The 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. Despite an extensive body of research in the field of psychosocial work environment [1
] and in that of the ward atmosphere [4
], there is little research that investigates the relationship between these two phenomena in psychiatric care. The psychosocial work environment has to do with the staff's working conditions, including organizational and work characteristics [7
], while the ward atmosphere reflects the milieu in which the care takes place and patient - staff relationships are developed [5
]. An understanding of how the nursing staff's perceptions of the ward atmosphere are related to the psychosocial work environment may contribute to new ways of improving their work conditions. Should a relationship be found, changing the ward atmosphere might be an alternative pathway for affecting the staff's psychosocial work environment.
Health care systems in many industrialized countries, such as Sweden, have undergone major changes in order to improve efficiency and to reduce the number of hospital beds [8
]. Still, in-patient care plays a major role in the care and treatment of patients with psychiatric problems [9
]. The major changes in psychiatric care have affected the nursing staff's personal situation at work, creating work in complex environments and putting organizational pressure and high demands on the staff [10
The psychosocial work environment can be described as a multifaceted and complex phenomenon and may be framed according to three levels; the Task level involving aspects of control, role expectations, and job demands, the Social and Organizational level involving aspects such as social interaction, communication, leadership and organizational culture, and finally the Individual level comprising aspects of, for example, commitment and work motives [7
]. The psychosocial work environment is crucial for the well-being and health of nursing staff working in psychiatric care and has been linked to the staff's perceived burnout, psychological distress and stress [11
]. Moreover a number of work environmental factors have been linked to the staff's absence due to illness [12
] and to perceived job satisfaction [15
]. Not only is the psychosocial work environment in psychiatric care important for the staff, it may also be reflected in the delivery of care and the relationship between the staff and the patients. Studies have, for example, found that the working conditions of psychiatric nursing staff are closely related to the quality of care, as perceived by patients [2
] and that in order to develop an effective treatment setting, the work environment should satisfy the staff [5
]. The staff's working conditions may thus also be an important factor that influences the patients and the care. Investigating factors that can influence how nursing staff perceive their psychosocial work environmental conditions may be of importance for improving their working conditions, and the care they deliver. As indicated above, issues related to the care of and relationships to patients, here framed as the psychosocial ward atmosphere, may be one such influential factor.
The ward atmosphere has been described by Eklund and Hansson [18
] as a phenomenon shaped by the social structures and social interaction in the caring environment. Moos [5
] expressed early on the necessity of putting an emphasis on the ward atmosphere and its influence on patients and staff in psychiatric and substance abuse programs. He described the ward atmosphere by means of three dimensions; Relationships dimension, Personal growth dimension, and System maintenance dimension. The Relationship dimension involves aspects of the quality of personal relationships, involvement and support in the ward. The Personal growth dimension captures the level of encouragement for personal change and development among patients. Finally, the System maintenance dimension emphasizes how well ordered and organized a ward is [5
].There is a large body of research about the ward atmosphere in psychiatric care and many studies have examined patients' perceptions. Results have shown that the ward atmosphere is important for treatment outcome [6
] and patient satisfaction [19
]. Studies that have included the staff found that these tended to view the ward atmosphere more favorably than the patients did [20
]. Moreover, the ward atmosphere factor Order and Organization has been found to support high morale among nursing staff in psychiatric in-patient care [23
]. Thus, there are some indications that certain aspects of the ward atmosphere may be related to the psychosocial work environment of the staff, but the relationship is far from clarified.
Different categories of staff may perceive their psychosocial work environment and the ward atmosphere differently, possibly due to them not having the same types of duties and responsibilities. Although nurses and nurse assistants work side by side, it is important to consider their different roles and thus possible differences in perceptions regarding the psychosocial work environment and the ward atmosphere. A few previous comparative studies have been made. Dallender and associates [24
], for example, compared psychiatric nurses and psychiatrists regarding their perceptions of the physical work environment. They found that the nurses reported more heavy lifts and a noisier environment, while no significant differences were found regarding their perception of the social work climate and mental well-being. Comparative studies of nurses and nurse assistants in psychiatric care focusing on the ward atmosphere and perceived psychosocial work environment are rare. Those studies that have compared these staff groups have focused on stress and burnout and found no differences in those respects between nurses and nurse assistants [25
]. Small differences could, however, be seen between stressors: the main stressors for nurses was lack of resources [25
] and high work demands [26
], while for the nurse assistants it was client-related difficulties [26
] and social relations [27
]. No studies that specifically investigate differences in perceptions of the ward atmosphere among nurses and nurse assistants in psychiatric in-patient care seem to have been performed. It is important to build an understanding of whether these two occupational groups' perceptions of the ward atmosphere and the psychosocial work environment differ, in order to establish what should be the focus of workplace improvements and whether these two groups would benefit from the same improvements.
As mentioned above, the ward atmosphere may be an important influential factor for the psychosocial work environment of the nursing staff, and it could also be used as a platform to indentify and find solutions for psychosocial work environmental problems. No studies appear to have investigated whether there is a relationship between the ward atmosphere and the psychosocial work environment, as perceived by the nursing staff in psychiatric in-patient care. The aims of the present study were thus to investigate in what way aspects of the ward atmosphere were related to the psychosocial work environment as perceived by nursing staff working in psychiatric in-patient care, while also paying attention to individual characteristics such as age and length of employment. A further aim was to describe if there were any differences between how nurses and nurse assistants perceived the psychosocial work environment and the ward atmosphere.