만성정신분열병 환자가 지각한 병실환경과 삶의 질 : 개방병동과 폐쇄병동의 비교

안병탁,한성희,이충경 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.6

연구 목적: 만성 정신분열병 환자가 지각하는 개방 병동과 폐쇄 병동의 병실환경의 특성을 비교해 보고, 그 차이가 그들이 보고하는 삶의 질과 어떠한 연관을 보이는가를 고찰함으로써 개방병동이 가지는 병실환경의 치료적 특성을 파악하고 향후 개방병동이 지향해야 하는 병실환경의 방향을 제시해 보고자 하였다. 방 법 : 국립서울정신병원의 일 개방병동과 일 폐쇄병동에 입원 중인 만성 정신분열병 환자 각 26명을 대상으로 하였다. 병실환경평가척도(Ward Atmosphere Scale : WAS)와 간이정신진단검사(SCL-90-R)에 응답케 하였으며, Lehman의 삶의 질 면담(Quality of Life Interview)의 일부를 이용한 면담을 통하여 삶의 질의 객관적 지표들과 주관적 지표들의 점수를 측정하였다. 개방병동군과 폐쇄병동군에서의 측정치의 차이를 비교하였고, 병실환경척도의 점수와 삶의 질 점수 사이의 상관관계를 분석하였다. 결 과 : 병실환경에 대한 지각에 있어 개방병동군은 패쇄병동군보다 병실환경을 보다 지지 적이고 자율적이며 실제 지향적이라고 지각하였다. 삶의 질에 대한 평가에 있어 개방병동군은 폐쇄병동군에 비해 높은 '전반적 삶의 질' 점수를 보고하였으며, 이러한 차이는 인구학적, 임상적 변수들과 삶의 질의 객관적 지표들에 의한 영향을 공분산분석으로 배제한 뒤에도 유의하였다. '전반적 삶의 질' 점수와 상관관계를 보인 병실환경특성들 중 개방병동군의 경우 '질서와 조직'(r=0.49, p<.05). 그리고 패쇄병동군의 경우 '지지'(r=0.59. p<.01)가 가장 높은 상관관계를 보였다. 결 론 : 개방병동군은 병실환경을 지지적이며 자율적이며 실제지향적이라고 지각하고 있었으며, 이러한 긍정적 지각은 그들이 보이는 삶의 질 점수와 밀접한 연관이 있었다. Objectives : This study was designed to compare the ward atmosphere of an open ward and that of a closed ward as perceived by chronic schizophrenic patients, and to find out whether the perceived ward atmosphere is associated with their quality of life, and also to get some practical suggestions for treatment policies of open wards. Methods : Fifty-two chronic schizophrenic inpatients were selected, 26 of them were in an open ward and the remaining 26 patients were in a closed ward, in Seoul National Mental Hospital. All the patients were asked to answer the whole items of Ward Atmosphere Scale (WAS) and SCL-90-R. Objective indicators and subjective indicators of their quality of life were scored during a face to face interview using potions of Lehman's Quality of Life Interview. The subjective indicators of quality of life were combined to a single global quality-of-life score and then examined for associations with other variables. All the measures were compared between the two groups. Covariate adjustments were made as needed. Results : The open ward patients reported significantly higher scores on 'support', 'autonomy' and 'practical orientation' subscales among WAS in comparison with closed ward patients. The open ward patients reported higher 'global quality-of-life score' compared with the closed ward patients. These differences were also significant fo11owing covariate adjustments for demographic, clinical and objective quality of life variables. Among the WAS subscales 'order and organization'(r=0.49, p <.05) was the highest correlate of 'global quality-of-life score' in case of open ward patients, and 'support'(r=0.59, p <.01) was the highest correlate in case of closed ward patients. Conclusion : The open ward patients reported better satisfaction with life, and their reported satisfaction were associated with their higher ratings on WAS:

