以照顧管理專員觀點探討長期照顧管理中心工作情境之困境：現象學研究

Exploring Care Manager's Perception of Job Difficulty in Long-Term Care Management Centers:A Phenomenology Study

周寶鈺(Pao-Yu Chou)

指導教授 ： 陳靜敏

共同指導教授 ： 蔡淑鳳 ； 李孟芬

臺北醫學大學/護理學院/護理學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00109

摘要

本研究是以照顧管理專員的觀點運用現象學方法，檢視我國長期照顧管理中心的照顧管理專員對個案管理服務、組織定位及工作情境面臨困境之看法。訪談對象是以北、中、南及東部四家具有特色的長期照顧管理中心的督導和照顧管理專員共8位為研究對象。
研究設計是透過深入訪談方式收集資料，並將訪談所得的結果完成逐字稿後，採內容分析法。先將相同意義的字句歸納成「細類目」，再將有連貫意義的「細類目」歸納成「從屬概念」，再將「從屬概念」歸納成四個「主概念」。最後將「細類目」與逐字稿內容做成交叉表，瞭解個案看法出現之頻次，並分析內容。經分析、歸類出「體察個案管理服務對於實務的衝擊」、「察覺個人專業能力的重要性」、「察覺妾身不明與未來的不確定感」與「體察業務推動過程的阻力」四個主要概念；而後衍生出13個從屬概念；在這13個從屬概念中又細分出40項細類目。
研究發現在「體察個案管理服務對於實務的衝擊」中，照顧管理專員紮根基層的深入性及宣傳不足，致使服務開發受到限制；而服務審核標準嚴謹度不足及資訊系統不符需求，往往造成服務供給的差異。在「察覺個人專業能力的重要性」中，照顧管理專員必須藉由不同的進修方式或同儕間學習，以獲得自己對專業與能力的認同。在「察覺妾身不明與未來的不確定感」中，由於長期照顧十年計畫是政府近期逐步推動的計畫，在人員的晉用標準及服務標準的內涵方面，讓人員有非常大的不確定性、壓力及負荷。在「體察業務推動過程的阻力」中，在行政面上由於行政流程的繁冗及缺乏主管機關的支持；在制度面上，缺乏穩定的財源經費、薪資福利的缺乏，造成人員穩定度不高而直接影響業務的推動。
研究建議在臨床實務若能建立照顧管理專員證照制度，讓照顧管理專員都能經過精細的規劃與培訓目標，並能取得專業證照，將可受惠更多層面需要長期照顧服務之廣大民眾。在護理教育上，應長期照護相關課程納入醫療相關教育體系中的養成教育，以培養更多醫療相關領域人員正確的知識；及繼續教育的內涵則需依各中心照顧管理專員不同的需求，規劃兼顧理論與實務之照顧管理人員培訓計畫。在護理研究上，可以中央政策制定者的觀點與基層執行者的觀點同時進行比較，採質、量性研究方式並行研究，期使研究結果之資料呈現上更為豐富。

關鍵字

照顧管理專員 ； 工作困境 ； 長期照顧管理中心

並列摘要

This study aimed to examine care manages’ perceptions of job difficulties on delivering case management and uncertainty about organizational structure and working situations. A total of 8 care manager supervisors and care managers from long-term care management centers in northern, central, southern, and eastern parts of Taiwan were in-depth interviewed. The semi-structure interview guideline was developed to collect data and results of interviews were transcribed for content analysis. Firstly, sentences with the same meanings were categorized into "theme”. Then, “Theme" carrying integral significance were classified into “Domain”. Finally, “Domain” were inducted into four “Category.” The frequency of interviewees’ certain perceptions was concluded using a cross-table by exploring the content of the transcribed script and “Theme” based on results of content analysis.
After analysis and induction, four category, “realizing the impacts of case management service in practice”, “identifying the importance of professionalism and competency,” “uncertainty about the ambiguous job status and the future,” and “aware of the obstacles in delivering service”, was developed and 13 domain 40 theme were further extended.
In “realizing the impacts of case management service in practice”, it was found that care managers can’t create enough long-term care services for their clients due to not fully understand community and unsuccessful promotion. In addition, the insufficient rigidity in the service reviewing criteria and the information system falling short of meeting requirements often resulted in service gap. In terms of “identifying the importance of professionalism and competency,” care managers must constantly advance themselves through continue education or peer-learning to be confident with their professionalism and competent. In “uncertainty about the ambiguous job status and the future,” due to the fact that the government has been gradually promoting the 10-year plan for long-term care, care managers feel extremely uncertain, pressurized and burdened about the content of service, job description and staff qualification. In terms of “aware of the obstacles in delivering service,” the lengthy administrative process flow and lack of support from the regulatory authority and steady financial support, budget, salaries, and benefits all resulted in the high personnel turnover rate, which directly impacted service delivery.
Recommendations of this study were as followed. A care manager certification system and in-job training programs should be established in clinical practice. Long-term care education should be added to school curriculum and continue education for all health care professionals. Both qualitative and quantitative research design should be utilized to compare perception difference between stakeholders in central government and practitioners.

並列關鍵字

Care manager ； Job Difficulty ； Long-Term Care Management Centers

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