嚴重特殊傳染性肺炎COVID-19對於居家長照人員訪視之壓力調適-以中部長照機構為例

研究背景: 2019年12月開始的嚴重特殊傳染性肺炎COVID-19紛紛對於工作或生活造成影響。對於居家長照機構的居家長照人員而言，由於到個案家庭工作時需要更加注意避免感染，對於個案及其家屬來說也擔心外面來的長照人員可能帶來感染機會的增加，因此探究疫情期間居家長照人員的工作壓力及其來由，對於改善這些員工的工作條件格外重要。研究目的: 本研究的目的在於探討居家長照人員在COVID-19期間訪視服務，是否因基本人口學變項、對疫情的特定困擾、及不確定感等因素造成訪視工作之壓力。研究方法: 本研究採橫斷性研究，調查對象是中部某社區居家型長照機構的居家長照人員進行進行結構式問卷普查調查，調查期間為民國111年02月17日至民國111年03月26日。問卷調查之內容包括：「基本屬性資料」、「COVID-19期間特定困擾」及「不確定感」與「工作壓力」。以SPSS 25.0統計軟體進行資料分析，運用敘述性統計，並使用迴歸分析、獨立樣本t檢定、單因子變異數分析等方式進行假設檢定。研究結果：本研究共回收有效問卷共219份，問卷回收率為100％。單因子變異數分析分析結果顯示，人口屬性變項「因工作關係，1週大約至案家訪視或服務次數」p=0.011 (p<0.05 )故為顯著，「工作年資」對於不確定感的差異為邊緣性顯著p=0.095(p＜0.1)，經獨立性樣本t檢定分析結果發現「疫情期間因我的工作遭受歧視或議論」對疫情困擾感受的差異是顯著的p=0.012(p＜0.05)，「最近一年是否接受傳染病教育訓練」，對疫情困擾是顯著p=0.037(p＜0.05)，「性別」對於工作壓力為邊緣顯著p=0.074(p＜0.1)。其餘人口變項皆為不顯著。迴歸分析發現「疫情困擾」對於居家長照工作壓力影響為顯著，而「疫情不確定感」對於居家長照工作壓力影響不顯著。結論：居家長照人員工作繁瑣、複雜、加上疫情COVID-19嚴峻造成居家長照人員訪視或服務時壓力增加，因此建議訪視前風險評估案家TOCC (旅遊史Travl history、職業別Occupation、接觸史Contact history、群聚史Cluster)、加強感染控制及防護教育訓練(包含正確洗手及配戴口罩)、工作服務量適當安排，以及提供員工心理紓壓管道，以改善居家長照人員工作壓力，以期提升居家長照服務品質。

關鍵字

新冠肺炎；居家長照機構；工作壓力

並列摘要

Background: The severe special infectious pneumonia COVID-19 that started in December 2019 has had an impact on work or life. For the home-based long-term care personnel of the home-based long-term care institutions, since they need to pay more attention to avoid infection when they go to work at the client's home, they are also worried that the long-term care personnel from outside may increase the chance of infection for the client and his family. During the epidemic, the work pressure of home-based long-term care workers and their causes are particularly important to improve the working conditions of these workers. Purposes: The purpose of this study was to investigate whether home-based long-term care workers visiting services during the COVID-19 period were under pressure due to basic demographic variables, specific distress about the epidemic, and a sense of uncertainty. Material and Method: This research adopts a cross-sectional study. The survey objects are the home-based long-term care personnel of a home-based long-term care institution in a community in the central part of the country. A structured questionnaire survey was conducted. The contents of the questionnaire include: "Basic Attribute Information", "Specific Troubles During COVID-19", "Uncertainty" and "Work Pressure". SPSS 25.0 statistical software was used for data analysis, using descriptive statistics, and using regression analysis, independent sample t-test, one-way ANOVA for hypotheses testing. Result and Discussion: A total of 219 valid questionnaires were collected in this study, and the questionnaire response rate was 100%. The results of One Way ANOVA analysis showed that the demographic attribute variable "due to work relationship, about the number of visits or services to the case in 1 week" p=0.011 (p<0.05), so it was significant, and "working experience" The difference in uncertainty is marginally significant p=0.095 (p<0.1). The independent sample t-test analysis results show that the difference in the feeling of being discriminated against or discussed because of my work during the epidemic is significant p=0.095 (p<0.1). = 0.012 (p < 0.05), "Whether you have received education and training on infectious diseases in the last year", it is significant for epidemic distress p = 0.037 (p < 0.05), and "gender" is marginally significant for work stress p = 0.074 (p < 0.1 ). The rest of the population variables are not significant. The regression analysis found that "epidemic distress" had a significant impact on the work pressure of home-based long-term care, while "epidemic uncertainty" had no significant impact on home-based long-term care work pressure. Conclusion: The work of home-based long-term care workers is cumbersome and complicated, and the severe COVID-19 epidemic has increased the pressure of home-based long-term care workers during visits or services. Therefore, it is recommended that the pre-visit risk assessment caseworker TOCC (Travl history, Occupation,Contact history, Cluster history), strengthen infection control and protection education and training (including proper hand washing and wearing masks), properly arrange work service volume, and provide employees with psychological relief channels to improve the work pressure of home-based long-term care workers, in order to improve the quality of home long-term care services.