개방병동과 폐쇄병동의 치료환경에 대한 비교연구

김경중,배안,조남현 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

연구 목적 : 정신과 병동의 치료환경은 환자의 치료전귀에 중대한 영향을 미친다. 저자들은 주로 만성적인 정신과 입원환자들이 입원 치료를 받고 있는 국립나주정신병원에서 개방병동과 폐쇄병동의 치료환경의 특성과 각각의 병동내 직원과 환자의 병동환경에 대한 태도를 비교해보고자 보았다. 연구 방법 : 본 연구자들은 국립나주정신병원에서 비교적 개방과 폐쇄의 전형성을 보이는 남녀병동 각각 1개씩, 총 4개의 병동을 선정하여 그 병동의 환자와 직원을 대상으로 1995년 6월부터 8월까지 3개월 간 월 1회 병실 환경평가척도(Word Atmosphere Scale : WAS)를 실시한 후 각 군들의 WAS에 대한 하위척도의 평균값을 Student's t-test로 비교 분석하였다. 연구 결과 : 1) 폐쇄병동은 직원의 통제와 병동의 규칙을 중요시하고 환자의 자율성이 무시된 통제위주프로그램(control-oriented program)의 치료환경과 유사하였으며, 이러한 평가는 직원들보다는 환자들이 보다 명확하게 지각하고 있다. 2) 개방병동은 직원과 환자 및 환자들끼리 서로 지지하고 격려해주면서 환자의 실제적인 문제의 해결에 중점을 두는 치료환경으로 나타났으며, 특히 직원들은 치료계획차원(treatment program dimension)이 활성화된 병동으로 지각하였다. 3) 두 병동의 치료환경을 비교한 결과 개방병동이 더 치료적임 병동으로 나타났으며, 개방병동은 자율적인 문제해결에 중점을 두고 있는데 반하여, 폐쇄병동은 환자의 보호에 중점을 두고 있었다. 또한 이러한 두 병동이 환경차이에 직원보다는 환자가 더 민감하게 반응하였다. 결 론 : 결론적으로는 병동에서 환자들에게 다양한 현실적인 프로그램을 제공할 수만 있다면, 대부분 만성 정신질환자가 입원된 정신과 전문병원에서 개방병동이 하나의 바람직한 치료유형으로서 대안이 될 수 있음을 볼 수 있었다. Objective : The treatment setting of mental hospital has a great influence on the outcome of treatment. The authors compared the characteristics of treatment setting of the open and the closed wards in a mental hospital and the attitudes of the staff and patients on each ward. Methods : Total four wards two typical open wards and two typical closed wards were selected and each contained one ward and one female ward. Ward Atmosphere Scale (WAS) was conducted to each and the mean scores of suscales of WAS were compared by using Student's t-test. Results : 1) The closed ward was similar to the treatment of control-oriented program which stresses the staff control and the rule of ward and ignores the autonomy of patient and such a evaluation was perceived more by the patients than by the staff. 2) The open ward supported and encouraged the staff and patients and focused on solving the practical problems of the patients, and especially the staff perceived it as the treatment program the activated ward. 3) It was shown that the open ward was more therapeutic and while it focused on the autonomous problem solving, the closed ward pup enguasis on the protection of patients. In addition, the patients were sensitive to the difference of setting between the two wards than the staff. Conclusion : In conclusion, if various and realistic programs were offered to the patients in the ward, the open ward would be proposed as a desirable therapeutic form for the chronic psychiatric inpatients.

국립서울병원에서 개방병동에 적응 못하는 정신분열병 환자들의 특성

서주행(Joo-Haeng Seo),장안기(An-Kee Chang),최종혁(Jong Hyuk Choi) 대한사회정신의학회 2002 사회정신의학 Vol.7 No.1

