上白木 悦子

type:Departmental Bulletin Paper 本研究の目的は,文献研究を通して,精神科病院に長期入院する患者とその家族等による退院に向けた意思決定および精神保健福祉士(PSW)による意思決定支援と今後の課題を明らかにすることである.学術情報検索サイトCiNii,J-STAGEを用いて,日本語であり閲覧可能なもの,本研究のテーマである精神科病院に長期入院する患者と家族等の意思決定,PSWによる意思決定支援についての文献検索を行った.その結果,39編が分析対象となり,長期入院患者は意思決定に対して満足感とともに困難さを感じ,家族等は患者に代わり行った意思決定に自信を持つことができずに葛藤を抱えていることが明らかになった.また,PSWは患者の生活全体を見渡し,患者や患者に代わり意思決定を行う家族等を支援することが明らかになった.今後の課題として,意思決定支援の過程でのPSWのかかわり,患者および家族等がPSWに求める支援,PSWによる家族等の負担を軽減する方法を明らかにすることが示唆された. The purpose of this study is to clarify the decision-making regarding discharge by patients and their families who have been hospitalized for a long term in a psychiatric hospital and their decision-making support by psychiatric social worker. We searched for literatures on the decision-making by patients and their families and their decision-making support by PSWs, the theme of this study, that were available in Japanese. As a result, 39 articles were analyzed, and it became clear that long-term hospitalized patients feel both satisfaction and difficulty in their decision-making, and that family members have conflicts because they cannot have confidence in the decisions made on behalf of the patients. In addition, PSWs were found to support patients and their family members who made decisions on behalf of the patients by looking at the patients' lives as a whole. It is suggested to clarify the involvement of PSWs in the decision-making support process, the support that patients and their families seek from PSWs, and how PSWs can reduce the burden on families.