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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00576

Ward atmosphere and patient satisfaction in psychiatric hospitals with different ward settings and door policies. Results from a mixed methods study

 Simone A. Efkemann1*, Johannes Bernard2, Janice Kalagi1, Ina Otte2, Bianca Ueberberg1, 3, Hans-Jörg Assion3, Swantje Zeiß4, Peter W. Nyhuis4,  Jochen Vollmann2, Georg Juckel1 and  Jakov Gather1, 2
  • 1Department of Psychiatry, Psychotherapy and Preventive Medicine, University Hospitals of the Ruhr-University of Bochum, Germany
  • 2Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany
  • 3LWL Clinic Dortmund, Germany
  • 4Department of Psychiatry, Psychotherapy and Psychosomatics, St. Marien Hospital Eickel, Germany

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 to 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.

Keywords: open-door policy, Acute psychiatry, qualitative-empirical interviews, mixed methods, Essen Climate Evaluation Schema, ZUF-8

Received: 10 Apr 2019; Accepted: 22 Jul 2019.

Edited by:

Christian Huber, University Psychiatric Clinic Basel, Switzerland

Reviewed by:

Alexandre Wullschleger, Charité Medical University of Berlin, Germany
Mario Luciano, Second University of Naples, Italy  

Copyright: © 2019 Efkemann, Bernard, Kalagi, Otte, Ueberberg, Assion, Zeiß, Nyhuis, Vollmann, Juckel and Gather. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ms. Simone A. Efkemann, Department of Psychiatry, Psychotherapy and Preventive Medicine, University Hospitals of the Ruhr-University of Bochum, Bochum, Germany,