연구목적: 개방병동에서 폐쇄병동으로 옮겨간 남자 정신분열병 환자들에 있어서 사회인구학적 특성과 임상적 특성, 전동환자 빈도와 전동이유를 알아 환자 치료에 도움을 주고자 하였다. 방 법: 2000년 1월 1일부터 2001년 12월 31일까지 국립서울병원의 남자 개방병동에서 치료를 받은 환자 302명 중에서 입원치료중 폐쇄병동으로 옮겨간 환자(전동군) 22명과 같은 기간동안 1년 이상 개방병동에서 입원치료를 하고 퇴원한 환자 또는 1년이상 입원 치료중인 환자 31명을 대조군(비 전동군)으로 하여 병력지를 조사하였고, 양군간의 차이를 알아보았다. 결 과: 연구 기간동안 남자 개방병동에서 퇴원한 정신분열병 환자는 302명이었고, 폐쇄병동으로 옮겨간 환자는 22명(7.28%)이었다. 전동이유의 빈도는 환청 또는 망상과 자해가 12명(54.5%)으로 가장 많았고, 옮겨간 시기는 환자의 40.9%(9명)에서 개방병동 입원 1개월 미만이었다. 전동군 환자들은 입원 시 주소에 있어서 난폭한 행동이 많았으며, 알코올 의존증을 많이 동반하였고, 난폭행동의 과거력이 있는 경우가 많았다. 그리고 개방병동 입원 생활 중에는 월평균 프로그램 참여회수가 낮았다(p<0.05). 결 론: 개방병동 입원환자 중 난폭행동을 주소로 입원하였거나, 동반질환으로 알코올 의존 및 물질남용이 있거나, 난폭행동의 과거력이 있는 경우에는 많은 치료적 관심을 요한다. Objectives:This study was designed to investigate socio-demographic and clinical characteristics, causes and occurrence time in the schizophrenic patients transferred from an open ward to a closed ward for treatment improvement. Methods:Twenty-two schizophrenic patients who were admitted at the Seoul National Hospital during the years between 2000-2001 and transferred from an open ward to a closed ward were selected. The characteristics of transferred patients were compared with those of all patients admitted to an open ward and not transferredduring the same period. Thirty-one were selected as control group. The patients’s chart was reviewed. Results:There were statistically significant differences between two groups in cohabitant, chief complaint on admission, alcohol dependence and substance abuse, the number of engagement in ward program and history of violent behavior(p<0.05). The causes of transfer were hallucination and delusion(31.8%), self-harm(22.7%), violation of ward rule(18.2%), violent behavior(13.6%) and escape(13.6%) in order. The majority of transfer occurred within 1st hospital month(40.9%). Conclusion:Psychiatrist should pay attention and interest to patients who have violent behavior in chief complaint, alcohol dependence and substance abuse and history of violent behavior in an open ward.

우리나라 정신병원 병동부에 관한 건축 계획적 연구 Ⅰ

주성철,김선국,김광문 한국의료복지시설학회 1997 의료·복지 건축 Vol.3 No.4

Mental hospital has been expanding its function to psychiatric treatment in the meaning of therapy. Therefore systematic research on thr mental hospital is urgent. This study aims to prepare the basic data which are needed on planning and designing the mental hospital with emphasis on the wards, which take the largest area ratio and play a principal role to psychiatric patients. The process of study is to 1) to survey facility of Mental hospital in Korea, 2) to analize charactor and behavior of psychiatric patients 3) to suggest element of ideal ward in general hospital.

우리나라 정신병원 병동부에 관한 건축 계획적 연구 I

주성철,김선국,김광문,Ju, Sung-Chul,Kim, Sun-Kook,Kim, Kwang-Moon 한국의료복지건축학회 1997 의료·복지 건축 Vol.3 No.4

Mental hospital has been expanding its function to psychiatric treatment in the meaning of therapy. Therefore systematic research on thr mental hospital is urgent. This study aims to prepare the basic data which are needed on planning and designing the mental hospital with emphasis on the wards, which take the largest area ratio and play a principal role to psychiatric patients. The process of study is to 1) to survey facility of Mental hospital in Korea, 2) to analize charactor and behavior of psychiatric patients 3) to suggest element of ideal ward in general hospital.

정신건강의학과 개방병동 입원 환자의 진단군별 약물 처방 경향 변화 : 경기도 소재 일 대학병원에서의 11년 비교 연구

변선정,김의태,유희정,하태현,윤인영,김기웅,Byun, Seonjeong,Kim, Euitae,Yoo, Hee Jeong,Ha, Tae Hyon,Yoon, In-Young,Kim, Ki Woong 대한생물정신의학회 2015 생물정신의학 Vol.22 No.4

Objectives This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. Methods We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. Results Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. Conclusions Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.

중환자실 병상주변공간의 면적과 간격에 관한 연구

이현진,권순정 한국의료복지건축학회 2019 의료·복지 건축 Vol.25 No.3

Purpose: This study tries to propose the dimensions and area related to patient bed and surroundings in ICU considering nurses’ observation and medical care. Methods: Literature survey, 11 Case studies, some Interviews with nurses and measuring of medical equipments’ dimension in ICU have been mobilized in order to deepen the ICU bed area standards. Results: 0.3m clearance between head wall and patient bed is necessary for emergency cases. The minimum distance at the foot of the bed should not be less than 0.9m for EMR cart and medical tray. The clear floor area of one bed and surroundings in open ward is 10.2㎡(3m×3.4m). In a single-bed patient room, the minimum clear floor area is 16.0㎡(4m×4m). Considering the control of cross infection in ICU, Single bed patient room is recommended. Implications: The result of this study can be applied to the design of ICU and legislation of ICU standard.