Ward Atmosphere and Patient Satisfaction in Psychiatric Hospitals With Different Ward Settings and Door Policies. Results From a Mixed Methods Study

Abstract

Background: Open-door policies in psychiatry are discussed as a means to improve the treatment of involuntarily committed patients in various aspects. Current research on open-door policies focuses mainly on objective effects, such as the number of coercive interventions or serious incidents. The aim of the present study was to investigate more subjective perceptions of different psychiatric inpatient settings with different door policies by analyzing ward atmosphere and patient satisfaction. Methods: Quantitative data on the ward atmosphere using the Essen Climate Evaluation Scale (EssenCES) and on patient satisfaction (ZUF-8) were obtained from involuntarily committed patients ( n = 81) in three psychiatric hospitals with different ward settings and door policies (open, facultative locked, locked). Furthermore, qualitative interviews with each of 15 patients, nurses, and psychiatrists were conducted in one psychiatric hospital with a facultative locked ward comparing treatment in an open vs. a locked setting. Results: Involuntarily committed patients rated the EssenCES’ subscale “Experienced Safety” higher in an open setting compared with a facultative locked and a locked setting. The subscale “Therapeutic Hold” was rated higher in an open setting than a locked setting. Regarding the safety experienced from a mental health professionals’ perspective, the qualitative interviews further revealed advantages and disadvantages of door locking in specific situations, such as short-term de-escalation vs. increased tension. Patient satisfaction did not differ between the hospitals but correlated weakly with the EssenCES’ subscale “Therapeutic Hold.” Conclusion: Important aspects of the ward atmosphere seem to be improved in an open vs. a locked setting, whereas patient satisfaction does not seem to be influenced by the door status in the specific population of patients under involuntary commitment. The ward atmosphere turned out to be more sensitive to differences between psychiatric inpatient settings with different door policies. It can contribute to a broader assessment by including subjective perceptions by those who are affected directly by involuntary commitments. Regarding patient satisfaction under involuntary commitment, further research is needed to clarify both the relevance of the concept and its appropriate measurement.

Coercion in psychiatric and mental health nursing: A conceptual analysis

“…2012) and risk of escape from the unit or psychiatric facility (Efkemann et al . 2019; Kalagi et al . 2018; Salzmann‐Erikson 2015) are presented as antecedents of coercion.…”

“…2008) and creating a sense of safety for clinical staff (Efkemann et al . 2019). Other positive effects are also pointed out in the literature (Valenti et al .…”

“…2018), is a highly controversial issue (Efkemann et al . 2019; Gustafsson & Salzmann‐Erikson 2016; Perkins et al . 2012; Valenti et al .…”

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

“…Open-door policies have been associated with an improved ward atmosphere (7,(35)(36)(37). Patients and HCP in our study reported improved well-being and improved establishment of therapeutic relationships due to decreasing control functions after opening the ward.…”

Perspectives on Involuntary Treatment of Anorexia Nervosa

“…Because the use of these more intrusive involuntary measures not directly relates to the symptoms of anorexia nervosa has been described in relation to compulsory tube feeding in two single case studies of anorexia nervosa (22, 23), we do not expect the results to reflect a country-specific practice. However, it remains relevant to examine whether the use of such measures is common across countries, as legislation on the use of involuntary treatment varies globally and cultural aspects have been shown to affect the frequency and type of involuntary measures (5,(24)(25)(26)(27). In addition, questions on the extent to which patient-specific, illness-specific, and contextual factors affect specific involuntary measures need to be answered as well as the impact of these measures on patients.…”