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

在西方国家精神卫生运动的年代，精神科病房的社会气氛（治疗气氛，病房气氛）是一个受到广泛关注的研究问题。虽然从业人员仍然意识到它的相关性，但近几十年来科学兴趣相当低。迄今为止，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项问卷是一个相当复杂的工具，不适合重复应用，其10个特征的概念也没有得到统计手段的证实。杜伊斯堡-埃森大学开发了一种简短的替代工具，即埃森气候评估方案（EssenCES）。这个包含15个项目的工具以多种语言版本出版，评估了三个气候特征：患者凝聚力、经验安全和治疗坚持。病房气候研究的缺陷之一是病房设置的客观和结构条件没有得到太多的关注。出版物表明了一些情况，与病房气候高度相关，如病房大小，病房功能和分配，人员配备水平，安全水平（限制）和患者流通量。该研究项目建议有两个目标：在50个普通精神科和50个法医精神科病房应用精华量表，从而创建涵盖精神科住院治疗这两个领域的量表手册。确定与病房环境治疗气氛最相关的客观环境和条件。参加调查不会给精神病院带来太多压力。每间机构只可参加2至最多4间病房。数据以完全匿名和保密的方式收集，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，关于病房条件和治疗气氛关系的实质性发现可以作为论据。

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.