綜合病院 一般病棟에 入院한 精神科 患者에 關한 考察

Psychiatric patients admitted to general ward

Among general hosditals in Korea only a few use general wards for psychiatric inpatients while most use the traditional psychiatric wards only. The author studied clinical characteristics and management problems of psychiatic inpatients admitted to the general ward, based on findings of 61 psychiatric inpatients admitted to one 28- beds general ward at the Seoul National University Hospital from July 1, 1980 to June 30, 1981. Research materials were obtained from the hos pital records, personal ssmi-structured interviews with and answer sheets to questionaires from 5 psychiatric residents, 8 medical residents and 6 non-psychiatric nurses who were assigned to that specifi cgeneral ward in the same period, and questionaires from 24 psychiatric residents at other institutions. Results were as follows： 1. Average bed occupancy of psychiatric patients in the general ward was lower than expected (5.8% ), because cf preference of traditional psychiatric wards by the psychiatrists and lack of availability of the beds in intense competition between several medical specialties. 2. Seventy five percents of psychiatric inpatients admitted to the general ward belonged to the category of neuroses. Psychiatric inpatients in the general ward stayed short (12. 5 days in average, in comparison to 18.6 days for the neurotics in the psychiatric ward and to 39 days for all the inpatients in psychiatric wards in the same period). Discharge rate against medical advice was unexpectedly high as 30%. 3. All of psychiatric residents from the Seoul National University Hospital and other institutions showed negativistic and skeptical views to the policy of admitting patients to the general ward, for lack of psychiatric treatment facilities in the general ward such as interview rooms, occupational therapy rooms and day rooms, intensification of anxiety from the itneraction between psychiatric and medico-surgical patients in the same rooms, lack of confidentiality, unsatisfactory nursing care by less motivated non-psychiatric nursing staffs, and greater chance of accidents such as violence, suicide and elopement. Interestingly all medical residents were in favor of accepting psychiatric patients in the general ward. 4. To improve psychiatric care in the general ward quantitavely and qualitatively, the authors suggested regularly scheduled didactic meetings for the non-psychiatric ward nurses, fixed assignment of rooms for the psychiatric patients and enforced use of various facilities in the psychiatric wards for the general inpatients during daytime.