醫務社工師推動出院準備之服務歷程：運用醫病共享決策輔助工具以急重症病人為例

Process of Discharge Planning Promoted by Medical Social Worker: Utilizing Patient Decision Aids for Critically Ill Patients

黃黛縈(Dai-Ying Huang) ； 李苹慈(Ping-Tzu Li) ； 陳庭楷(Ting-Kai Chen)

《社會工作實務與研究學刊》 12期 (2022/12) Pp. 63+65+67-107

https://doi.org/10.6690/JSWPR.202212_(12).0003

摘要

在醫療實務場域中，急重症病人入住加護病房後，因急性疾病導致喪失獨立日常生活活動功能，面臨出院後照顧議題，本文在於探討醫務社工師採取及早介入策略，運用社會工作以家庭為中心之理念，結合醫病共享決策概念建置『出院照顧計畫之決策輔助工具』，用於急重症病人之出院準備服務。透過出院照顧計畫之決策輔助工具，醫務社工師與病人、家屬共同討論出院照顧計畫過程，從初始評估家庭關係、家庭整體性、健康識能和家庭內外在資源，並參與家庭決策過程從中瞭解出院照顧困境，透過銜接、連結適切的社會支持網絡，支持和強化家屬於出院準備決策的正向能力，且相信病人及家屬即是專家，都有能力依做出適切性的決策來因應後續照顧議題。運用出院照顧計畫之決策輔助工具過程，筆者發現影響家庭出院照顧型態因素包含家庭支持、健康識能、討論出院計畫的行為模式、新冠肺炎疫情影響照顧服務輸送四者，透過了解影響因素有助團隊推動出院準備之效率；另此工具於使用過程之限制在於新冠肺炎疫情下，會談模式變更無法確定溝通成效性，與執行過程需多次執行團隊討論與家庭會議，所耗人力與時間成本增加。雖本計畫有上述之限制，但整體而言執行過程確實幫助醫療團隊更了解家庭於出院準備計畫的困難處，透過及早之介入討論時有實際助益，期許本計畫之分享有助於社會工作實務領域之運用與發展。

關鍵字

醫務社會工作 ； 醫病共享決策 ； 出院照顧計畫 ； 決策輔助工具

並列摘要

Medical social worker using patient decision aids in discharge planning. Start with assess family relations, background, health literacy, internal and external resources with patient and their families. Next, participating in family decision making process has revealed their difficulties. Finally, empower family problem solving abilities by connecting social support resources that make them get together and make proper discharge caring plan for themselves. Most critically ill patients are losing their normal activities of daily living caused illness, especially having treatment in intensive care unit. As well as confronted caring problems before ready discharged from hospital. The article describes early discharge intervention of medical social worker by using patient decision aids which designed concepts include social work family-based concept and shared decision making concept. Author found four reasons on hard discharge families by using patients decision aids that help medical team more understanding difficulties in families. Four factors include family support, health literacy, discussion behavior and unpredictable situation happened likes pandemic of Covid-19 which affect services delivery of long-term care. Besides, there are limitations on the tools, one is communication ways changing by covid-19 pandemic that hard to judge real efficiency. Another is increasing cost of labor and time in many times discussing with families. Although, there are limitations on the project, view all results it's help medical team more realize hard discharge planning factors on families. By early intervention that do help and expect the article sharing will help part of social work profession and practical development.

並列關鍵字

Medical social work ； Shared decision making ； Patient decision aids ； Discharge planning

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