Ward Atmosphere Scale Research Articles

Burnout, working alliance, and ward atmosphere: A multisite study of mental health professionals and patients with schizophrenia.

This study examined the association between burnout, psychological distress, ward atmosphere, and working alliance (WA) among mental health workers treating patients with schizophrenia spectrum disorder (SSD). Data were collected from 345 patients with SSD and 151 mental health workers across 98 residential facilities (RFs) as part of the DiAPAson project from October 2020 to October 2021. Participants were excluded from the study if they exhibited patient-operator matching errors, dropped out, or had many missing Maslach Burnout Inventory (MBI) scores. The final sample included 282 patients and 155 healthcare workers. Burnout was assessed using theMBI. Psychological distress was evaluated with the 12-item version of the General Health Questionnaire. WA and ward atmosphere were evaluated with the WA Inventory and the Ward Atmosphere Scale, respectively, in both staff and patients. Sociodemographic and clinical data was also collected and analysed. Burnout was associated with a less supportive ward atmosphere, a weaker WA, and higher staff distress. Severe psychiatric symptoms evaluated with Brief Psychiatric Rating Scale in patients were also linked to staff burnout levels. Discrepancies in the perceptions of the ward atmosphere and the WA were observed between staff and patients, with patients reporting better perceptions in both domains. Our findings highlight the complex dynamics of well-being within psychiatric care settings, emphasizing the importance of role clarity, professional autonomy, and a positive ward atmosphere in mitigating burnout. Interventions focused on such factors may help support mental health professionals involved in SSD patient care. ISRCTN registry ID ISRCTN21141466.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment.

This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions. Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables. The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG. The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

Interventions to Improve Social Climate in Acute Mental Health Inpatient Settings: Systematic Review of Content and Outcomes.

Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits. This study aimed to identify and critically review research about the effectiveness of interventions for improving social climate in inpatient adult acute mental health settings. Systematic review reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive terms were used to search multiple electronic databases from inception to July 2019. Information about intervention type(s), complexity was extracted and study quality was assessed. Twenty-three papers met inclusion criteria of which 20 used a pretest-posttest study design and three employed randomized and/or controlled designs. Interventions were environmental/structural, operational/process-oriented and developmental/person-oriented in nature and they ranged in complexity. The Ward Atmosphere Scale was the most common outcome measure used. Following quality assessment, six studies were judged to be sufficiently robust in terms of quality, theory-base, user-inclusion, and outcomes evaluation to contribute credibly to the evidence base. Of these, four complex person- and process-oriented intervention studies and two less complex structural/environmental intervention studies resulted in positive outcomes. There is limited strong evidence that interventions positively influence measures of ward social climate in acute adult mental health settings. Such measures should not be the sole criterion of success when evaluating change. Decisions about implementing change to improve social climate should be informed by meaningful proxy measures including the views and preferences of service users and other stakeholders. Studies using stronger designs are required to establish the ability of interventions to improve social climate.

Ward Atmosphere Before and After Relocation of a Psychiatric Hospital to a New Building

To determine effects on ward atmosphere of a relocation of a psychiatric hospital to a new building. Patients and employees of a psychiatric hospital rated their view of the ward atmosphere using the German version of the Ward Atmosphere Scale before and after relocation of the hospital to a new building. 171 patients and 44 employees participated in the study. There was no influence of the relocation of the hospital on the ward atmosphere. However, working or being treated in the day clinic predicted significantly more positive ratings of the ward atmosphere. Relocation to new buildings alone does not necessarily lead to better ratings of the ward atmosphere.

Effect of Ward Atmosphere on Everyday Life of Hospitalized Psychiatric Patients: Patients’ Perspectives

Ward atmosphere has long been viewed as a potentially important factor underlying the efficacy of psychiatric inpatient facilities to promote recovery through a process of encouraging individual empowerment and respect for the mentally ill patient as a consumer and partner. Aim: this study aimed to explain the effect of ward atmosphere on everyday life of hospitalized psychiatric patients as perceived by patients. Methods: sequential explanatory design was utilized in this study. Structured interview followed by unstructured interview were conducted with a sample of one hundred hospitalized psychiatric patients at Psychiatric Medicine and Addiction Prevention Hospital – El Manial Hospital of Cairo University. Two tools were utilized: socio-demographic data sheet and short version of Ward Atmosphere Scale (WAS-S). Results: three themes were extracted after analysis of the participants' verbatim which are: ward atmosphere has no effect on everyday life, ward atmosphere has bad effect on everyday life and ward atmosphere has good effect on everyday life. The study concluded that, mentally ill patients have positive and negative perspectives of the effect of ward atmosphere on the everyday life.

