精神科急性期医療における隔離室使用と看護上の問題との関連

Relationship between the Use of a Seclusion Room and the Difficulty of Nursing Care of Locked-Ward Inpatients with Acute Psychiatric Disorders

【抄録】　神奈川県立精神医療センター芹香病院の1閉鎖病棟内隔離室への新規入院患者41名について，隔離室使用状況と看護上問題となった因子の関連を1997年5月より6か月間調査した。対象は男女比約1.3，平均年齢40.5歳，措置入院約75％で，精神分裂病が約50％を占めた。平均隔離室使用期間は，部分開放まで6.8日，日中開放まで8.6日，転室または退院まで16.4日で，開放度は入院形態や入院経路に影響され，性別や疾患とは相関しなかった。設定した13項目の看護上の問題は5因子に収束され，部分開放には粗暴性因子，不穏因子，介助因子の3因子が，日中開放にはこれら3因子のほか合併症因子の関与が高く，自立度や合併症についての考慮が必要と考えられた。

　Kanagawa Psychiatric Center Kinkou Hospital in Kanagawa prefecture has nine wards including eight seclusion rooms for psychiatric emergency cases in the evenings and on holidays. Our locked-ward has six seclusion rooms including four for emergency purpose. We investigated the relationship between the use of a seclusion room and the difficulty of nursing care from May 1997 to October 1997. The number of new inpatients admitted to the seclusion rooms was 43, and 2 of them were not able to be entered for the purpose of study. Male/female ratio was 1.3, and average age was 40.5 y. Involuntary admission because of fear of self injury and of harming others under the mental health and welfare law was about 75%. The most frequent diagnosis was schizophrenia. The period of use of the seclusion room was 16.4±8.3 days until transfer to a non-restricted room or a different hospital was possible. Opening the seclusion room at mealtime was possible 6.8±3.8 days after admission, and opening during daytime was possible 8.4±4.7 days after admission. These periods were influenced by admission form and route, but not by sex or diagnosis. We selected 13 items for checking the difficulty of nursing care. These items were summarized to 5 factors using factor analysis. Among them, the aggression factor, irritation factor and care factor were significantly related to whether the room was to be opened or not at mealtime. Beside these 3 factors, the complication factor was closely associated with the suitability of opening the room during daytime. These data suggest that the level of self-care and physical complications have to be taken into account when considering the use of seclusion rooms.