Development of acute care protocol to promote community living among psychiatric patients in Japan

摘要本文旨在探讨一所公立精神科医院急性照护治疗部对精神病患之护理。本文对出院3个月内再入院患者（A组）与出院3个月以上留在社区患者（B组）的护理进行比较。十四个主要护士进行了采访，在急性护理治疗单位的意向护理。他们讨论了47例患者的护理。同样的47名患者也接受了出院后在家自我护理的采访。护士和病人都同意这项研究，他们充分合作。资料收集于2000年8月1日至10月31日。在急诊治疗室的护理工作包括：（1）监测症状和自我护理;（2）监测药物的效果和副作用;（3）创造一个健康的环境;（4）了解病人如何控制自己的症状;（5）认识症状与自我护理的关系;（6）支持其他在家中与病人互动的人，（7）寻求经济支持，（8）扩大自我护理，以满足每个病人的个人需求，（9）帮助建立一个病人在家支持系统。在B组中，护士能够影响每个护理类别，而在A组中，护士不能影响（5）至（9）护理类别。此外，在A组，护士无法获得重要的信息，使他们能够影响家庭支持系统的质量。在前期研究的基础上，制定了护理协议，并于2002年10月至2002年1月进行了护理协议的实施，该护理协议使护士易于与多学科团队和社区护士合作。此外，护士很容易照顾病人的家人。从本研究的局限性角度对这些结果进行了讨论。

The purpose of this paper is to describe the nursing care for patients with mental illness at an acute care treatment unit in a praivate psychiatric hospital. This paper compares the nursing care for patients readmitted within 3 month after discharge (Group A) with nursing care for patients remain in the community more than 3 month after their initial discharge(Group B). Fourteen primary nurses were interviewed about intentional nursing care at an acute care treatment unit. They discussed the nursing care given to 47 patients. Those same 47 patients were also interviewed about self-care at home after discharge. The nurses and patients agreed to this study and they cooperated fully. Data were collected between Aug.1 and Oct.31 in 2000.The nursing care at the acute care treatment unit were (1)to monitor symptoms and serf care, (2)to monitor effects and side effects of medication, (3)to create a sage environment, (4)to understand how patients control their own symptoms, (5)to recognize the relationship between symptoms and self-care, (6)to support other people who interact with patients at home, (7)to find financial support, (8)to expand serf-care to meet each patient's individual needs, (9)to help create a patient support-system at home. In group B, nurses were able to influence every category of nursing care, but in group A, nurses were unable to influence nursing category of (5)to(9). Furthermore,in group A, nurse were unable to obtain important information which allow them to influence the quality of the family support system. Based on the previous research nursing care ptorocal had been developed and it had been done between Oct. in 2002 and Jan. in 2002, That nursing care protocol made nurses easy to cooperate with muitidisciplinary team and community nurses. Furthermore nurses were easy to take care of patients's family. These results were discussed from the view point of limitation of this study.