Nursing care strategy for the families of institutionalized schizophrenic patients to promote the patients' discharge and community living in Japan.

本研究旨在建立长期住院精神分裂症患者及其家属的护理管理系统，以促进患者出院及支持其社区生活。我们研究了以下两点：1。通过调查长期住院精神分裂症患者家属的经历，探讨促进患者出院和社区生活所需的家庭护理。本研究以住院一年以上精神分裂症患者的17个家庭（20名成员）为研究对象。这些家庭通过半结构化的访谈被问及。因此，将家庭体验分为五个主题：1)对患者疾病的态度，2)对患者的关注，3)家庭护理，4)家庭生活质量，5)基于家庭生活对患者的护理。这些家庭还经历了与1)医疗、2)家庭支持小组、3)社区资源和4)社会有关的其他问题。我们对24名住院精神分裂症患者出院护理现状进行了访谈。通过定性分析，提出了加强患者与家属联系的护理新策略：1)与患者一起评估家属，2)支持共同生活，3)护士作为协调者加深患者与家属之间的了解，4)家庭成员的心理教育，以更好地了解患者，5)管理，保持患者与家属之间的联系，6)保证医院的护理和支持，7)保持家庭成员在社区资源中，8)培训患者自我支持。

The purpose of this study is to establish a nursing care management system for long-term hospitalized schizophrenic patients and their families in order to promote the discharge of the patients and the support of their community living.We have studied the following two points :1.We investigated experiences of family members of long-term hospitalized schizophrenic patients, and explored nursing care for the families needed to promote discharge and community living of the patients. The subjects in this study were 17 families (20 members) of the patients with schizophrenia experiencing hospitalization for more than one year. The families were asked through semi-structured interviews. As a result, the families' experiences were structured with five themes : 1)Attitude toward patient's illness, 2)Concern about the patient, 3)Family care, 4)QOL of the family, and 5)Care for the patient based on the family life. The families also experienced additional problems associated with 1)Medical treatment, 2)Family support groups, 3)Community resources and 4)Society.2.We interviewed with 24 primary nurses about the present status of nursing care for the discharge of institutionalized schizophrenic patients. As a result of qualitative analysis, eight categories were emerged as a new nursing care strategy to strengthen the linkage between patients and their families : 1)Assessment of the family together with the patient, 2)Support to live together, 3)Nurses acting as a coordinator to deepen understanding between patients and their families, 4)Psycho-education of the family members for better understanding the patients, 5)Management to keep contact between patients and their families, 6)Guaranteed after care and support by the hospital, 7)Keeping the family members in their community resources, and 8)Training the patients for self-support.