Sustainability initiatives in inpatient psychiatry: tackling food waste.

Background: Food plays a dual role in promoting human health and environmental sustainability. Yet, current food systems jeopardize both. Food waste poses a major global challenge due to its significant economic, social, and environmental impacts. Healthcare facilities generate the largest amounts of food waste compared to other forms of catering provision. Food waste correlates with environmental unsustainability and diminished patient satisfaction, compounding the prevalent challenge of hospital malnutrition and contributing to suboptimal patient outcomes. Materials and methods: In a three-year interventional study (2020-2022) at a psychiatric tertiary care center, we assessed and mitigated food waste using evidence-based measures. We conducted systematic food wastage audits over three years (2020-2022) in May and June, each lasting four weeks. Costs were analyzed comprehensively, covering food, staff, infrastructure, and disposal. Environmental impact was assessed using Umweltbelastungspunkte (UBP) and CO2e/kg emissions, alongside water usage (H2O - l/kg). Results: Economic losses due to food wastage were substantial, primarily from untouched plates and partially consumed dinners, prompting meal planning adjustments. Despite a >3% increase in meals served, both food waste mass and costs decreased by nearly 6%. Environmental impact indicators showed a reduction >20%. Vegetables, salad, and fruits constituted a significant portion of waste. Overproduction minimally contributed to waste, validating portion control efficacy. Conclusion: Our study highlights significant economic and environmental losses due to hospital food waste, emphasizing the importance of resource efficiency. The strategies outlined offer promising avenues for enhanced efficiency. The decrease in food waste observed over the three-year period underscores the potential for improvement.

Implementation of a Budo group therapy for psychiatric in- and outpatients: a feasibility study.

Introduction: Physical exercise has been shown to have numerous health benefits on co-morbid somatic conditions in psychiatry and can also enhance mental health. Thus, it is not difficult to recommend physical training programs as part of an integrated and holistic treatment approach for mental health disorders. However, getting patients to participate and keeping them engaged is a major challenge. Programs based on martial arts training could be interventions improving physical and mental health with higher attachment rates. The structured discipline, holistic approach integrating physical and mental elements, and empowering activities, may explain higher participant attachment rates. Methods: Thus, the main objective of this feasibility study is to describe a newly established group therapy program incorporating interventions from martial arts training with its physical and philosophical parts including mindfulness and breath work. Results: During the 14-month study period from April 2021 to May 2022, a Budo group therapy was used by 215 individual persons with a total of 725 group therapy participations. Retention in the program was good across all settings and very good for persons who participated as outpatients. The mean age of the participants was 33.5 years with a range from 14 to 69 years of age, and about 41% of the participants were female. The therapy program was able to address patients over the whole spectrum of psychiatric diagnoses. Satisfaction and motivation were uniformly self-reported as very good. Patients self-reported improved mental and physical health after participating in a Budo session compared to pre-session. Discussion: Budo group therapy thus can be seen as a feasible, well-accepted and promising new transdiagnostic treatment approach, combining physical activation with resilience enhancement. With minimal contraindications, a broad spectrum of individuals seeking mental health support can engage in this group therapy.

Psychometric assessment of the German version of the Questionnaire about the Process of Recovery.

Personal recovery is important for mental health services and service users; moreover, valid and reliable assessment instruments are necessary for measuring personal recovery. Therefore, this study aimed to evaluate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. The study was conducted using a cross-sectional design with a convenience sample. The questionnaire was completed by 200 patients of outpatient services of two psychiatric hospitals in Switzerland. A confirmatory factor analysis was conducted to validate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. Cronbach's alpha was calculated to assess the internal consistency. The results showed an overall acceptable model fit (χ2  = 134.188, df = 90, P = 0.002; RMSEA = 0.050, 90% CI: 0.031-0.067; CFI = 0.937; TLI = 0.927) and excellent internal consistency (Cronbach's α = 0.91). These results are consistent with those of studies that have examined the Questionnaire about the Process of Recovery in other languages. This study provides preliminary evidence that the German version of the Questionnaire about the Process of Recovery is a reliable assessment instrument for measuring personal recovery among people with mental illness experiences. However, it is necessary to conduct further psychometric tests to verify the validity and reliability of the instrument. The German version of the Questionnaire about the Process of Recovery can be applied to both research and clinical practice, especially as a means of facilitating communication during the planning and evaluation of treatment goals.

Psychometric evaluation of the German version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC).

