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

Abstract

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.

The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

“…Results have shown that the ward atmosphere is important for treatment outcome [6,18] and patient satisfaction [19]. Studies that have included the staff found that these tended to view the ward atmosphere more favorably than the patients did [20-22]. Moreover, the ward atmosphere factor Order and Organization has been found to support high morale among nursing staff in psychiatric in-patient care [23].…”

Associations between ward atmosphere, patient satisfaction and outcome

“…Intentional efforts to change programme policies have also been studied, and it has been shown that the WAS can be used to assess changes after such efforts (Melle et al. 1996, Eklund & Hansson 2001).…”

Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study

“…The Relationship dimension comprises three subscales (Involvement, Support and Spontaneity), the Personal Growth dimension comprises four subscales (Autonomy, Practical orientation, Personal problem orientation and Angry and aggressive behaviour) and the System maintenance dimension comprises three subscales (Order and organization, Programme clarity, Staff control). The different subscales of the WAS have in several studies proven to be strongly related to patient satisfaction (4, 6, 7). Furthermore, studies have revealed that the treatment environment, measured by WAS, is related to improvement in psychiatric symptoms and patient functioning (8–10) and drop out rates (5).…”