A nurse is discussing psychiatric advance directives (PAD) with a client. Which of the following statements should the nurse make?

A. "The gathering spaces should have the chairs positioned around the perimeter of the day room." Seating arrangements should encourage interaction and engagement, not isolation. A circular arrangement fosters group discussion and socialization.

B. "The milieu consists of the physical and psychosocial environmental factors." Therapeutic milieu refers to the structured environment of a mental health unit, which includes both physical (safety, layout) and psychosocial (staff interactions, routines) components that support healing.

C. "The clients can keep any personal items they would like in their rooms." While personal items can be comforting, safety concerns may limit what clients can keep. Sharp objects, lighters, or items that could be used for self-harm are typically restricted.

D. "A therapeutic milieu requires unstructured programming, allowing clients to focus on their interests." A structured routine is essential in a therapeutic milieu to promote stability, predictability, and therapeutic engagement. Unstructured environments may increase anxiety or behavioral issues.

A. Projection is a defense mechanism where a client attributes their own feelings to someone else (e.g., “I know you don’t like me” when they actually dislike the nurse).

B. Countertransference is the nurse’s emotional reaction toward the client, not the client’s reaction to the nurse.

C. Empathy involves understanding and sharing another person’s emotions, which is not what is happening in this scenario.

D. Transference occurs when a client projects feelings about another person onto the nurse (e.g., seeing the nurse as a loved one).