How patients and nurses experience the acute care psychiatric environment

Mona M. Shattell, Melanie Andes, Sandra P. Thomas

Research output: Contribution to journalArticlepeer-review

88 Scopus citations


The concept of the therapeutic milieu was developed when patients' hospitalizations were long, medications were few, and one-to-one nurse-patient interactions were the norm. However, it is not clear how the notion of 'therapeutic milieu' is experienced in American acute psychiatric environments today. This phenomenological study explored the experience of patients and nurses in an acute care psychiatric unit in the USA, by asking them, 'What stands out to you about this psychiatric hospital environment?' Three figural themes emerged, contextualized by time, which was a source of stress to both groups: for patients there was boredom, and for nurses, pressure and chaos. Although they shared some themes, nurses and patients experienced them differently. For instance, nurses felt caged-in by the Plexiglas-enclosed nursing station, and patients felt caged-in by the locked doors of the unit. The findings from this US study do not support the existence of the therapeutic milieu as described in the literature. Furthermore, although the nurse-patient relationship was yearned for by nurses, it was nearly absent from patients' descriptions. The caring experienced by patients was mainly derived from interactions with other patients.

Original languageEnglish (US)
Pages (from-to)242-250
Number of pages9
JournalNursing Inquiry
Issue number3
StatePublished - Sep 2008
Externally publishedYes


  • Acute care psychiatry
  • Mental health nursing
  • Therapeutic milieu

ASJC Scopus subject areas

  • Nursing(all)


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