BACKGROUND: Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the German language version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a self-report measure of stigmatizing attitudes. METHODS: Staff (n = 392) on general psychiatric inpatient wards (excluding child, forensic and geriatric psychiatry) at five psychiatric hospitals in Switzerland (n = 3) and Germany (n = 2) participated in the study. The internal consistency of the OMS-HC was examined as well as its factor structure using exploratory and confirmatory factor analyses. To assess the scale's concurrent validity, we used the Social Distance Scale. RESULTS: Internal consistency for the OMS-HC total score was good (α = 0.74), acceptable for the subscales Attitudes (α = 0.62) and Social Distance (α = 0.69), and poor for the Disclosure subscale (α = 0.55). The original three-factor structure fit our data well. The OMS-HC total score and the Social Distance subscale score were significantly correlated with the Social Distance Scale, supporting concurrent validity. CONCLUSION: The German version of the OMS-HC demonstrated satisfactory psychometric properties and can be recommended for future research and intervention evaluation.

Nursing Perspectives: Reflecting History and Informal Coercion in De-escalation Strategies.

Health professionals like nurses respond to aggression and violence with de-escalation techniques, and still often with coercive measures. Such measures applied by institutions are often rooted in historically grown traditions rather than evidence, reflection, or formation. In this article, we present de-escalation strategies integrating a high and critical awareness toward traditions and the practice of formal and informal coercion.

Knowledge on types of treatment pressure. A cross-sectional study among mental health professionals.

Treatment pressure restricts patients' voluntary and autonomous decisions. Yet interventions involving treatment pressure are widely used in mental health and psychosocial services. This cross-sectional study explored whether mental health professionals' knowledge on five types of treatment pressure (no coercion, persuasion or conviction, leverage, threat, and formal coercion) was associated with sociodemographic, professional and contextual factors. A more positive attitude towards interventions involving treatment pressure was associated with underrating the level of those interventions compared with a predefined default value. The treatment setting and professional group played a minor role in 'leverage' and 'formal coercion' types of treatment pressure, respectively.

[The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study]. / Die Praxis der psychiatrischen Intensivbetreuung bei Erwachsenen in der Deutschschweiz ­ eine deskriptive Querschnittstudie.

The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study Abstract. INTRODUCTION: Psychiatric Special Observation (PSO) is an intervention often used by nurses to prevent service users of harming themselves or to protect others. The intervention ranges between control and therapy and is resource intensive. Despite the widespread use of PSO, there is still no data on the practice of the intervention in Switzerland. AIM: What is the current practice of PSO in adults in psychiatric hospitals in the German-speaking part of Switzerland? METHOD: Descriptive cross-sectional study. Nurses from inpatient psychiatric services in the German-speaking part of Switzerland completed a questionnaire based on a concept analysis of PSO. RESULTS: 538 questionnaires were analysed. PSO was more often conducted intermittent than as constant observation. In more than one out of four cases, suicidality reasoned as a cause for prescription. Nurses generally used standardized instruments to assess the risk of harming oneself or others. The duration of PSO lasted eight hours or more in three out of four cases. In every fifth case, there was no validation of the need of the intervention taking place during one shift. Nurses have a neutral attitude towards the intervention and are experiencing no or weak negative feelings during performance of PSO. CONCLUSIONS: The results suggest that there is an inconsistent performance of PSO in Switzerland as well as in other countries. The validation of the need of the intervention is insufficient. To facilitate PSO as a justified performance, the preparation of an interprofessional guideline is recommended.

Positive Effects of an Anti-Aggression and De-Escalation Training on Ward Atmosphere and Subjective Safety May Depend on Previous Training Experience.

Anti-aggression and de-escalation (ADE) trainings of health-care professionals working on psychiatric inpatient wards have been shown to increase staff knowledge and confidence, which could be connected with higher subjective safety. Additionally, a potential reduction of aggressive incidents could improve ward atmosphere. Thus, the current study aimed to investigate the effects of ADE training on ward atmosphere and subjective safety. In 2015, an ADE training was established at the Psychiatric University Clinics (UPK), University of Basel. Nursing staff from 22 wards received theoretical and practical training over the course of 5 days. Ward atmosphere and subjective safety were assessed using the Essen Climate Evaluation Schema (EssenCES). A total of 46 people had been assessed in 2012 before training implementation (baseline), and 45 persons in 2016 after implementation. In the 2016 group, 23 people had previously participated in an ADE training, and 22 were first-time participants. Patients' coherence (p = 0.004), subjective safety (p = 0.004), and ward atmosphere (p = 0.001) were rated significantly higher by first-time ADE training participants compared to baseline, and patients' coherence (p = 0.029) and ward atmosphere (p = 0.011) were rated significantly higher by first-time ADE training participants than by nurses with prior ADE training. There were no significant differences regarding any EssenCES ratings by nurses with prior ADE training compared to baseline. ADE training was exclusively connected with higher ratings on most EssenCES scales for first-time participants. This indicates that the positive effects of ADE training may depend on previous training experience.

Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland.

AIMS: Informal coercion is a frequently used form of communication among mental health professionals to influence treatment outcomes. This study investigates the recognition, attitude, and application of different forms of informal coercion by mental health professionals. METHODS: Mental health professionals of five psychiatric institutions in Germany and Switzerland (n = 424) took part in an online survey assessing the recognition of, attitudes towards, and application of different forms of informal coercion. RESULTS: Mental health professionals did not recognize the extent of informal coercion adequately; especially stronger forms were underestimated. Recognition and application of informal coercion was predicted by attitudes towards coercion. Furthermore, there were differences between profession of participants regarding the recognition and application of informal coercion. CONCLUSIONS: It is important to realize that the extent of applied informal coercion in therapeutic communication is often not recognized by practitioners, although it might interfere with a sound therapeutic relationship.

Patients' subjective perspective on recovery orientation on an acute psychiatric unit.

BACKGROUND: Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. AIM: This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made were the introduction of treatment conferences and conjoint treatment planning, reduction of the total time spent on reports about patients (in their absence), and recovery-oriented staff training on an acute psychiatric unit of the University Hospital of Psychiatry, Zurich, Switzerland. METHODS: During 1 year (2011/2012) eligible patients on the study unit were interviewed on a voluntary basis using established instruments to assess several recovery-relevant aspects. Two different samples (before and after the project; n = 34 and n = 29) were compared with regard to subjective parameters (e.g. patients' attitudes toward recovery, quality of life, perceived coercion, treatment satisfaction, and hope), clinical and socio-demographic basic data, as well as the functional outcome according to the Health of the Nation Outcome Scales (HoNOS). RESULTS: Some patient attitudes towards recovery and their self-assessment of the recovery process improved during the study. Other subjective parameters remained stable between samples. Functional outcome was better in subjects who were treated after the implementation of the new concept. The length of stay remained unchanged. CONCLUSIONS: The implementation of recovery-oriented structures and providing the necessary theoretical underpinning on an acute psychiatric unit is feasible and can have an impact on attitudes and knowledge of personal recovery.

[Between control and therapy: an evolutionary concept analysis of special observation in acute psychiatric wards]. / Zwischen Kontrolle und Therapie: Eine evolutionäre Konzeptanalyse von Intensivbetreuung in der stationären Akutpsychiatrie.

OBJECTIVE: Special observation is a seriously invasive and resource intensive intervention. It is necessary to scientifically conceptualise this measure for further investigations and practice. METHODS: Evolutionary concept analysis. RESULTS: The identified antecedents, attributes and consequences of special observation range between control and therapy as well as the safety of patients and the coverage of the professionals. Antecedents comprise of legitimisation (indication, assessment, prescription), resources (internal guidelines, architectural structures, information) as well as context factors (security needs, personal attitudes). The identified attitudes are organisation (qualification, shifting carers, length, place), intervention (relationship, re-assessment, transparency) as well as the field of tension between control and therapy. The consequences consist of side effects (patients, nurses, resources) and conflicts (ethical dilemmas, role conflicts). CONCLUSION: Society and discipline have influenced the concept over time and a distinction between the custodial and controlling pattern versus a therapeutic approach is recommended.

Informal coercion in acute inpatient setting--knowledge and attitudes held by mental health professionals.

This pilot study aimed at investigating how mental health professionals on acute psychiatric wards recognize different levels of formal and informal coercions and treatment pressures as well as their attitude towards these interventions. An explorative cross-sectional survey among mental health professionals (N=39) was conducted using a questionnaire that consisted of 15 vignettes describing typical clinical situations on five different stages of the continuum of coercion. Low levels of coercion are recognized adequately while higher levels are grossly underestimated. The degree of coercion inherent to interventions comprising persuasion and leverage was underestimated by professionals with a positive attitude and overestimated by those with a negative attitude towards the respective interventions. No associations of the ability to recognize different levels of coercion with ward or staff related variables were found. Higher knowledge on ambiguous variations of coercive interventions seems to foster more balanced reflections about their ethical implications. Advanced understanding of influencing factors of professionals׳ attitudes towards coercion could lead to improved training of professionals in utilizing interventions to enhance treatment adherence in an informed and ethical way.

[Perception of ethical aspects in psychiatric patient care: a pilot study]. / Pilotstudie: Wahrnehmung ethischer Aspekte in der psychiatrischen Patientenversorgung.

