PREPARING A SAFE AND THERAPEUTIC ENVIRONMENT FOR A PSYCHOGERIATRIC PATIENT

REQUIREMENTS #

These are determined by the specific needs of patient, patient’s condition and resources available

STEPS #

1. Advance Preparation
   1. Establish individualized goals for caring
      1. Maintain an environment which can be adapted to sensory, motor or cognitive needs of patient
      2. Educate patient’s family and significant others about potential threat to patients safety and the environment
      3. Determine general and specific safety needs in the environment
2. Motor of physical domain
   1. Maintain a calm consistent environment
   2. Keep floors dry but not highly polished
   3. Use curtains to prevent glare from windows
   4. Ensure proper lighting in the environment
   5. Install steps with uniform depth if necessary
   6. Mark the edge of steps with bright colors to serve as caution reminders
   7. Ensure that there is enough head-room in rooms and corridor
   8. Remove all protruding objects from walls
   9. Teach patient on how to use corridors, hand rails, bathrooms and toilets
   10. Provide patient with walking stick (tripod is preferable to a cane)
   11. Minimize noise in the environment
   12. Provide heavy furniture to avoid skidding
   13. Provide adult cot or padded rails
   14. Ensure that patient’s clothing fit properly (loose fitting clothing and slippers increase the risk of falling)
   15. Keep all drugs locked and secured
   16. Secure all carpet, mats and tiles
   17. Move patient to a room or unit downstairs
   18. Use commode if there is a need to attend to the toilet
   19. Engage and supervise patient in passive exercise
3. Sensory Domain
   1. Ensure that halls, rooms, baths and toilets are adequately lighted
   2. Speak to patient in clear, loud but gentle tone if he has hearing defect
   3. Stand in front of patient when talking to him, ensuring that he can see your face
   4. Give patient “communication card” to indicate his needs (if he has speech problem)
   5. Ensure that patient’s hearing aid and spectacles (if any) are within easy reach of him and he knows where each is
   6. Place the call bell within his reach and teach him how to use it
   7. Avoid unnecessary sedation (especially at night)
4. Cognitive (memory and intellectual) domain
   1. Continuously remind patient of what is going on his environment
   2. Keep reminding the patient of the item, date and his location (environment)
   3. Assist patient to select and organize his individualized activities
   4. Supervise patient in the use of his property and money( if there is the tendency to give them out)
   5. Refer social and family problems to head nurse or psychiatric social worker