不同專業背景照顧管理專員對資格訓練課程之需求探討

背景照管專員是照顧管理中心的核心角色，工作領域包括護理、社工、復健、營養、藥事等多項專業服務，為組成內部跨專業團隊運作，其進用資格為具備師級證照之醫護專業、社會工作師或公共衛生碩士、老人照顧相關科系，並具2~5年相關實務經驗者，期藉由整合及運用不同專業知識與專業能力，回應長照家庭的多元照顧需求。台灣現行照管專員培訓制度採先聘後訓方式，任職照管中心6個月內須完成資格訓練課程，然而，不同專業背景照管專員的專業養成教育，缺乏整體性長期照顧概念且對照顧管理的專業知能不足，加上現行之訓練課程內容並無考量不同專業背景照管專員之差異與不同需求，導致實務上因專業差異影響照顧管理工作之情形。目的以照管專員層面，瞭解對資格訓練課程之需求情形，並探討不同專業背景之照管專員於資格訓練課程需求之差異。方法本研究為橫斷式研究，採分層比例抽樣，將台灣22縣市照管中心依區域特性分為直轄市、縣轄市及偏鄉離島縣市，以2017~2019年新增照管專員人數比率(55.9%、28.3%、15.8%)及專業背景比率(護理背景63%、非護理背景37%)，選取任職於照管中心的照管專員並於2017~2019年期間完成照管專員資格訓練課程者為受訪對象，回收有效樣本數314份。研究工具為結構式問卷，內容包括研究對象之基本資料和專業背景、對資格訓練課程內容的需求程度、對課程時數之適切性以及缺乏之課程內容，專家內容效度為.997，內在一致性為.965。資料分析使用描述性統計及獨立樣本t檢定、單因子變異數分析等推論性統計。結果研究對象平均年齡37歲（SD=6.66），以女性(91.4%)、大學(80.8%)居多，護理背景有203人(64.6%)，非護理背景有111人(35.4%)。資格訓練課程需求程度最高的課程是職能治療議題(含復能概念)和物理治療議題(含復能概念) (M=3.66、SD=0.49)，需求程度較高的課程面向主要為「溝通協調」、「長照專業議題」及「照顧管理流程與實務」，需求程最低的課程是機構住宿式服務之品質評估與監測(M=3.09、SD=0.63)，需求程度較低的課程面向主要為「服務品質管理」；資格訓練課程時數適切性最高的課程是擬定照顧計畫2小時(M=3.34，SD=0.57)，適切性較高的課程面向主要為「照顧管理流程與實務」，表示照管專員認為時數是足夠的，最低為職能治療議題(含復能概念)1小時和物理治療議題(含復能概念)1小時(M=3.06、SD=0.71)，適切性較低的課程面向主要為「長照專業議題」，表示課程時數不足，建議增加為2小時。護理背景照管專員在「社會工作議題與社工實務技巧」需求程度高於非護理背景(t=2.26, p=.009)，非護理背景在醫療議題及護理議題課程的需求程度相較其他課程比較高。研究對象認為缺乏之課程歸納有五大項，建議將身心障礙者之長照需求與評估、早期療育兒童之長照需求與評估納入資格訓練課程中，其餘課程可納入在職教育訓練課程。結論目前照管專員之專業背景以護理背景居多，非護理背景則以社會工作師為主，照管中心的照顧管理人力配置若能同時涵蓋不同專業，有助於同儕學習與擴展不同專業視角。研究對象對強調復能概念的職能治療議題和物理治療議題之課程需求最高且認為課程時數太少，對服務品質管理課程較不重視，整體上較著重於學習長照專業議題及照顧管理實務的課程，故資格訓練課程可增加復能相關課程時數，而減少服務品質管理課程時數；針對不同專業背景，護理背景照管專員應加強社工實務技巧課程，非護理背景可加強醫護需求評估課程，建議課程內容融入實際案例討論與不同專業視角觸發，以因應不同專業背景對資格訓練課程的需求，避免因專業差異影響照顧管理工作。照管專員資格訓練課程是新進照管專員的基礎培訓課程，仍需持續接受在職教育與累積實務經驗，能運用所學知能，協助解決長照家庭的問題。本研究結果可做為各縣市照管中心新進照管專員訓練課程之參考。

