日本建築学会計画系論文集
Online ISSN : 1881-8161
Print ISSN : 1340-4210
ISSN-L : 1340-4210
患者のコミュニケーションに寄与する精神医療環境に関する考察
段階的空間構成を持つ精神科病院の治療・療養環境に関する研究 その3
厳 爽岡本 和彦松田 雄二
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ジャーナル フリー

2017 年 82 巻 740 号 p. 2501-2510

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 Based on Jurgen Ruesch and Gregory Bateson's classic theory on psychiatry and Harry Stack Sullivan's personality developmental theory, this study focuses on the environment of psychiatric hospitals that contribute to the restoration of patients' communication system by examining interpersonal relationships between psychiatric patients. The following four points concerning the inpatient environment of psychiatric hospitals designed with the purpose of healing patients is sought to elucidate: (1) from the standpoint of “total institution,” exploration of the issues and limits concerning improving the quality of space; (2) discussion of how medical staffs who contribute to patients' communication should be involved as “others”; (3) discussion of ideal hospital ward spaces that contribute to patients' communication, and (4) elucidation of features of young patients and identification of clues for constructing a theory of space for child and adolescent psychiatric wards.
 The survey target was “A” Medical Center. A “mapping” survey of all patients and staffs who use the common spaces of the hospital wards was carried out over a total of two days. Decrease in patients' desire for interpersonal communication and tendency to avoid others was observed in all adult inpatient wards. These trends were especially noticeable in both the Rehab ward patients with long inpatient stays and the MTSA. It can be said that both environments are stereotypical “total institutions.” The survey revealed the following:
 1. It is important to keep a proper distance from the SS where the staffs stay to the common space where patients stay. For ideal space that contributes to communication between patients, there is the need to construct spaces that support the diverse needs of patients with different disorders. Also it is necessary to provide the space which could spend time alone in the public space for the long term patients. Therefore it is desirable to have common space configurations that enable creating spaces and environments that meet patients' needs by, for example, having rich flexibility of changing functions and being equipped with furniture. Practices such as lining up many dining tables in one place and placing a TV in the common space should be avoided to the utmost by, for example, adopting a style of decentralized dining.
 2. Direct nursing intervention by the staff for patients has the effect of promoting patients' use of common spaces. Nurses' Observation promotes communication between patients. On the other hand, excessive Nursing Intervention carries the possibility of hindering communication between patients.
 3. The spatial needs of patients in the child and adolescent psychiatric ward are different from adult patients. These patients enjoy staying in common spaces, and in many cases they are with others. They carry out many dynamic acts such as conversations, and they have not lost their desire to be involved with other people. Also, a characteristic of these patients is their ease of being influenced by staff and programs. Because their relationship with others differs depending on their desire for friends, desire for being needed, or desire for intimacy, it is necessary to provide stay spaces and play spaces on different scales as spaces in an adolescent ward. Because they have few stays in patient rooms, there is more necessary to expand the floor size of common rooms than individual patient rooms. Furthermore, there is the need to take into consideration the characteristics of different genders.

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