Exploration and support in psychotherapeutic environments for psychotic patients

The psychosocial atmosphere in community-based activity centers for people with psychiatric disabilities: visitor and staff perceptions

This study investigated how visitors and staff in community-based activity centers in Sweden perceived the psychosocial atmosphere and whether this could be explained by the centers' orientation (work-oriented versus meeting place-oriented centers). Eighty-eight visitors and 37 staff members at three work-oriented and three meeting place-oriented centers participated. The Community-oriented Programs Environmental Scale was used to estimate the psychosocial atmosphere. The result showed that the psychosocial atmosphere at the centers was in accordance with a supportive ward atmosphere profile. Visitors and staff perceived several aspects of the psychosocial atmosphere differently, especially in the meeting place-oriented centers. The visitors in the meeting place-oriented centers did not perceive the psychosocial atmosphere differently from those visiting the work-oriented centers. The results indicated that the psychosocial atmosphere at the centers was in line with what previous research has shown to be beneficial for visitors regarding outcome and favorable for promoting a good therapeutic alliance and a good functioning in daily life.

Ward atmosphere in acute psychiatric inpatient care: differences and similarities between patient and staff perceptions

The purpose of the study was to compare patient and staff perceptions of the social climate in a psychiatric department, in order to investigate to what extent the two groups agree in their view of the ward milieu. Ninety-six patients and 66 staff members answered the Ward Atmosphere Scale (WAS) questionnaire, comprising a 100-item "real-form" concerning the ward atmosphere as it is actually perceived and a 100-item "ideal-form" concerning the atmosphere in an imagined "best of all" ward. Staff scores were significantly higher than patient scores on the WAS-R subscales Involvement, Spontaneity, Practical orientation, Personal problems orientation and Program clarity, and on the WAS-I subscales Spontaneity, Practical orientation, and Anger and aggression. Patient scores were significantly higher than staff scores on the WAS-R subscale Staff control and on the WAS-I subscales Support, Autonomy and Staff control. At the same time, the findings showed that the WAS-profiles of the two groups were highly concordant regarding both "realities" and "ideals". In conclusion, patients and staff do to some extent differ in their perception of the social climate in the ward. However, the differences seem to reflect nuances in views rather than fundamental differences in opinion. From an overall point of view, the findings suggest a basic agreement between patients and staff regarding the valuation of the treatment environment as well as the general preferences concerning the ward milieu.

Demand characteristics of residential substance abuse treatment programs

PURPOSE

This study examined the objective demand characteristics of treatment programs in which substance abuse patients, or psychiatric patients, were residing. It also examined associations of objective demand with substance abuse patients' perceived expectations for functioning during treatment and patients' in-program participation.

METHODS

A total of 994 patients living in 79 programs took part.

RESULTS

When patients had a substance abuse rather than a psychiatric problem, objective demand was higher: program policies had higher requirements for functioning and more resident control; programs offered fewer health-treatment services; and the physical design provided fewer safety features and social-recreational aids. Compared to substance abuse patients in low-demand programs, patients in high-demand programs perceived the program to have higher expectations, in that the treatment climate exerted more press to develop relationships, set goals, and be organized. Patients in high-demand programs engaged more in self-initiated activities and participated more in treatment services and program-organized events. Substance abuse patients' activity and participation levels were determined jointly by the level of demand and by the expectations for patients' expressiveness and self-understanding of their personal problems.

IMPLICATIONS

The findings illustrate the importance of considering objective indices of demand in conjunction with perceived expectations to improve patients' treatment outcomes.

Perceptions of the real and the ideal ward atmosphere among trainees and staff before and after the introduction of a new work rehabilitation model

Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees' and staff's perspective concerning the real ward atmosphere and that the staff's perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff's estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee's perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time.

Ward atmosphere in acute psychiatric in-patient care: patients' perceptions, ideals and satisfaction

OBJECTIVE

To investigate the relationship between patients' perception of the real and ideal ward atmosphere and their satisfaction.

METHOD

Patients filled in the Ward Atmosphere Scale (WAS, Real and Ideal Form) and a satisfaction questionnaire. Patient characteristics were derived from clinical assessments.

RESULTS

WAS ratings were almost independent of patient characteristics. Patients in locked wards perceived more anger and aggression and patients subjected to coercive measures perceived less autonomy and practical orientation. Patient satisfaction was predicted by higher scores on the WAS Relationship- and System Maintenance dimensions, explaining 41% of the variance. In particular support, order and organization predicted satisfaction. Except from the areas of anger/aggression and staff control, patients gave the 'ideal' ward higher ratings on all subscales. The perceived gap between the 'ideal' and 'real' ward explained 45% of variance in satisfaction.

CONCLUSION

Patients' perception of ward atmosphere is a clinically meaningful measure appearing to be a strong predictor of satisfaction.

Relationships between characteristics of the ward atmosphere and treatment outcome in a psychiatric day-care unit based on occupational therapy

The relationships between characteristics of the ward atmosphere and treatment outcome in a psychiatric day-care unit were investigated. The treatment programme was based on occupational group therapy and included long-term mentally ill patients, equally distributed with regard to psychosis and non-psychosis diagnoses. The ward atmosphere was rated on the Community-Oriented Programs Environment Scale (COPES), and outcome variables concerned symptoms, global mental health, quality of life, and functioning in daily life. The COPES ratings were re-coded in order to control for the fact that different levels of ward atmosphere factors are recommended for psychotic and non-psychotic patients. The results revealed that an optimal initial level of anger and aggression in treatment was significantly associated with improvement in global mental health and functioning in everyday life. Initial optimal levels of staff control and practical orientation were significantly associated with improvement in psychiatric symptoms. The characteristics of the ward atmosphere at the end of the treatment period were significantly correlated with various aspects of functioning in daily life. The study demonstrated associations with outcome variables not previously linked with ward atmosphere characteristics, e.g. functioning in daily life and quality of life.