한 정신병원에서의 강박 처치에 대한 입원 환자 및 병원 직원의 지각의 차이

Different Perceptions of the Physical Restraints between Psychiatric Inpatients and Staffs in a Mental Hospital

Objectives : The purpose of this study was to examine different perceptions of physical restraint and their nature between psychiatric inpatients and hospital staffs in a mental hospital and to provide baseline data for establishing the practicing standard of this therapeutic maneuver. Methods ： Two hundred and two psychiatric inpatients who experienced physical restraint and 103 hospital staffs who frequently used this maneurer were surveyed with a questionnaire regarding indications, complications, alternative methods, emotional influences, duration of treatment and subjective effects of restraint. Results ： Regarding indications of physical restraint, the inpatient group had negative viewpoint on most items except “physical assault to other patients”. Regarding the perception about possible complications of this treatment, the inpatient group had more concerns about “deterioration of mental status” and increasing risk of self-injury” . For experienced complications, staffs stressed “skin abrasion” while inpatients believed of “respiratory difficulties” and “deterioration of mental status” more frequently. As alternative methods of physical restraint, increasing frequency of interview” was suggested by the inpatient group and “using seclusion room” was favored by the staff group. The inpatient group had an impression that physical restraint was more effective than high-dose neuroleptic tranquilization. For suspected emotion during this procedure, the inpatient group reported “sorrow” most frequently while the staff group presumed that “hostility” might be most frequent. Inpatients estimated that the average duration of physical restraint was longer than staffs did. Ideal duration of physical restraint was shorter in the inpatient group. Conclusion ： These results suggest that there are definite differences in the perception of physical restraint between psychiatric inpatients and hospital staffs. Formal practing guideline for restraint should be set up with careful attention for these differences to maximize the therapeutic effect of this maneuver