Perception and Satisfaction of Patients Versus Staffs in Three Psychiatric Wards in Tehran in 2010 and 2011

Objectives: To evaluate the perception and satisfaction of patients versus staffs in three psychiatric wards in Tehran. Methods: 219 participants (patients and staffs) from Imam Hossein, Taleghani and Rouzbeh hospitals were evaluated using WAS (ward atmosphere scale), WES -10 (working environment scale), Moos and VSSS (verona service satisfaction scale- 32) questionnaires. Results: 217 participants including 121 patients (55.2%), 58 staffs (26.4%) (nurses and assistant nurses) and 38 doctors (17.3%) (Psychiatrist and residents) were evaluated. The highest mean score in WAS for patients was in order and organization (0.57 ± 0.13) and for staffs was in anger and aggressive behavior (0.58 ± 0.13) items, moreover the lowest mean score in patients and staffs was in autonomy. The mean scores for patients regarding order and organization, staff control and clarity items were higher compared to staffs and in other items the staffs scored higher than patients. Involvement with therapy strongly correlated with Verona (+ 0.75). MOOS showed direct significant correlation with self-realization and indirect significant correlation with nervousness, conflict and work load in WES-10. Conclusions: Staff and patients perceive the treatment environment differently, moreover staff consider ward atmosphere more suitable than patients, but staff satisfaction did not correlate with their perception from treatment environment.

The effect of training in mindfulness and affect consciousness on the therapeutic environment for patients with psychoses: an explorative intervention study

The ward atmosphere and the relationships between patients and staff contribute to the improvement in symptoms and psychiatric patient functioning and satisfaction. The quality of the therapeutic relationship is connected to the degree of self-reflection and self-awareness by the staff. To examine the effect of two different training programmes for healthcare professionals on the ward atmosphere in wards for psychotic patients. Exploratory intervention study with two eight-week interventions of mindfulness training and affect-consciousness training. The outcome was measured on mindfulness and on relevant subscales of the Ward Atmosphere Scale. Data were collected by means of questionnaires and analysed using paired samples t-tests and repeated measures anova. Two groups professionals (n = 27 & n = 23) participated in the study. Improvements indicated that both interventions had a positive impact on the ward atmosphere. The exploratory design and the small samples size make definitive conclusions difficult. Patient assessment on the ward atmosphere scale would have strengthened the validity of the results. The ward atmosphere in two different wards for psychotic patients improved after staff training in mindfulness or affect consciousness. There were differences in change profiles for the groups in accordance with the differences in the two interventions. We recommend awareness on the quality of the ward atmosphere in wards for psychotic patients. Both training in mindfulness and affect consciousness can support healthcare professionals in their awareness.

The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment.

This study investigated changes in the 'atmosphere' of an acute adult mental health setting following relocation to a new purpose-built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital-based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose-built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less 'staff control' in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer 'involvement' in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the 'atmosphere' of a health facility, for both staff and consumers.

Predictors and treatment outcomes of perceived ward atmosphere among therapeutic community residents

Poor retention has been an impediment to the effectiveness of therapeutic communities (TCs) for substance use disorders. We assessed the impact of the resident's perception of the therapeutic environment through the Ward Atmosphere Scale (WAS) on TC retention and examined predictors of the WAS in order to better understand this construct. Among a sample of admissions (N=123) to a 9-month residential TC, forward entry logistic regression analyses using WAS, demographic and clinical variables revealed that heightened perceptions of the orderliness of the therapeutic environment (i.e., the WAS domain of system maintenance) best predicted treatment completion. Furthermore, scores on WAS variables were best explained by the formal therapeutic elements of the TC (as measured by the Survey of Essential Elements Questionnaire) using linear regression. Efforts to improve the resident's perception of these aspects of the ward atmosphere may assist in improving TC completion rates.

The Perceptions of the Ward Atmosphere in Four Jordanian Psychiatric Hospitals From the Perspective of Patients' Relatives

To describes the perceptions of the ward atmosphere of psychiatric hospitals from the perspective of the relatives of people who were inpatients in those hospitals. A nonexperimental descriptive survey was used. Data were collected using the Arabic version of Moos Ward Atmosphere Scale Ideal and Real forms. Data indicate that even though relatives of Jordanian mental health patients were generally positive about the ward atmosphere, they would like to see changes. By describing their current and ideal treatment environments, participants have provided information that can guide interventions to change the ward atmosphere and thus help foster better patient treatment outcomes.

