title: Calming an escalated psychiatric milieu.
abstract: On inpatient psychiatric units, nurses control the tone, pace, and activity level of the environment. But under the influence of factors such as high patient acuity and negative group contagion, a milieu can become unacceptably loud and chaotic. A volatile milieu is a potentially dangerous environment because patients' anxiety and agitation can quickly lead to acting out and aggression. This article focuses on how nurses can regain control of a milieu spiralling into chaos by tightening the structure of the routine, anticipating potential problems, and maintaining a confident calm manner. The charge nurse orchestrates the staff group's response to escalation through detailed planning, decisive interventions, and strategic use of every available resource.
authors.forename: K R
authors.initials: KR
authors.lastname: Delaney
mesh_terms: D002648:Child; D002665:Child Psychiatry / Q000379:methods; D003617:Dangerous Behavior; D006126:Group Processes; D006272:Health Facility Environment; D006801:Humans; D008884:Milieu Therapy; D011568:Psychiatric Nursing / Q000379:methods*