急性期における統合失調症患者家族アセスメントツールの考案

Abstract

背景 国内の精神病院では急性期病棟(短期入院病棟)が定着しつつある。統合失調症を発症した患者を、短期間の入院で早期の退院に繋げるためには、入院時から患者の地域社会における支援者である家族へのケアが重要となる。しかし、急性期における家族に対するケアの確立は不十分な状況にある。目的 精神科病院において急性期の患者家族に必要なケアを考察することを前提に、精神科に勤務する看護師に急性期の患者家族の状況や気になる家族についてインタビューし急性期の家族アセスメントツールを作成した。方法 精神科に5年以上勤務する看護師10名に対し、急性期の家族の状況、看護師として気になる家族等について、インタビューを実施した。その内容を逐語録にし、質的な分析を試みた。結果 「看護師から見た急性期の家族の状況」からは家族の状況を示す内容として、70のフレーズを抽出し、最終的には九つの中位カテゴリーへと分類することができた。また、「看護師から見て気になる家族」を示す内容として、54のフレーズを抽出し、最終的には九つの中位カテゴリーへと分類することができた。さらに、その結果から、家族の対処状況からの視点と、家族の資源や認知からの視点で捉える二種類のアセスメントツールを考案した。結論 急性期の家族の状況を基に考案したアセスメントツールは、入院時から家族が示す反応を捉えながら、ケアの対象となるのか否かを判断していくものであり、精神科や家族へ対応の経験が浅い看護者であっても、アセスメントがしやすいと考える。また、気になる家族を基に考案したアセスメントツールは、問題となるポイントに焦点を当てたものであり、早期より看護の介入を見据えたアセスメントが展開できると考える。

Background Acute (short-term inpatient care) psychiatric wards are becoming established in Japan. 1) To enable patients admitted for the onset of schizophrenia to be discharged early after short-term hospital stay, provision of satisfactory care for patients' families, as primary supporters of the patients in the community, is seen as critical throughout the hospitalization period and thereafter as well. However, acute phase care for the families has not been thoroughly established. Purpose For the purpose of establishing care necessary for the families of acute phase patients admitted to psychiatric hospitals, psychiatric department nurses were interviewed about the status of the families of such patients and families of concern from the nurses' viewpoint, based on which tools for assessment of acute phase patients' families were created. Methods Ten nurses who had worked for 5 years or more in the psychiatric departments of three hospitals were interviewed about the status of families of acute phase patients and families of concern to nurses. The interviews were recorded and transcribed for qualitative analysis. Results From the interviews on the "status of families of acute phase patients as viewed by nurses," 70 phrases were extracted as attributes representing the families' status, and were ultimately divided into nine median categories. Regarding "families of concern to nurses," 54 phrases representing attributes of such families were extracted and ultimately divided into nine median categories. Based on these findings, two assessment tools were developed, one from the standpoint of how the family is coping with their situation, and the other, of the family's overall resources and recognition of their situation. Conclusions The assessment tool that was devised based on the acute phase family status enables care providers to evaluate whether the family requires care in consideration of their reactions observed during the patient's hospital stay and is believed to be useful even for nurses with little experience in the psychiatric field or in dealing with families of psychiatric patients. Another assessment tool created based on families of concern focuses on their difficulties, allowing assessment leading to timely, early intervention by nurses where necessary.