, which is referred to as a therapeutic milieu. Environments must be free of all physical safety hazards and also free of any hazards that could potentially jeopardize psychological wellbeing and safety. A therapeutic milieu eliminates as many stressors from the environment as possible. The goal of this environment is to facilitate the client's coping and recovery without the need to cope with these extraneous and avoidable stressors.

Some of the elements of a therapeutic milieu environment include consistency, client rules, limitations and boundaries, and client expectations, including contracts, relating to appropriate behavior.


SEE – Psychosocial Integrity Practice Test Questions

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