Sicherheit, therapeutischer Halt und Patientenzusammenhalt auf geschlossenen, neu geöffneten und offenen psychiatrischen Stationen

Zusammenfassung

Ziel der Studie war es, Stationsklima, Sicherheit, therapeutischen Halt und Patientenzusammenhalt auf geschlossenen, neu geöffneten und offenen Stationen zu vergleichen.

Methodik: Untersuchung der Zielparameter mittels Essen Climate Evaluation Schema.

Ergebnisse: Das globale Stationsklima (p < 0,001), die Sicherheit (p < 0,001) und der Patientenzusammenhalt (p < 0,001) auf den neu geöffneten Stationen wurden als signifikant besser bewertet als auf den anderen Stationen.

Schlussfolgerung: Die Öffnung von Stationen ist geeignet, zur Etablierung eines therapiefördernden Behandlungsklimas beizutragen.

Abstract

Objective: To compare ward atmosphere, safety, therapeutic hold, and patients’ coherence on closed, recently opened, and open psychiatric wards.

Methods: Ward atmosphere on two closed, two recently opened, and two permanently open wards was examined using the Essen Climate Evaluation Schema (EssenCES), and structural as well as clinical data were extracted.

Results: Global ward atmosphere (p < 0.001), safety (p < 0.001), and patients’ coherence (p < 0.001) on the recently opened wards were significantly higher than on the closed and permanently open wards. No significant differences were found regarding therapeutic hold. Recently opened wards had the highest occupancy, and there were no significant differences regarding severity of illness.

Conclusion: Opening closed psychiatric wards can help establish a positive therapeutic atmosphere without omitting more severely ill patients or endangering patients and therapists.

Schlüsselwörter

Akutpsychiatrie - Behandlungsklima - geschlossene Stationsführung - Stationsatmosphäre - Türöffnung

Keywords

acute psychiatry - closed ward - open doors policy - therapeutic climate - ward atmosphere

