精神療養病棟の治療構造における病棟規則の機能についてのエスノグラフィー

Ethnography of the Function of Ward Rules within the Therapeutic Framework of Psychiatric Hospital Wards

要旨

　目的：精神療養病棟の治療構造における病棟規則の機能を明らかにすること．

　方法：3施設4か所の精神療養病棟で月1回6か月間のエスノグラフィーを実施し，構造機能主義を理論的パースペクティブとして質的帰納的分析を行った．

　結果：病棟規則の機能として，【管理指示型集団従属的規則運用パターン】の規則は，【地域住民・病院職員が安心で入院患者が安全に生活する場としての閉鎖的施設環境】の治療構造の存続を維持するために順機能していた．【対話支持型個人主体的規則運用パターン】の規則は，【急性期の病状を脱した患者や慢性期の患者を地域生活に近づけるための治療】の治療構造の存続を維持するために順機能していた．

　結論：精神療養病棟の病棟規則は，患者の医療保護および社会防衛の機能と，患者を社会復帰に向ける機能を有していた．患者個人を支援する規則の内容と対話を用いた運用が，患者を社会復帰に向ける機能を果たすと示唆された．

　Purpose: To clarify the function of ward rules within the therapeutic framework of psychiatric hospital wards.

　Methods: We conducted ethnography once a month for 6 months at 4 psychiatric wards at 3 medical institutions, and then performed qualitative inductive analysis from the theoretical perspective of structural functionalism.

　Results: The “pattern of top-down administration-directed implementation of group-subordinate ward rules” functioned positively in order to ensure the continuation of a therapeutic framework based on a “closed facility environment wherein inpatients can live safely in a manner enabling peace of mind among members of the local community and psychiatric ward personnel.” The “pattern of dialog-supportive implementation of individual-oriented ward rules” functioned positively in order to ensure the continuation of a therapeutic framework in which “patients who had emerged from acute-stage psychiatric care and patients with chronic-phase conditions can receive medical care enabling them to move towards community interaction”.

　Conclusion: Psychiatric ward rules served the functions of providing patients with medical care and protection, protecting members of society, and preparing patients for social rehabilitation. Our findings suggested that ward rules that support individual patients and their implementation utilizing dialog achieved the function of preparing patients for social rehabilitation.