The Psychiatric hospital最新文献

Psychiatric hospitals are environments of subtle complexity in both their physical structures and in the psychosocial interpersonal relationships occurring within them. Good planning and groundwork involving disciplines other than those necessary to plan the physical environment are essential for a full interpretation and implementation of a facility's potential. An institution's outer and inner environmental quality will quickly communicate a message of welcome and caring, or one of indifference, to patients and family. The physical structure is invariably an important catalyst to the therapeutic process and, as such, needs to have a high level of amenity for all of its occupants. Due to the diversity of patients and the manifestations of their illnesses, the psychiatric hospital must be carefully planned to serve many obvious and hidden needs.

Medical services are under increasing cost/benefit scrutiny; at the same time, regulatory agencies are increasingly involved in requiring specific formats for treatment. A 1982 report of the Joint Commission on Accreditation of Hospitals (JCAH), requiring more structure for multidisciplinary Treatment Planning Conferences (TPCs), provided an opportunity for a prospective study comparing the benefits of the "old" (N = 92) vs. the "new" (n = 91) TPCs. Ratings, obtained from patients, psychiatrists, and other staff, included ratings of helpfulness of the TPC and of coordination of treatment. Results indicated superior benefit from the new TPCs on staff ratings, but not on patient ratings. The cost/benefit ratio for the new TPCs, given the need for increased staff time, is discussed. While not definitive, this study suggests that regulatory agency requirements, when feasible, should be subjected to study and to cost/benefit analysis, prior to widespread implementation.

The design and construction process is important for any hospital group. The process consists of many steps and contributing factors such as accurate estimating, realistic completion schedules, and comprehensive construction data. It is the responsibility of the Design and Construction Team to insure that these items are met. In the design and construction of a project, time is of the essence. The timely completion can add to the earnings of a hospital group. Conversely, the delayed completion of a project will cause the hospital group to lose tens of thousands, if not hundreds of thousands of dollars. Therefore, it is imperative that the hospital group establishes a Design and Construction Team that will promote the interest of the owner through contract cost containment and efficient project scheduling.

The maturing of technologies in computer capabilities, particularly direct digital signals, has provided an exciting variety of new communication and facility control opportunities. These include telecommunications, energy management systems, security systems, office automation systems, local area networks, and video conferencing. New applications are developing continuously. The so-called "intelligent" or "smart" building concept evolves from the development of this advanced technology in building environments. Automation has had a dramatic effect on facility planning. For decades, communications were limited to the telephone, the typewritten message, and copy machines. The office itself and its functions had been essentially unchanged for decades. Office automation systems began to surface during the energy crisis and, although their newer technology was timely, they were, for the most part, designed separately from other new building systems. For example, most mainframe computer systems were originally stand-alone, as were word processing installations. In the last five years, the advances in distributive systems, networking, and personal computer capabilities have provided opportunities to make such dramatic improvements in productivity that the Selectric typewriter has gone from being the most advanced piece of office equipment to nearly total obsolescence.

This paper reports the results of a survey of 13 private psychiatric hospitals conducted in the summer and fall of 1984. The survey, which consisted of separate, structured interviews with each hospitals chief psychiatrist (or designee), rehabilitation or work activities specialist, and patient rights advocate (or equivalent), sought to determine professional opinion as to the value of work programs for hospitalized psychiatric patients and the impact of Souder v Brennan on hospital programs and patient treatment. The survey revealed that most respondents believed work programs to be beneficial; that they insisted that the purpose of such programs should be patient treatment, not hospital maintenance; and that they felt that the Souder decision had hampered the ability of hospitals to provide treatment and consequently should be modified to allow for expanded work programs and opportunities for patients. The survey also indicated that shorter hospital stays and more intensive treatments had shifted the dominant focus of work treatment from symptom relief and chronic occupation to training for discharge; and it pointed to the existence of subtle differences in the perception of patient work programs between psychiatric and rehabilitative staff members.

This paper surveys the epidemiological characteristics of the first 100 patients committed to a new private psychiatric hospital in Upper East Tennessee, under a pilot program of the Tennessee Department of Mental Health and Mental Retardation. The number of psychiatric commitments in the region has increased since the opening of a local hospital required, by contract, to accept them. While all commitments were because of a psychiatric diagnosis, many patients might have been treated as outpatients had their illness not been complicated by substance abuse. Greater integration of all levels of psychiatric care would make it possible for such patients to receive care in settings more appropriate to their condition before they experience a crisis requiring inpatient commitment.

Particular issues of the interior built environment can influence the patient's perception of space, and therefore his or her behavior. This article specifically deals with the methodology of how to achieve successful psychiatric hospital design, planning and selecting the design team, organizing the design process, and budgeting within the context of interior design. Also discussed are various design elements such as furnishings, wall coverings, floor coverings, and window treatments as they pertain to patients' acceptance, aesthetics, maintenance, and budget.

The authors describe philosophical and logistical issues they encountered in opening a new unit in an existing, freestanding psychiatric hospital. The historical background of the hospital is described. Four principles were found essential in ensuring a smooth opening and providing consistent high-quality patient care: 1. Medical staff input on design of the new unit. 2. Careful selection of key personnel by the unit's chief of service. 3. Team meetings to develop unit concepts prior to opening. 4. Using patient feedback and criticism as a guide to change.