長期入院を経て退院に至った統合失調症患者の自己決定のプロセス

Process of self-determination of discharge after long-term hospitalization in patients with schizophrenia

　本研究は、長期入院の統合失調症患者がどのように自己決定をして退院に至ったのか、そのプロセスを明らかにすることを目的とした。1年以上の入院を経て退院した患者9名に半構成的面接を実施し、質的な分析を行った。さらに、入院時の診療記録等との関連を検討し、退院に至った自己決定のプロセスを分析した。その結果、管理的な環境での長期入院統合失調症患者は、退院の基準を自ら見出すことが困難で、退院の可否は医療者の判断に委ねてきた。退院意向のある患者は、決定の場に参加することで「自己の決定」と認識し、退院意向のなかった患者は、退院支援の実感や、関与の度合いによって「自己の決定」や「共同の決定」、「周囲の決定」と捉えていた。退院の決定には患者－看護師関係が影響し、決定を支援する看護師の8つの役割が明らかになった。

　The purpose of this study was to clarify the process of self-determination that led to the discharge of patients with schizophrenia after long-term hospitalization. Nine patients with schizophrenia underwent semi-structured interviews after hospital discharge. The interviews were qualitatively analyzed, and each patient's responses were analyzed in relation to their medical records. Patients with schizophrenia found it difficult to adopt a suitable self-determination process in an administrative environment because of long-term hospitalization. Instead, they entrusted this responsibility to the person in charge of their medical care. Patients with intentions of being discharged recognized “self-determination” and “decision of others” as factors that influenced the decision-making process. Patients were classified on the basis of participation in a discharge meeting. Patients who had no such intentions regarded “self-determination,” “codetermination,” and “decision of others” as factors. Patients were classified according to the extent of participation in the decision-making process and the discharge support they received. The results also showed that nurse.patient relationships influenced the decision of patient discharge. A total of 8 roles played by nurses in the process of supporting patient decisions were identified.