精神科病棟の機能分化に即した作業療法プログラムの改変における課題

Problems in the modification of occupational therapy programs in responding to functional specialization in psychiatric wards

要旨：精神科病棟の機能分化に即した作業療法（以下，OT）プログラムの改変における課題を明らかにするため，協力病院をモデルにプログラム改変を試み，参加観察と作業療法士（以下，OTR）へのインタビューを行った．1期はOTRの認識不足や組織体制の未整備，2期はマネジメント技能や他部署のOTに対する認識不足，3〜4期は臨床技能の不足や治療環境の未整備など，具体的な課題が明らかになり，5期に大枠のプログラムが整備された．これらは先行研究で示唆された課題と類似し，どの病院にも共通した課題があるものと推察された．プログラムの整備とともに，OTRの認識・技能の向上や体制の整備，他部署への働きかけなど総合的な取り組みが望まれる．

　This study clarified problems in the modification of occupational therapy (OT) programs in their response to the functional specialization in psychiatric wards. Modifications of OT programs were carried out in a model hospital that agreed to participate and participant observations and interviews for occupational therapists were conducted. The first stage of the study indicated a lack of recognition of occupational therapists and an underdeveloped system; the second stage showed a lack of both management skills and understanding of other professionals on the part of the OT; in stages 3 and 4, a lack of clinical skill and underdeveloped treatment environment became clear; finally, an outline of OT programs were modified in the fifth stage. The problems are similar to those that have been suggested in previous research, and are common in most hospitals. The results indicate that the following improvements be made in the overall approaches of OT: alteration of OT programs, the improved recognition of OT and development of systems, and cooperation with other professionals.