• Literatur

• 1 Huber CG, Lambert M, Naber D et al. Validation of a Clinical Global Impression Scale for Aggression (CGI-A) in a sample of 558 psychiatric patients. Schizophr Res 2008; 100: 342-348
• 2 Huber CG, Schottle D, Lambert M et al. Brief Psychiatric Rating Scale – Excited Component (BPRS-EC) and neuropsychological dysfunction predict aggression, suicidality, and involuntary treatment in first-episode psychosis. Schizophr Res 2012; 134: 273-278
• 3 Huber CG, Schottle D, Lambert M et al. Applicability of the Clinical Global Impressions-Aggression (CGI-A) scale for use in file audit trials. Pharmacopsychiatry 2011; 44: 189-192
• 4 Cornaggia CM, Beghi M, Pavone F et al. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011; 189: 10-20
• 5 Steinert T. After 200 years of psychiatry: are mechanical restraints in Germany still inevitable?. Psychiat Prax 2011; 38: 348-351
• 6 Spengler A, Koller M. Compulsory without Compulsion?. Psychiat Prax 2012; 39: 313-315
• 7 Haglund K, van der Meiden E, von Knorring L et al. Psychiatric care behind locked doors. A study regarding the frequency of and the reasons for locked psychiatric wards in Sweden. J Psychiatr Ment Health Nurs 2007; 14: 49-54
• 8 Sollberger D, Lang UE. Psychiatry with open doors: Part 2: Therapeutic challenges. Nervenarzt DOI: DOI: 10.1007/s00115-013-3770-3.
• 9 Sollberger D, Lang UE. Psychiatry with open doors: Part 1: Rational for an open door for acute psychiatry. Nervenarzt DOI: DOI: 10.1007/s00115-013-3769-9.
• 10 Falkowski J, Watts V, Falkowski W et al. Patients leaving hospital without the knowledge or permission of staff-absconding. Br J Psychiatry 1990; 156: 488-490
• 11 Lanza ML, Kayne HL, Hicks C et al. Environmental characteristics related to patient assault. Issues Ment Health Nurs 1994; 15: 319-335
• 12 Nijman HL, aCampo JM, Ravelli DP et al. A tentative model of aggression on inpatient psychiatric wards. Psychiatr Serv 1999; 50: 832-834
• 13 Frajo-Apor B, Stippler M, Meise U. “In psychiatry, nothing more degrading can happen to you”. Psychiat Prax 2011; 38: 293-299
• 14 Modestin J, Abdel-Rehim H. Einfluss der partiellen Abteilungsöffnung auf die Abteilungsatmosphäre. Psychiat Prax 1996; 23: 285-289
• 15 Deutschenbaur L, Lambert M, Walter M et al. Pharmakologische Langzeitbehandlung der Schizophrenie. Nervenarzt [im Druck]
• 16 Fan Z, Huang J, Wu Q et al. Comparison of standard locked-ward treatment versus open-ward rehabilitation treatment for chronic schizophrenic patients. A one-year controlled trial in Canton. Br J Psychiatry Suppl 1994; 24: 45-51
• 17 Middelboe T, Schjodt T, Byrsting K et al. Ward atmosphere in acute psychiatric in-patient care: patients’ perceptions, ideals and satisfaction. Acta Psychiatr Scand 2001; 103: 212-219
• 18 Schalast N, Redies M, Collins M et al. EssenCES, a short questionnaire for assessing the social climate of forensic psychiatric wards. Crim Behav Ment Health 2008; 18: 49-58
• 19 Maslow AH. A theory of human motivation. Psychol Rev 1943; 50: 370-396
• 20 Howells K, Tonkin M, Milburn C et al. The EssenCES measure of social climate: a preliminary validation and normative data in UK high secure hospital settings. Crim Behav Ment Health 2009; 19: 308-320
• 21 Schalast N. A short questionnaire for assessing the social climate on forensic psychiatric wards. Psychiat Prax 2008; 35: 175-181
• 22 Southard K, Jarrell A, Shattell MM et al. Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?. J Psychosoc Nurs Ment Health Serv 2012; 50: 28-34
• 23 Schalast N, Redies M. SK-M. Entwicklung eines Fragebogens zur Beurteilung des Stationsklimas im Maßregelvollzug. Essen: Universität Duisburg-Essen; 2005
• 24 Long CG, Anagnostakis K, Fox E et al. Social climate along the pathway of care in women's secure mental health service: variation with level of security, patient motivation, therapeutic alliance and level of disturbance. Crim Behav Ment Health 2011; 21: 202-214
• 25 Tonkin M, Howells K, Ferguson E et al. Lost in translation? Psychometric properties and construct validity of the English Essen Climate Evaluation Schema (EssenCES) social climate questionnaire. Psychol Assess 2012; 24: 573-580
• 26 Baruch Y. Response rate in academic studies: A comparative analysis. Hum Relat 1999; 52: 421-438
• 27 McGowan S, Wynaden D, Harding N et al. Staff confidence in dealing with aggressive patients: a benchmarking exercise. Austral NZ J Ment Health Nurs 1999; 8: 104-108
• 28 Abderhalden C, Needham I, Dassen T et al. Predicting inpatient violence using an extended version of the Broset-Violence-Checklist: instrument development and clinical application. BMC Psychiatry 2006; 6: 17
• 29 Kunze H. Person-related treatment in psychiatric hospitals and beyond – combining practice and economy. Psychiat Prax 2007; 34: 150-153
• 30 Ng B, Kumar S, Ranclaud M et al. Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatr Serv 2001; 52: 521-525
• 31 Lambert M, Huber CG. Akut- und Notfallbehandlung der Schizophrenie: Grundlagen und Behandlungsrichtlinien. Psychiatr Psychother up2date 2007; 1: 337-355
• 32 Schjodt T, Middelboe T, Mortensen EL et al. Ward atmosphere in acute psychiatric inpatient care: differences and similarities between patient and staff perceptions. Nord J Psychiatry 2003; 57: 215-220