照顧中的互惠：失智老人日間照顧中心照顧服務員的情緒勞動

Reciprocity of Care: Emotional Labor of Care Attendants in Elderly Dementia Day Care Center

丁茹喬(Ju-Chiao Ting)

指導教授 ： 楊培珊

國立臺灣大學/社會科學院/社會工作學研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.01742

摘要

臺灣在人口老化與失智症人口增加的背景下，老人日間照顧服務是長期照顧政策重點發展項目之一，惟因失智症照顧困難度相對較高，照顧服務員的情緒勞動經驗卻尚未受到重視，故本研究目的為：瞭解失智老人日間照顧中心照顧服務員的情緒勞動經驗，與照顧服務員對組織環境與文化的感受。資料蒐集方法有參與觀察、深度訪談及次級資料分析，以臺灣北部與中部地區各一家失智老人日間照顧中心為田野交錯進行觀察，合計觀察時數305 小時、訪談照顧服務員9 位。

研究結果為：（1）照顧服務員的情緒勞動經驗多元複雜，在情緒知覺上，失智症長輩無預警的言行舉止，時而讓照顧服務員覺得新鮮有趣，但突發的衝突或意外事件，照顧服務員也會被嚇到、難過、自責。在情緒處理上，為了配合失智症長輩當下情境，照顧服務員以理想化、戲劇化等策略，進行正向情緒淺層與深層演出；當無法配合演出之際，照顧服務員藉由轉換照顧空間與對象以調節負向情緒，來自失智症長輩口頭與肢體的安慰，可見其不因疾病喪失關懷他人能力；當無法調節情緒之際，照顧服務員也可能自言自語、或忍無可忍而爆發出真實的負向情緒。（2）在組織環境與文化的感受上，由於長輩的疾病與正常身分界線相對模糊，照顧服務員實踐情感規則不易，若當組織溝通能考量照顧服務員個別差異，採用間接督導而非直接責備方式，彈性調整情感規則落實程度，則照顧服務員感受來自組織管理的情緒勞動壓力較小。

依據研究結果，本結論指出情緒勞動在長期建立關係的照顧工作情境中，是基於「工作考量」與「人的考量」，不只涉及照顧服務員對情緒調節付出心力，照顧服務員也接受來自外界的情緒調節資源，由此生成照顧中的互惠。最後，本研究以人的考量出發，提出：硬體設施、團隊默契、個案更替、家屬溝通、同儕督導或引進專業資源、增進情緒演出能力、覺察象徵物件意義等7 項實務建議；並針對技能檢定、專業分科與職業分級、繼續教育等3 個面向提出政策建議。

關鍵字

失智症 ； 老人日間照顧 ； 照顧服務員 ； 情緒勞動 ； 情感規則

並列摘要

As population in Taiwan is aging rapidly, clients with dementia increase steadily. Elderly day care services become one of the most important projects in the long-term care policy. However, caring the demented elderly is more difficult than caring the disabled elderly. The emotional labor experiences of care attendants in elderly dementia day care centers still need more research. Therefore, this thesis aimed to (1) understand care attendants’ emotional labor experiences, and (2) care attendants’ feelings about organizational environment and culture. My research gathered materials through document analysis, participant observation, and in-depth interview with 9 care attendants from two elderly dementia day care centers in the northern section and central section of Taiwan, respectively. I took turns observing two centers, and finally conducted for a total of 305 hours of participant observation.

The research findings emerged as follows: (1) Care attendants’ emotional labor experiences were complex. First, they felt fresh and fun when people with dementia made unexpected movements; nevertheless, care attendants were also scared, sad, or self-condemned when conflicts or accidents suddenly happened. Second, in order to enter the world of people with dementia, care attendants performed surface acting and deep acting by idealization and dramatization. Sometimes when care attendants could not work with clients, they choose to care another person and changed to another space, so as to manage their negative emotions. The comforts from clients also showed that the demented elderly still had the abilities to care about others. Sometimes when care attendants could not regulate their emotions, they made murmur or burst out in anger at the end of their patience. (2) Due to the relatively vague criteria to define whether the demented elderly were patients or normal people, it was hard for care attendants to follow feeling rules. Therefore, if managers considered individual differences of care attendants, applied indirect supervision instead of direct blame, and flexibly revised the range of feeling rules, care attendants felt less emotional labor pressure from the organizational management.

Under the special working condition to care about others and build long-term relationships, it was concluded that the core concerns of emotional labor were both job-centered and person-centered, and the caring process of emotional labor was reciprocity, which meant that care attendants not only made efforts to manage emotions, but also received emotional supports from external resources. Finally, according to the person-centered concern, this research pointed out 7 practical suggestions, including hardware facilities, team chemistry, client replacements, family communication, peer supervision, professional resources, enhancement of acting ability, and awareness of symbols, and 3 policy recommendations on the aspects of vocational qualification, career ladder for promotions, and on-the-job training.

並列關鍵字

dementia ； elderly dementia day care center ； care attendant ； emotional labor ； feeling rule

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