臺北縣市居家照護營養師的執業情況 ─ 一個質性研究

The Practices of Home Care Dietitians in Taipei City/County: A Qualitative Study

彭又文(Yu-Wen Peng)

指導教授 ： 蘭淑貞

臺北醫學大學/公共衛生暨營養學院/保健營養學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00083

摘要

臺北縣市居家營養照護發展至今已10年，但居家照護營養師之執業現況尚未有研究文獻。本研究以質性方式探討該主題，自98年9月至99年3月深入訪談10位居家照護營養師34.1~163.5分鐘，平均97.5±44.6分鐘。全程錄音訪談內容，之後完成逐字稿，進行歸納、分析與整理。本研究經臺北醫學大學人體研究倫理委員會審查通過。10位營養師之年齡為29~50歲，居家照護年資2~10年，平均6.1±2.7年，中位數5.5年。初次接觸居家營養照護領域的原因主要是正職工作環境給予機會。個案以老人為主，經濟或住家情形差異大，主要照顧者為家屬(伴侶、子女、媳婦，以女性為主)，健康問題以中風最常見，進食以鼻胃管為主。訪視過程除完成公會規定事項外，營養師各自做法有些不同，訪視次數會依個案需求與自我習慣決定。受訪者大致認同迷你營養評估(Mini- Nutrition Assessment, MNA)的使用，但對部分問題有疑慮如身體質量指數不適用於兒童。出訪遭遇問題包括交通、個案或家屬意見及照顧能力不足、個案家庭問題、轉介問題、營養師自我安全。收穫有：自我能力發揮與成就感、擴展視野、體認健康重要性、為自己的未來做準備並懂得惜福。營養師認為進階課程需求為吞嚥困難飲食和心理課程。

關鍵字

居家營養照護 ； 居家營養師 ； 質性研究

並列摘要

The development of home nutrition care in Taipei City/County has been over ten years. This is a qualitative study to investigate the practices of home care dietitians (HCDs) by in-depth interview. Ten HCDs were interviewed from September 2009 to March 2010. The interview lasted for 34.1~163.5 with an average of 97.5±44.6 minutes. All processes have been tape-recorded. Contents were typed word by word. The results was induced, analyzed and reorganized. The study has been approved by TMU-Joint Internal Review Board.
Ten HCDs were 29~50 years (yrs) old. Their home nutrition care (HNC) services lasted for 2~10 yrs, median was 5.5 yrs. Reason for entering the HNC area was the job environment providing the opportunities. Majority of home care clients are older adults. The economic status and housing environment were various. Caretaker included spouse, adult children including daughter-in-law, neighbors, home caregivers and foreign servants. Stroke was major disease among the clients. Feeding route was mainly through nasogastric tube. Home care service with standardized procedure set-up by Taipei Dietitians Association is provided to client. However, not all dietitians followed the procedure exactly. Dietitians recognize the value in use of MNA to evaluate the nutritional status, but doubt about appropriateness of some questions such as BMI used for children . Problems encountered in home visits were transportation, the inconsistent opinions and inability to take care of clients among family members, family problems, case referral, nitpicking and safety. Rewards from home care services included potential to be explored, sense of achievement, vision expansion, sense of important health and appreciation of thanksgiving. HCD felt the need to take advanced courses such as swallowing difficulty diet and psychology.

並列關鍵字

home nutrition care ； home care dietitian ； qualitative study

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