美沙冬個案管理師的工作困境與因應策略

The Exploration of Dilemma and Coping Strategies of Methadone Maintenance Treatment Case Managers

王蓓平(Pei-Ping Wang)

指導教授 ： 盧美秀

臺北醫學大學/護理學院/護理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00154

摘要

本研究目的在了解美沙冬個案管理師在工作上所面臨的困難與如何因應。藉由訪談美沙冬個案管理師，了解未來在培訓各領域之個案管理師時，需要規劃何種訓練課程、繼續教育或在職教育。並提供建議給相關主管機關，讓美沙冬替代治療計劃更順利的進行。
　　本研究採立意取樣訪談北、中、南區替代治療執行機構之美沙冬個案管理師，共九人。結果發現：美沙冬個案管理師的工作內容可分為臨床工作與行政作業，臨床工作為聯繫個案、跟診、給藥、追蹤個案及會談，行政作業為補助款的申請、與衛生主管機關業務聯繫、院內各單位業務聯繫、處理公文、統計資料與協助研究；而美沙冬個案管理師所面臨的困境為：1.政府機關政策不明：因經費來源不同，每年需重提計畫、經常修訂經費來源與項目，難以明確遵循、無清楚人力配置規範，導致人力不足；2.個案管理師權責不清：經常更換院內主事者、醫療機構內個案管理師職責規範不清，面臨跨單位溝通障礙；及3.業務執行之困難：警務人員執行法務公權力的干擾，影響護病關係的建立、行政業務繁雜、藥癮個案的言語威脅，人身安全受威脅。採取的因應方式為：1.期待學會支持：期待提供不同的課程，以增加專業能力、藉由經驗分享，來成為彼此的幫助；2.提升自我的能力：使用批判性思考找尋問題的答案、尋求其他專業課程，來協助解決個案問題；3.應用及整合資源：閱讀文獻，利用網路資源，增加知識找尋答案、尋求學長及其他醫院的照護經驗及資源；和4.被動的面對：順應主管的要求，避免主從衝突、無力改變，只好配合執行。
　　研究建議：1.衛生主管機關在制訂相關政策（如經費申請）時，應先了解實際運作及狀況，以利醫療機構的執行。2.專業團體可提供藥癮相關的教育訓練及證認。

關鍵字

美沙冬替代治療 ； 個案管理師 ； 困境 ； 因應策略

並列摘要

This exploration aims at understanding in for methadone case managers at work facing the difficulties and how to cope. Through interviews in for methadone case managers, understanding when training in the areas of case management in the future, need to plan training courses, continuing education or in-service training. And provide recommendations to the relevant authorities, so Methadone Maintenance Treatment (MMT) more smoothly.
Study on purposive sampling, North, Central, and southern alternative treatment schemes implementing body of currently serving in for interviews with methadone case managers for a filed object, a total of nine people. Results found: methadone in case managers of work content can is divided into clinical work and administrative job, clinical work for contact case, and with consultation, and to drug, and track case and the talks, administrative job for grants paragraph of applications, and health competent organ business contact, and homes within units business contact, and processing documents, and statistics data and assist research. The difficulties faced by the case manager of the methadone are the following: 1. The government policy is not clear because of the different source of funding, every year they need to revisit the plan, frequent amendment of the sources of the fund and project, it is therefore difficult to follow the staff norms which lead to lack of manpower. 2. The unclear responsibilities of case managers, due to frequent replacement of the hospital managers so the case manager duties in medical institution is unclear facing the inter-unit communication barrier. 3. The execution of work difficulties: In the execution of legal affairs of public authority by the police officer affects the nurse-patient relationship and established administrative operations of the complex. And verbal threat of drug addiction cases arises so personal safety is threatened. Various responses are taken: 1. Looking forward to learn on how to support expected to provide different courses to increase the professional competence by sharing and helping each other. 2. To enhance the ability of oneself: Use critical thinking to find the answer to the question, to seek other professional courses, to help solve the case problem. 3. The application and integration of resources: reading literature, use of network resources, to increase the knowledge to find answers and seek the experience and resources of the sister school and hospital care. 4. Passive in the face: to conform to the requirements of the managers to avoid the main conflict, inability to change, as well as with the implementation.
Study recommends: 1. health authorities in the formulation of relevant policies (such as grant applications), you should first understand the actual operation and status, in order to facilitate implementation of medical institutions. 2. the professional body may provide relevant education and training and the identification of drug dependence.

並列關鍵字

methadone maintenance treatment ； case managers ； dilemma ； coping strategy

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