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Application of Milieu Based Principles in Primary Care.

Sean Convoy1, Dana Convoy1, Jacquelyn McMillian-Bohler1

  • 1School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, USA.

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|January 25, 2026
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Summary

This study reframes the therapeutic milieu concept for primary care settings. It offers a framework for healthcare teams to improve patient care, focusing on preserving life, preventing harm, and promoting recovery.

Keywords:
Care environmentPrimary careTherapeutic milieuWorkplace violence

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Area of Science:

  • Healthcare Management
  • Primary Care Medicine
  • Psychiatry

Background:

  • The therapeutic milieu is a key concept in psychiatric care.
  • Its application in primary care settings requires adaptation.
  • Effective management is crucial for patient outcomes.

Purpose of the Study:

  • To reintroduce the traditional therapeutic milieu construct.
  • To reframe its application within the primary care environment.
  • To provide a framework for healthcare teams to manage the primary care therapeutic milieu.

Main Methods:

  • Literature review and conceptual analysis based on Gunderson's work.
  • Reframing the therapeutic milieu for primary care contexts.
  • Developing an actionable framework for healthcare teams.

Main Results:

  • The foundational elements of the therapeutic milieu offer an accessible framework.
  • This framework enables healthcare teams to better assess and manage the primary care milieu.
  • The approach is relevant to patients, families, and the healthcare team.

Conclusions:

  • The therapeutic milieu concept can be effectively applied to primary care.
  • Implementing this framework supports preserving life, preventing harm, and promoting recovery.
  • This approach enhances the therapeutic relationship and patient outcomes in primary care.