居家照顧服務員在失能者日常生活功能促進的訓練經驗

臺灣已於1993年正式邁入「高齡化社會」，截至目前為止國內老年人口占總人口數12.2%。由於醫療技術及衛生保健水準提升，使死亡率大幅下降，但隨著人口老化，慢性病的罹病率卻增加。老化與慢性病經常是導致日常生活能力下降的主因，當失能者面臨身體功能衰退的過程，就需要外力來協助他們生活，因此如何協助失能者提升日常生活獨立性，值得重視及關心的課題。本研究採取質性研究設計探討居服員在日常生活功能促進訓練之現況與所需支援。針對5位居服員、2位居服督導、2位居家治療師及2位失能者家屬進行半結構訪談，訪談內容由多位分析者進行逐字稿分析，以發展出主題。研究結果共歸納出兩個影響居服員在日常生活功能促進訓練的現況與困難，分別為：一、做為一位居家服務員及二、影響日常生活功能促進訓練的因素。第一個主題有三層的次主題；第二個因素有四層的次主題。研究得知，居家服務員的工作未被充分尊重與接納，居服團隊及家屬對於「日常生活功能促進訓練」的概念也未見重視，許多原因成為推廣的阻礙。建議以實務為導向的教育訓練方式，提高照服員對日常生活功能促進訓練的認識，且充實照顧服務員培訓時數及內容，才能有助於推動失能者日常生活功能訓練的實施。

關鍵字

居家服務員；居家服務；日常生活功能；復能訓練

並列摘要

Taiwan became an "aging society" since 1993. In 2016, 12.2% of the national population of Taiwan are elderly. Since medical technology and health care improves, the mortality rate has dropped significantly. Chronic morbidity has increased as the population aging. Aging and chronic diseases often lead to the decline of activities of daily living function. When the elderly became disabled and had functional declines, external helps are required. How to promote the activities of daily living function of the disabled elderly? It is an important issue. This study adopted qualitative research to explore the status quo and required support of home helpers in functional training. Semi-structured interviews were conducted with 5 home helpers, 2 supervisors of home helper, 2 occupational therapists and 2 family members of those with disabilities. Interview transcripts were analyzed by multiple researchers. Themes were developed accordingly. Two major themes of this study are: “Being a home helper”; and “Factors influencing the training of daily living functions”. Three layers of sub-themes of “Being a home helper” were developed. Four layers of sub-themes of “Factors influencing the training of daily living functions” were developed. From this study, we found that the job of home helpers did not received respect and acceptance. Home helper team and clients did not value the concept of training of daily living functions. Many factors became obstacles of promotion of training of daily living functions. We suggested: to adopt practice-oriented education model and enhance the time and content of education of home helpers. In these ways, the knowledge of training of daily living functions among home helpers can be increased. The implementation of promotion of training of daily living functions can be carried on.