問題患者とリハビリテーション・チーム

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We studied the negative feelings of medical personnel toward patients in a rehabilitation setting. Via a questionnaire, 110 personnel were asked to recall patients who troubled them or whom they had considered to be "problems". The following results were obtained : 1) Out of 246 patients, 45 patients (18%) were considered problematic.2) Neither age nor sex were important factors : rather diagnosis associated with severe disability, viz., cerebrovascular accident (CVA), brain injury, and tetraplegia, were highyl correlated with "problem patients".3) Nurses tended to see CVA patients as problematic when the patients were severely disabled.4) Among 239 causes that personnel identified as problematic, 36 causes (15%) appeared to be derived from troubles within the service team, for instance, role conflicts among staff members.5) Four patients were unanimously considered problematic. Two of them were severely disabled CVAs, another was an orthopedic patient who was a gangster, and the remaining patient was a young person with a spinal cord injury. The last case was difficult to deal with bacause the personnel in charge were unaccus-tomed to managing spinal cord injuries.These results indicate that not only severity of disability, but also troubles in teamwork can engender feelings of antipathy toward a patient. Such negative feelings may thus be synonymous with negative "counter-transference".In conclusion, to establish harmonious rapport between staff and patients in a rehabilitation setting, the personnel should 1) recognize the existence of negative feelings when they arise, 2) discuss such feelings from the viewpoint of role theory, 3) clarify the purposes and functions of the team, and 4) have an active system for learning new solutions to the problems.
社団法人日本リハビリテーション医学会の論文
1989-01-18

問題患者とリハビリテーション・チーム

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