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  • 學位論文

安寧緩和療護之臨終關懷社會工作方法在地化初探-以天主教台東聖母醫院為例

Practive of Social Work in Hospice and Palliative Care - A Case Study of Saint Mary's Hospital.

指導教授 : 蔡青芬

摘要


自第四世紀開始了臨終關懷概念,1967年開始發展安寧緩和療護,而台灣至今也發展了26個年頭,從早期與國外的單向吸取,至今國內已可與國際交流分享及討論。社會的變動是跟著世界的變動,全球化的思維讓更多人重視起在地化的行動。在安寧緩和療護的領域中,它正是透過全球化的過程接收了相關的資源與訊息,實際操盤演練後發現無法完全滿足在地的需求,即便人權與服務的精神一樣,但細膩的服務過程卻必須透過在地化的行動來實踐。社會工作在安寧緩和療護團隊中提供了病患與家屬臨終關懷的全程陪伴與照顧服務,但卻容易因各地文化等的差異性,無法用一套完整的工作方法來提供服務對象適切性服務。因此,社會工作者本身除了擁有最基礎的專業知識與技巧外,更必須了解在地文化與精神,如此才能聽見病患與家屬在幽谷中漫步時所發出的「弦外之音」。 本研究以天主教台東聖母醫院為研究對象及場域,透過天主教台東聖母醫醫院的安寧緩和療護服務,企圖了解天主教台東聖母醫院社會工作者在多元文化共存的台東地區如何提供每位不同族群與文化的病患及家屬適切性服務,同時如何對病患與家屬的需求加以評估及處遇;另一方面,透過本次研究來了解目前台東地區安寧緩和療護現有資源的運用與建構現況,期待能找出屬於天主教台東聖母醫院的在地化臨終關懷服務內涵。 研究結果發現,天主教台東聖母醫院雖然因地區專業人力不足,須由團隊人員去分擔不足的專業人力之角色與任務。以社會工作者為例,除了提供病患與家屬在社會層面需求的服務外,還必須兼負臨床心理師的角色與任務,提供病患與家屬在心理層面的需求協助;除此之外,在其他領域中,也必須要協助與支援,如靈性層面、生理層面等的需求服務提供;這一點,與國外或台灣其他地區單一職責是有所不同的。雖然如此,天主教台東聖母醫院還是以這樣的工作模式在台東地區走過了十個年頭。除此之外,因台東地區僅有天主教台東聖母醫院提供安寧緩和療護臨終關懷服務,團隊成員運用了現有的資源與在地的團體做跨團隊的合作,為台東地區建置了一個安寧緩和療護臨終關懷服務的通報轉介網,使得台東地區的病患與家屬在需求時獲得更快速的服務。雖然現有的工作模式使得天主教台東聖母醫院的運作順利,但非正式的服務網絡也給台東地區帶來了不安全感。唯有正式且經規劃的組織或網絡才可使台東地區的民眾能在生命的最後一段路上擁有更多的安全。因此,跨專業及領域的彙整與合作是有其必要性的。現階段衛生署及社福相關部門已合併為衛生福利部,相信未來在跨專業的合作及對話上將能夠更加的順暢,使得偏遠及偏鄉地區能享有更完整的服務資源,避免落入福利服務的孤島之中。

關鍵字

臨終關懷 在地化

並列摘要


Caring for the dying began in the 4th Century and since 1967, hospice and palliative care was developed. In Taiwan, it has been 26 years since the early development of hospice and palliative care from one-way learning from international cases to now the engagement in international exchanges and discussions. The society in Taiwan has changed along with the world and global thinking has driven localized actions. In the field of hospice and palliative care, under globalization, relevant resources and information have been received but the practical applications indicate the failure to fully satisfy local needs. Even with the same principle of human rights, the dedicated services requires to be provided with local actions. Social workers in the teams of hospice and palliative care offer patients and their families whole range accompanying and caring services, yet due to differences in local cultures, it is impossible to provide competent care for service receivers with a complete set of approaches. As a result, social workers, in addition to basic professional knowledge and skills, need to understand local culture and spirit in order to really understand the “underlying meaning” of terminally ill patients and their families. This study used St. Mary’s Hospital in Taitung as the research subject and field and through hospice and palliative care provided by the Hospital, this study attempts to understand how social workers provide competent care for patients and their families from different ethnical groups and cultures in culturally diversified Taitung and at the same time how they evaluate and respond to the demands of patients and their families. On the other hand, through the investigation, this study aims to understand the use of existing resources and development state of hospice and palliative care in Taitung in order to identify the local contents of hospice and palliative care at St. Mary’s Hospital in Taitung. Research results indicate that St. Mary’s Hospital in Taitung is lack of professional human resources and team members need to share the roles and tasks of professional talents. For example, social workers, in addition to the provision of services needed by the patients and their families in the demands of social aspects, need to play the role and undertake the tasks of clinical psychiatrists to assist to respond to the demands of patients and their families in the psychological aspect. In addition, they need to give assistance and support in other fields such as demands in spiritual and physical aspects. This is distinct from social work services provided in other areas of Taiwan and other countries that may only involve in single responsibility. St. Mary’s Hospital in Taitung, however, has been working with this model for more than a decade. Since the Hospital is the only one in Taitung that offers hospice and palliative care and team members makes uses the existing resources to work with local groups for inter-team cooperation by building an information network for hospice and palliative care in Taitung to provide quicker services for patients and their families in need. Although current work model enables St. Mary’s Hospital in Taitung to operate smoothly, yet the informal services network does bring insecurity to Taitung. Only with formal and planned organization or network, people in Taitung can feel more secured in the last journey of life. Hence, it is necessary to promote inter-professional and inter-disciplinary coordination and cooperation. At present, Department of Health and relevant departments of social welfare have been integrated under Ministry of Health and Welfare and it is expected to have smoother operation of professional cooperation and dialogue that will enable more comprehensive service resources provided to remote and rural areas and prevent from the marginalized areas of social welfare services.

參考文獻


Cynthia Goh(2010).The development of Hospice Palliative Care in the Asia Pacific Region.安寧療護國際高峰論壇學員手冊(pp.8-9)。台北:安寧照顧基金會。
台灣安寧緩和醫學學會(2007)。安寧緩和醫療─理論與實務。台北:新文京。
馬偕醫院癌症中心:安寧緩和醫療。2012/01/04。
衛生福利部:安寧緩和醫療條例。2013/09/17。
姚建安:緩和醫療(安寧療護)的團隊(2012)。教育部醫學學習網。

被引用紀錄


蘇添芳(2009)。台灣有機生活之研究〔碩士論文,國立屏東科技大學〕。華藝線上圖書館。https://doi.org/10.6346%2fNPUST.2009.00177

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