關鍵字

照顧管理；照管專員；資格訓練課程

並列摘要

Background Care manager is the core role in long-term care management centers, providing multiple professional services including nursing, social work, rehabititation, nutritional support, pharmaceutical care, and other duties. In order to form an internal multidisciplinary team, the qualifications for employment denote the candidate must be medical personnel or a social worker with professional licensure or hold a master’s degree in public health, or a degree from the Department of Eldercare. Additionally, they must have 2–5 years of relevant practical experience. This is to meet the goal of fulfilling the diverse care needs of long-term care families by integrating and applying professional knowledge and expertise from multiple fields. The current training system for care managers in Taiwan employs the “First-Hire-Then-Train” approach in which care managers are required to complete a qualification training course within six months of employment. However, the educational development for care managers from different professional backgrounds lacks the concept of holistic long-term care and professional knowledge of care management. In addition, the current training curriculum does not take into account the differences and different needs of care managers from different professional backgrounds, resulting in a situation whereby care management in practice is affected by professional differences. Objective To explore the perspectives of care managers, to understand their need for qualification training courses, and to discuss the variety of needs among care managers with different professional backgrounds. Methods In this cross-sectional study, stratified proportional sampling was used. Care centers in 22 counties and cities in Taiwan were classified into three groups according to their regional characteristics, i.e., direct-controlled municipality, county-administered city, and remote area. Care managers who are employed at long-term care management centers and have completed the care management qualification training course from 2017 to 2019 were selected according to the proportions of new care managers (55.9%, 28.3%, 15.8%) from 2017 to 2019 and proportions of care managers from different professional backgrounds (63% from nursing backgrounds and 37% from non-nursing backgrounds). 314 valid samples were collected. A structured questionnaire was used for the research, the content of which included basic information and professional backgrounds of the study participants, their level of needs for the course content, the suitability of course hours, and an evaluation of the course content. The expert content validity was .997 and the internal consistency was .965. The data was analyzed using descriptive statistics and inferential statistics such as independent samples t-test and one-way analysis of variance. Results The mean age of the study participants was 37 years (SD=6.66), with a majority being females (91.4%) with university degrees (80.8%). Among them, there are 203 (64.6%) with a nursing background and 111 (35.4%) from a non-nursing background. The qualification training courses with the highest level of need were Occupational Therapy Issues (including the concept of reablement) and Physical Therapy Issues (including the concept of reablement) (M=3.66, SD=0.49), while the courses with relatively high need were mainly Communication and Coordination, Long-term Care Profession and Care Management Process and Practice. The course with the least need was Quality Assessment and Monitoring of Institutional Residential Services (M=3.09, SD=0.63) and the course with relatively low need was Service Quality Management. As for the suitability of training hours, the two hour Care Planning course was suggested as the most suitable (M=3.34，SD=0.57). The course with relatively high suitability regarding training hours was Care Management Process and Practice, indicating that the care managers considered the hours to be sufficient. The courses with the most unsuitable training hours were Occupational Therapy Issues (including the concept of reablement) and Physical Therapy Issues (including the concept of reablement) (M=3.06, SD=0.71), which are both one hour long. The Long-term Care Profession course had relatively low suitability in terms of training hours, indicating that the single hour is insufficient; it was recommended to increase the course time to two hours. The need for Social Work Issues and Social Work Practice Skills was higher among care managers from nursing backgrounds than those with non-nursing backgrounds (t=2.26, p=.009), while care managers from non-nursing backgrounds had a higher need for medical and nursing courses. According to the study participants, the current curriculum lacks five major categories of courses. It was recommended to incorporate content covering the long-term care needs and evaluation of people with disabilities and the long-term care needs and evaluation of early intervention for children, and to include the remaining courses in the on-the-job training courses. Conclusions Currently, care managers mostly come from nursing backgrounds, while those from non-nursing backgrounds are predominantly social workers. If the staffing of long-term care management centers can incorporate different professions at the same time, it will help care managers to learn and expand their professional perspectives. The study participants have a significant need for occupational and physical therapy training that emphasizes the concept of reablement and consider the current course hours to be insufficient. They place less attention on service quality related courses and generally focus more on learning about long-term care issues and care management practices. Therefore, the qualification training curriculum should be modified by increasing the hours of reablement-related courses and reducing the hours of service quality management courses. To support different professional backgrounds, care managers from nursing backgrounds should focus more on social work practice skill courses, while those from non-nursing backgrounds concentrate on medical and nursing needs assessment courses. It is recommended to integrate practical case discussions into the course content and to approach teaching from a variety of perspectives in order to meet the needs of people from different professional backgrounds and avoid the impact of professional differences on the quality of care given. The qualification training course is a basic training course for new care managers. It is still necessary for them to continue to receive on-the-job training and accumulate practical experience so that they can apply their acquired knowledge and problem-solving skills to support long-term care families. The results of this study can be used as a reference for training courses for new care managers in long-term care management centers.