1. An approach for enabling schizophrenic in-patients to be discharge within three months Yoko NAKAYAMA, Michiko TANOUE, Junko NIMURA, Takako OHKAWA, Mayumi OHTAKE, Naoko CHO JAPAN

2. Social Background ： Japanese psychiatric hospitals have been criticized for keeping the patients for too long. In fact, on average, psychiatric patients stay on ward over 300 days in each admission. There are still many long-stay patients as well as nurses who provide custodial care in traditional psychiatric hospitals. Institutionalization has not only been problems among inpatients but for nursing staff in psychiatric hospitals. In the last 15 years, Japanese psychiatric nurses, those who work in psychiatric hospitals, have made efforts to shift from institutional care to community care.

3. Purpose ： The purpose of this study is (1)to analyze the categories and timing of nursing care in wards, (2) to explore the health promoting approaches, both of which may help patients to remain in communities after discharge.

4. Subjects ： Subjects ： 36 Nurses Average of Age: 30 years old Average of Clinical NursingExperience: Average of Clinical Nursing Experience: 8 years

5. Methods ： 1.The nurses were interviewed to recall what kind of care they gave in order to prepare patients for community living. 2.Before interviewing, we received informed consents in writing from the subjects for the participation into our research.

6. 3.The cases of 38 schizophrenic in- patients who discharged within three months were described by the nurses in the interviews. 4.The interview data was qualitatively analyzed. Methods ：

7. In this presentation, (1)we focused on 26 patients remain in the communities for more than 6 months after discharge. (2)their average length of stay in hospitals was 62 days. Focus ：

8. 1 In Hospital 1 No Information11 6 months after discharge: Discharged within 3 months38 patients patients Remain in the Communities26 After 6 months

9. Table1-1. Characteristics of 26 Patients : Sex n % Male 12 46.2 Female 14 53.8 26 100.0

10. Table1-2. Characteristics of 26 Patients : Age n % 20s 3 11.5 30s 10 38.5 40s 8 30.8 50s 4 15.4 60s 1 3.8 26 100.0

11. Table1-3. Characteristics of 26 Patients : Time of Admission n % 1 st time 7 26.9 2 nd time 5 19.2 3-5 times 7 26.9 6-9 times 5 19.2 more than 10 times 2 7.7 26 100.0

12. Table1-4. Characteristics of 26 Patients : Type of Admission Ｔｉｍｅ ｏｆ Admission Total 1 st time more than 2 times Voluntary Admission 11617 Involuntary Admission 63 9 Total 71926

13. Table1-5. Characteristics of 26 Patients : Style of Living in Community n % Single 4 15.4 With Family 22 84.6 26 100.0

14. Table1-6. Characteristics of 26 Patients : Activity in Community n % House Work 10 38.5 Day Care 5 19.3 Ware Shop 4 15.4 Occupational Therapy 2 7.7 Part-time Job 1 3.8 Full-time Job 1 3.8 Noting 2 7.7 No Information 1 3.8 26 100.0

15. Categories of care: Ⅰ. Maintaining a Health promoting life style after discharge. Ⅱ. Coping with problems. Ⅲ. Compliance with medication regimen. Ⅳ. Management of psychiatric symptoms. Ⅴ. Understanding their own mental illness. Ⅵ. Discussing how to develop interpersonal relationships. Ⅶ.Re-establishing and re-framing family relationships. Ⅷ. Motivating patients for continuation of outpatient treatment. Ⅸ. Spending time outside the hospital on weekends. Ⅹ. Developing connections with support professionals in the community.

16. Table2. Area and Timing of Care ntimingmost Ⅰ. Life Style after Discharge 55 1 ～ 11w 3w Ⅸ. Spending Time Outside 32 2 ～ 11w 3w Ⅲ. Medication Regimen 31 1 ～ 10w 3w Ⅶ. Family Relationships 29 1 ～ 11w 4w Ⅹ. Support Professionals 20 1 ～ 13w 4w Ⅳ. Management of Symptoms 17 1 ～ 12w 4w Ⅵ. Interpersonal Relationships 14 1 ～ 13w 2w Ⅱ. Coping with Problems 14 1 ～ 13w 10w Ⅷ. Outpatient Treatment 6 3 ～ 9w Ⅴ. Understanding Mental Illness 4 1 ～ 8w

17. Discussion ： 1.Many areas of care were given in the context of preparing for community living at the first week after admission. 2.The range of timing of the start of care was between the second week and the sixth week. 3.Most frequent week of the introduction was the forth week. 4.60% of care for “Compliance with medication regimen” was being addressed by the third week.

18. Discussion: 5.Care for “Developing a health promoting life style after discharge” began at the first week after admission. Most frequent week of the introduction was the third week. 6.There were differences between first admission patients and re-admission patients, and between the case of voluntary admission and the case of involuntary admission.