The social and therapeutic climate on general and forensic psychiatric wards with a special focus on objective and structural conditions of hospital settings

在西方国家心理健康运动的年代，精神科病房的社会氛围(治疗氛围、病房氛围)是一个备受关注的研究课题。虽然从业者仍然意识到它的相关性，但近几十年来，科学兴趣一直相当低。到目前为止，鲁道夫·穆斯的沃德大气尺度一直被认为是气候研究的黄金标准。但100个项目的问卷是一个相当复杂的工具，不适合反复使用，其10个特质的概念还没有得到统计方法的证实。杜伊斯堡-埃森大学开发了一个简短的替代工具--埃森气候评估方案(Essence)。这份包含15个项目的工具有多个语言版本，评估了三个气候特征：患者凝聚力、体验的安全性和治疗性。病房气候研究的缺陷之一是，病房环境的客观和结构条件没有得到太多关注。出版物指出了一些与病房环境高度相关的情况，如病房规模、病房功能和分配、人员配备水平、安全水平(限制)和病人流失率。研究项目建议有双重目标：在50个普通精神科病房和50个法医精神科病房应用Essence量表，允许创建一份涵盖精神科住院治疗两个领域的量表手册。确定与病房环境的治疗气氛最相关的客观情况和条件。参与调查不会对精神病院造成太大压力。每个机构最多只能有两到四个病房参加。数据是以完全匿名和保密的方式收集的，但如果管理层和病房工作人员同意，医院可能会收到个人反馈。在讨论精神科病房的资源和人员配备时，有关病房条件和治疗氛围关系的实际结果可能会成为辩论的依据。

During the years of the mental health movement in Western countries, the social climate of psychiatric wards (therapeutic climate, ward atmosphere) was an issue of research receiving a lot of interest. Whilst practitioners still are aware of its relevance, scientific interest has been rather low in recent decades. The Ward Atmosphere Scale by Rudolph Moos has been considered a gold standard of climate research up to now. But the 100 item questionnaire is a rather complex instrument, not adequate for recurrent application, and its 10-trait-concept has not been confirmed by statistical means. A short alternative instrument was developed at the University of Duisburg-Essen, the Essen Climate Evaluation Schema (EssenCES). The 15 item instrument, published in a number of language versions, assesses three climate traits: Patients Cohesion, Experienced Safety and Therapeutic Hold.One of the deficits of ward climate research was that objective and structural conditions of a ward setting have not received too much attention. Publications indicate a number of circumstances, being highly relevant for the ward climate, like ward size, the wards function and assignment, staffing level, level of security (restriction) and patients turnover.The research project suggested has a double target: Application of the EssenCES scale on 50 general psychiatric and 50 forensic psychiatric wards, allowing creating a scale manual covering both fields of psychiatric inpatient treatment. Identification of objective circumstances and conditions most relevant for the therapeutic climate of ward settings.Participating in the survey will cause little strain to mental hospitals. Only two to maximum four wards should participate per institution. Data are collected in a completely anonymised and confidential way, but hospitals may receive an individual feedback if management and ward staff agree.Substantial findings on the relation of ward conditions and therapeutic climate may serve as arguments when discussing the resources and staffing of psychiatric wards.