Nursing in child psychiatric milieus: Part I: What nurses do

Because of the reduced length of inpatient hospitalization and the increasing emphasis on biopsychiatric treatments, milieu psychiatry is in decline. However, certain aspects of the therapeutic milieu are essential to the operation of child inpatient units. Children with acute psychiatric illness need a safe, structured, and supportive environment. Nurses are the professional group responsible for instituting and maintaining this type of environment, yet their specific functions are vaguely stated and often intuitively derived. A useful way to delineate and describe what nurses do is to organize nursing behaviors into five therapeutic processes: (a) safety, (b) structure, (c) support, (d) involvement, and (e) validation. By delineating essential milieu dimensions in this way, the form and purpose of nursing interventions are clarified.