INTRODUCTION: Research on staff perception of ethical aspects of psychiatric patient care are scarce; little is known about systematic supplies of ethics support in psychiatric institutions. The goal of this pilot study is to inform the implementation of Clinical Ethics Support Services in psychiatric institutions by assessing which topics of psychiatric practice are considered ethically challenging by the staff. METHOD: Explorative survey as pilot study by questionnaire with clinical staff, quantitative (descriptive) and qualitative (coding) data-analysis. RESULTS: Involuntary treatment, the relationship between healthcare professionals and patients, staff shortage and the collaboration between the professions as well as dealing with patient relatives came up as ethical challenges. CONCLUSIONS: Clinical Ethics Support in psychiatric patient care should not only cover aspects that are specific for psychiatry, but also structural topics such as short resources, interprofessional collaboration and communication with relatives.

A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction?

To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n = 17) did not differ from the control group (n = 21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level = 0.05) from study begin to study end (p = 0.003), and compared to the control group (p = 0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p = 0.004, ABB subscale working conditions: p = 0.043, satisfaction: p = 0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project.

Measuring recovery: validity of the "Recovery Process Inventory" and the "Recovery Attitudes Questionnaire".

Considerable lack of publications and inconsistent results on construct validity make it difficult to choose an appropriate instrument to measure recovery. The aim of the present study was to evaluate additional psychometric aspects of two established measures of personal recovery with differing focuses. Bivariate associations of the recovery measures with personal, clinical and subjective factors were conducted as indicators of concurrent (convergent and divergent) validity. The scales were also tested concerning internal consistency. The sample comprised of 81 inpatients on an acute psychiatric ward (main diagnoses: 27% substance-related disorders, 27% schizophrenic disorders, 25% affective disorders, 10% neurotic or stress-related disorders, and 11% personality disorders). The "Recovery Attitudes Questionnaire (RAQ)" has to be reevaluated before further administration due to serious psychometric shortcomings concerning internal consistency and concurrent validity. The "Recovery Process Inventory (RPI)" total scale showed acceptable concurrent and within-scale validity and can be recommended in order to measure the personal recovery process for clinical and scientific purposes.

[How do nurses in psychiatric institutions assess suicide risk? A survey in the German-speaking part of Switzerland]. / Wie schätzen pflegende die suizidalität von patient(inn)en ein? Erhebung in psychiatrischen institutionen der deutschen Schweiz.

In the interdisciplinary treatment process nurses play an important role, assessing suicide risk. To cope with this responsibility, the use of assessment instruments is recommended. Although a lot of instruments exist to assess the risk of suicide, nurses do not use them consistently. This cross-sectional study seeks to answer the following questions: How do nurses assess the suicidality of patients of psychiatric hospitals in the German speaking part of Switzerland? Do they use assessment instruments and if so, which ones? Ward nurses in every psychiatric hospital (n = 32) were asked about the state of the nursing practice in assessing the suicide risk by means of an electronic questionnaire. The following results emerged: Nurses use instruments to assess suicide risk on about half of the wards (n = 119, 50.63%). 13% of the mentioned instruments are research-based. Nurses mostly assess suicide endangerment in the case of a presumed danger, less often at admission and least often during the discharge process. As suicidality is assessed mostly when nurses assume a danger in this study, and due to the fact that suicides most frequently occur shortly prior to or during the discharge process, an expansion of or the introduction of the assessment is recommended before the discharge process.

Influence of single peer interventions on the recovery attitude of persons with a psychiatric disability.

OBJECTIVE: This study examined the influence of single peer to peer interventions on participants' recovery attitudes. METHODS: Following a 40-hour training, pairs of individuals with a psychiatric disability offered a session (2.5 hour) in outpatient and residential psychiatric institutions. These peer to peer interventions aimed at inspiring and contributing to participants' recovery process, by introducing them to constituent parts of the concept Recovery. Thirteen of the peer interventions were evaluated by measuring participants' recovery attitudes before (N = 145), just after (N = 115) and at 6 months postintervention (N = 53) using the Recovery Attitudes Questionnaire (RAQ7) and the Recovery Process Inventory (RPI). RESULTS: Wilcoxon tests demonstrated that individuals participating in a peer intervention felt significantly more certain that Recovery is possible (factor 'Recovery is possible') just after the intervention (p = 0.004), but not 6 months later; likewise, the perception of the difficulty of recovery in spite of a mental illness (factor 'Recovery is difficult and differs') was significantly lower 6 months later (p = 0.016), but not from pre to just after. CONCLUSIONS: The statistically significant effect of a single recovery-oriented peer intervention on participants' attitude that recovery is possible was not sustainable. These results suggest a possible higher sustainability of repeated or longer-lasting peer interventions.