THERAPEUTIC COMMUNITY
The concept was first developed by Maxwell Jones in 1953.
Definition
"It is a therapy in which patients social environment
would be used to provide a therapeutic experience by involving him as an active
participant in his own care and daily problems of his own community"-Stuart
& Sundeen
"Therapeutic community is defined as scientific
structuring of the environment in order to effect behavioral changes and to
improve psychological health and functioning of the individual"- (Skinner,
1979)
Objectives
·
To use patients social environment to provide a
therapeutic experience for him
·
To enable the patient to be an active
participant in his own care and become involved in daily activities of his
community
·
To help patients solve problems, plan activities
and develop the necessary rules and regulations for the community
·
To enable the patient become aware of how their
behaviour affects others
Elements of therapeutic community
·
Free communication
·
Shared responsibilities
·
Active participation
·
Involvement in decision making
·
Understanding of roles, responsibilities,
limitations and authorities
Characteristic of a therapeutic community
·
Respect the individual client as a citizen with
a capacity for autonomous action
·
Share decision making with residents about day
to day life of community
·
Use mechanism of meetings and groups to develop
openness of communication about problems, feelings, and conflicts
·
Stress an ordinary domestic environment in which
client can enjoy meaningful purposeful activity
Principles
·
Responsibility for treatment belong to the staff
and client
·
Role of staff and client is equalized
·
Democratic environment is fostered
·
Open communication is encouraged
·
Interpersonal interaction are utilized to
improve communication skills
·
Inappropriate behaviour are dealt with as they
occur Team approach is used
·
Clients are treated as a part of team and share
their responsibility
·
Two main goals for clients, - learn to set
limits, learn psychosocial skills
·
Focus is own client assets
Components of therapeutic
community
Daily community meeting:
l. Composed of
60-90 patients
2. Meeting regularly
for one hour
3. Focus discussion
on day to day life in the unit
4. Patients feelings
and behaviour is noted by other members
Patient government or ward
council:
·
Purpose is to deal with practical unit such as
house keeping functions, activity planning
·
A group of 5-6 patients with specific
responsibilities, such as house keeping, physical exercise, personal hygiene,
meal distribution, a group to observe suicidal patients, etc. staff members
should be available always
·
All decisions should be fed back through
community meetings
Staff meetings/review:
·
patients are excluded and only staffs are
present
·
Staff would examine their own responses, expectations,
and prejudices
Living and learning
opportunities:
·
learning opportunities are to be provided within
the social milieu, which should provide realistic learning experiences for the
patients
Advantages
·
Harmonious relationship with other members of community Gains self confidence
·
Learns to understand and solve problems of self
and others
·
Develop leadership skills
·
Becomes socio-centric
·
Learns to live and think collectively with the
members of the community
·
Provides opportunities to participate in the formulation
of hospital rules and regulations
Disadvantages
·
Role confusion between staff and patient
·
Group responsibility can easily become nobody's
responsibility
·
Individual needs and concerns may not be met
Role of nurse
·
Providing and maintaining safe and conflict free
environment through role modeling and group leadership
·
Sharing responsibilities with patients
·
Encouraging patient to participate in decision
making function
·
Assist patient to assume leadership role
·
Gives feedback
·
Supervisory function
COMMENTS