BACKGROUND: The therapeutic environment is commonly acknowledged as a significant influence on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a distinct, secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic interactions and collaborative attentiveness. The review aimed to explore the studies related to the role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting. MATERIALS AND METHODS: A systematic literature search was conducted between 1976 and 2021 using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review. RESULTS: A total of 70 studies were found, out of which 13 of them were analyzed. These studies looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction, nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most of the studies explored the concepts of milieu therapy in community settings. CONCLUSION: In the mental health nursing literature, the milieu, as well as milieu therapy, is a well-debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized, empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety, and good interpersonal relationships.
Background: Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected. Aim: The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs. Materials and Methods: An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann–Whitney, Kruskal–Wallis, and binary logistic regression). Results: The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92–3.06), loss of valuables (OR = 2.62; 95% CI = 0.78–9.04), self-blame (OR = 6.06; 95% CI = 1.15–31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89–46.85) acted as determinants in the occurrence of PTSD and depression. Conclusion: A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.
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