The ward atmosphere scale for psychiatric inpatients with intellectual disability: a pilot study

PurposePatients who have intellectual disability and mental illness will occasionally need inpatient treatment. However, research is sparse on psychosocial factors influencing psychiatric units for patients with intellectual disabilities. The aim of this study is to examine whether adults with intellectual disabilities can reliably rate the Ward Atmosphere Scale – Real Ward (WAS‐R).Design/methodology/approachA total of 17 patients with mild and moderate intellectual disability and 21 staff members were asked to complete the WAS‐R. The authors used six subscales (involvement, support, practical orientation, order and organisation, angry and aggressive behaviour, and staff control) that have proved to be of major importance for patient satisfaction and treatment outcome to measure the patients' and the staff members' perceptions of the treatment milieu. To examine the internal consistency Cronbach's alpha was calculated for the patient and staff scores, respectively.FindingsA total of 16 patients completed the form. Patients with mild intellectual disabilities were able to answer the WAS with some help, whereas patients with moderate intellectual disabilities had major difficulties with understanding more than half of the WAS items. These difficulties were also reflected in the internal consistency scores. Cronbach's alpha was satisfactory (≥0.50) for five subscales for patients with mild intellectual disabilities, but only satisfactory for two of the six subscales for patients with moderate intellectual disabilities.Research limitations/implicationsA replication study should use a shorter version of the WAS‐R, and family or caregivers should answer the WAS‐R additionally to the patients.Originality/valueThis study may encourage more research on treatment milieu for patients with intellectual disability and mental illness.

Enclosed Versus Open Nursing Stations in Adult Acute Care Psychiatric Settings: Does the Design Affect the Therapeutic Milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.

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

BackgroundThe nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants.Methods93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney U-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses.ResultsThe data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate.ConclusionsThe results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.

Evaluation of the impact of a consultation in a secure setting

Organisational consultation is widespread in the National Health Service (NHS), but little is known about its impact. To evaluate the impact of a psychodynamically informed consultation to a high-security hospital ward. This prospective study compared measures before and after the consultation with similarly timed measures on a comparison ward in the hospital, matched for patient characteristics, but not exposed to the consultation. The intention was to compare the consultation with 'treatment as usual', but the study became a comparison of interventions after a programme to facilitate staff-patient communication was instituted by management on the comparison ward. Measures included the Ward Atmosphere Scale (WAS) and an index of burnout. Interactions between staff and patients were observed and rated for content and quality. Most scales on two of three dimensions of the WAS improved on both wards, as did the quality of staff-patient contact. Change at the levels of behaviour and attitude strengthens confidence that a shift occurred in a positive direction. The overall importance of professional supportive attention to staff in such settings was established. Although there was little evidence here for a distinct advantage of one intervention style, the results were encouraging for the consultation, because ward atmosphere and staff-patient interaction were not a direct target for change. Further study is needed to test the possibility that specific interventions may carry specific advantage in other settings or with other patient groups. The nature and quality of institutional support for such research itself needs strengthening. In this case, the institutions' intention to assist was robust, but real understanding and/or sustained ability to facilitate it is lacking. This problem is hardly unique to this setting.

Residential alternatives to acute in-patient care in England: satisfaction, ward atmosphere and service user experiences

Alternatives to traditional in-patient services may be associated with a better experience of admission. To compare patient satisfaction, ward atmosphere and perceived coercion in the two types of service, using validated measures. The experience of 314 patients in four residential alternatives and four standard services were compared using the Client Satisfaction Questionnaire (CSQ), the Service Satisfaction Scale - Residential form (SSS-Res), the Ward Atmosphere Scale (WAS) and the Admission Experience Scale (AES). Compared with standard wards, service users from alternative services reported greater levels of satisfaction (mean difference CSQ 3.3, 95% CI 1.8 to 4.9; SSS-Res 11.4, 95% CI 5.0 to 17.7). On the AES, service users in alternatives perceived less coercion (mean difference -1.3, 95% CI -1.8 to -0.8) and having more ;voice' (mean difference 0.9, 95% CI 0.6 to 1.2). Greater autonomy, more support and less anger and aggression were revealed by WAS scores. Differences in CSQ and AES scores remained significant after multivariable adjustment, but SSS-Res results were attenuated, mainly by detention status. Community alternatives were associated with greater service user satisfaction and less negative experiences. Some but not all of these differences were explained by differences in the two populations, particularly in involuntary admission.

Psychometric evaluation of the Ward Atmosphere Scale in a Russian psychiatric hospital

Aim: The aim of the study was to evaluate the psychometric properties of the 10 subscales of the Ward Atmosphere Scale (WAS) in a Russian psychiatric hospital. Methods: A total of 212 patients and 96 staff members at five wards for acute psychiatric patients completed the WAS. We calculated Cronbach's alpha, the Corrected Item Total Subscale Correlation (CITC), and item-revised subscale intercorrelations. Results: By removing a total of 32 items, the psychometric properties for all subscales except “Autonomy”, reached an acceptable level for the patient scores. Although several of the revised subscales were highly intercorrelated, the specificity of the items of the revised scales appeared acceptable. Conclusions: The revised WAS version appeared applicable within this Russian psychiatric hospital context. Several of the items that were dropped appeared inapplicable because of differences between Russian and Western culture and psychiatry.

