急診,除處理病患危急的生理問題外,也存在著社會心理問題需要立即處理。急診社工如何界定急診病患社會心理問題急迫性、與不同專業之間看法上的差距,以及是否回應急診病患社會心理需求等問題,是強調以病人為中心和全人照顧觀點的現代醫療體系亟需重視的議題。 本研究以兩間南部醫學中心、兩間區域醫院以及中部區域醫院作為研究場域,以深度訪談法針對7名急診社會工作者進行資料蒐集,並採主題分析法進行研究分析。研究結果有三:(一)急診社會工作者界定病患社會心理問題急迫性之基礎,實質意涵著「緊急」與「棘手」兩個概念;(二)急診社工員對社會心理問題急迫性看法,主要與法律規範、醫療機構人力配置、院外單位合作意願、專業團隊期待、病患病情與期待,醫療資本化下的壓迫、不平等的醫療團隊互動等脈絡中型塑而成;(三)病患社會心理問題急迫性的主觀看法,在急診室中有被邊緣化的現象。 本研究建議增加急診醫療專業人力、強化院外網絡合作單位協調合作之意願及確保急診社工專業自主性,以維護病患權益,並在貼近病患社會心理問題需求基礎上,透過專業角色的反思與強化,使病患社會心理問題需求受到急診醫護人員之關注。
Emergency room, where medical personnel handle with critical physiological problems of the patients, is also where urgent psychosocial problems of the society needed to be dealt with immediately. How social workers in the emergency room define the urgency about the patients' psychosocial problems, the distances resulted from different views of different professionals, as well as whether to respond to the psychosocial needs of the patients, are all critical issues demanding urgent attention to emphasize on patient-centered and holistic view of modern health care system. This study adopts qualitative method by using two medical centers and two regional hospital in southern Taiwan, as well as a regional hospital in central Taiwan as the research fields for conducting in-depth interview for seven emergency social workers to collect data. In addition, theme analysis is utilized for research and analysis. There are three research results: (a) What emergency social workers define urgency of the of the patient’s psychosocial problems in fact implies two concepts, "emergency" and "difficulty"; (b) the perspectives of emergency social workers at the urgency of the psychosocial problems are mainly shaped in the following contexts-- legal norms, manpower allocation in medical institutions, willingness to cooperate outside the hospital, expectations of the professional team, the patient's condition and expectations, oppression under managed care capitalization, unequal interaction among medical team; (c) patient’s subjective views of the urgency of the psychosocial problems tend to be marginalized in the emergency room. This study suggests the hospital increase emergency medical professionals, strengthen the willingness of network cooperation units outside the hospital to coordinate and cooperate, and ensure emergency social works' professional autonomy in order to safeguard the interests of patients. Besides, patients with psychosocial problems can be concerned by emergency medical personnel on basis of getting close to the patients’ psychosocial problems and through retrospection and strengthening of the professional’s role.