Nursing in child psychiatric milieus: What nurses do: An update

In 1992, a paper published in the Journal of Child and Adolescent Psychiatric Nursing detailed the work of psychiatric nursing staff on inpatient child/adolescent psychiatric units. The paper was organized around five therapeutic processes seen to organize nursing interventions into the essential functions of a therapeutic milieu. This paper updates that scheme as well as the nursing interventions that operationalize these therapeutic processes. The model is now organized according to four therapeutic categories: Safety, Structure, Support, and Self-Management. Each of these categories is explained and updated with recent nursing literature and psychiatric inpatient research. The support category highlights recent qualitative research focused on adolescents' perceptions of their psychiatric hospitalization experience. Recommendations for future directions for nursing milieu practice are suggested.