A revised Swedish version of the Ward Atmosphere Scale: Usability and psychometrics

Background: The ward atmosphere of psychiatric care units has a major impact on treatment and satisfaction for both patients and staff. The Ward Atmosphere Scale (WAS) was developed to capture the ward atmosphere in different psychiatric settings and is a well-established instrument for this purpose. However, there is need for an update and revision of the WAS. Aim: The aim of the present study was to test a Swedish version of the revised WAS in terms of its internal consistency, content and construct validity, and usability. Methods: Data collection took place at four psychiatric wards and 31 patients and 34 staff completed the WAS, as well as content and construct validity questions. Results: Results showed that the WAS had acceptable to satisfactory internal consistency for all subscales, except for autonomy. Low correlation values between the WAS and the Good Milieu Index were obtained, against which construct validity was discussed. Results of the content validity and usability questionnaires indicate that the WAS is easy to understand and complete, but some of the items were difficult for the respondents to understand and some of the subjects were missing aspects of the physical ward environment. Conclusions: The present study confirms that the Swedish version of the revised WAS can be useful for examining the ward atmosphere in psychiatric care. However, more studies are needed in order to further test the psychometric properties of the WAS and the results of the usability questionnaire may indicate a need to use supplementary instruments in order to capture the physical ward environment as well.

A Randomized Study Comparing the Treatment Environment in Alternative and Hospital-Based Acute Psychiatric Care

Programs that offer alternatives to hospital-based acute psychiatric care have reported promising results of lower costs, equivalent or superior outcomes, and greater patient satisfaction. This study supplements previous research that compared the outcomes, satisfaction, and cost of hospital-based care and one such alternative program, short-term acute residential treatment (START), with an analysis of patient and staff perceptions of the treatment environments. Patients who participated were all veterans and were randomly assigned to receive treatment in a hospital psychiatric unit (N=45) or in START (N=48). Both groups completed the Ward Atmosphere Scale (WAS), a standardized measure of treatment environment, at the time of discharge. During the study, staff members from both types of programs also completed the WAS (15 hospital staff and 75 START staff). Both patients and staff rated the START environment more favorably than the hospital environment on five of ten WAS subscales. No differences were found in congruence between staff and participants' scores at START or the hospital. WAS profiles for patients and staff from the hospital closely matched published national norms for hospitals, whereas WAS profiles for patients and staff from START more closely resembled treatment environments recommended for the most disturbed patients (lower levels of anger and aggression and higher levels of support, problem orientation, and order and organization). The more favorable ratings of the treatment environment at START in this study are consistent with previously published findings demonstrating the viability of the START model as an alternative to hospital-based acute psychiatric care.

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

The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction. The study was approved by the Regional Ethics Committee for Medical Research. To measure the patients' perceptions of the treatment environment we used the Ward Atmosphere Scale (WAS). The ward atmosphere was evaluated three times during a 12-month period. Additionally, the patients completed five questions concerning satisfaction with the treatment environment. Between the first and the second ward evaluation the nursing staff was given 3 weeks of lectures on different aspects of milieu therapy. The nursing staff completed the WAS and three satisfaction items. The study revealed a change in desired direction after education in five of the six key subscales of the WAS (Involvement, Support, Practical orientation, Angry and aggressive behaviour and Order and organization). Staff control was the only subscale with no changes. The patients also reported an increase in satisfaction. The study revealed no major changes in the staff scores. The present study included only a small number of patients and examined the changes in only one psychiatric department; hence it could be argued that the results cannot be generalized to equivalent populations within the forensic services. The study indicated that it is possible to improve the ward atmosphere in a desirable direction by a 3-week training programme for nursing staff about important aspects of milieu therapy.

Associations between ward atmosphere, patient satisfaction and outcome

Previous studies have found important associations between the ward atmosphere and patient satisfaction. However, fewer studies have examined the relationship between ward atmosphere and outcome of treatment. The aim of the study was to examine whether or not differences in ward atmosphere were associated with differences in satisfaction and outcome. Eighty patients at three different ward units responded to a questionnaire at admission and by the time of discharge from the hospital. The questionnaire comprised the ward atmosphere scale, a five-item index of patient satisfaction, the Generalized Self-Efficacy Scale, an index of life satisfaction and the symptom checklist SCL-90R. The results showed that differences in the treatment environment between the ward units were associated with differences in patient satisfaction. There was mixed evidence for associations between ward atmosphere and outcome, while no associations were found between ward atmosphere and self-efficacy and life satisfaction. The results may suggest that the relationship between ward atmosphere and outcomes of treatment may be of a more indirect character than the relationship between ward atmosphere and satisfaction.