安寧療護中的靈性陪伴─以長照機構社會工作者為例

Spiritual care at the end of life in long-term care institutions: From social workers’ perspectives

錢鳳家(Chian Feng-Jia)

指導教授 ： 游美貴

國立臺灣師範大學/國際與社會科學學院/社會工作學研究所/碩士(2022年)

https://doi.org/10.6345/NTNU202200541

摘要

靈性陪伴是安寧療護的核心，然而在實務的執行上，容易不被專業所重視，影響住民與家屬，無法維護整體性的照顧品質。故此論文的研究目的，以住宿型的長照機構社會工作者的視角，探討長照機構執行安寧療護的過程，以及當中靈性陪伴的實務技術與經驗，並提出看法與建議，作為鞏固「以家屬和住民為中心」照顧策略之參考。本研究以大台北地區的六位住宿型長照機構社會工作者，為研究對象，年資皆達兩年以上，以深度訪談進行研究，其研究結果如下：
(一)安寧療護在長照機構的實施狀況
長照機構可作為安寧療護的實施場域，滿足住民與家屬的臨終照顧需求。安寧療護有四個階段的過程，其依序為宣導期、評估篩選期、決策期、醫療照顧期。
(二)社會工作者在安寧療護的角色功能
社會工作者在安寧療護的四階段中，有多種角色功能，例如資訊提供者、招集者、協調者、傾聽與陪伴支援者、資源連結者、轉譯者的角色。
(三) 安寧療護中靈性陪伴的實務技巧
運用同理心的陪伴與傾聽技巧，並透過機構和居家安寧團隊共同協作，輔導住民與家屬，完成疾病末期可行的目標並建立希望，緩解靈性困擾的不適與不安。
(四)安寧療護中靈性陪伴的經驗
靈性陪伴能產生互惠效應，使長照機構及社會工作者，展現優勢和自我成長的價值，但仍面臨制度、環境、缺乏靈性陪伴專業化的重視和資源不足等困境。
依上述研究結論，提出制度面上的建議，需強化長照機構工作人員對安寧療護的共識，並融入本土化的整體性照顧模式，提升靈性陪伴在專業上的重要性等。

關鍵字：長期照顧、安寧療護、靈性陪伴

關鍵字

長期照顧 ； 安寧療護 ； 靈性陪伴

並列摘要

Spiritual care, despite being a core domain of hospice care, is not likely to be taken seriously professionally in practice. This phenomenon may hinder residents and their families from maintaining holistic care quality. Therefore, the current study aims to explore, from the perspectives of social workers at residential long-term care institions, the process of hospice care implementation at these institions as well as the practical skills and experience of spiritual care involved therein. Further, views and recommendations are proposed as a reference for the reinforcement of the “resident- and family-centered” care strategy. In this study, six social workers serving at residential long-term care institions in the Greater Taipei area, all with two or more years of experience, were enrolled as the research subjects, and research was conducted through the in-depth interview approach. The results of this study are as follows:
(1) Status of hospice care implementation at long-term care institions
Long-term care institions may serve as sites for the implementation of hospice care to satisfy the end-of-life care needs of residents and their families. The process of hospice care involves four stages: the stages of advocacy, evaluation and screening, decision making, and healthcare, in order of time.
(2) Roles and functions of social workers in hospice care
Throughout the four stages of hospice care, social workers provide a variety of tasks, including information giver, organizer, coordinator, listening and companionship supporter, resource connection, and translator.
(3) Practical skills of spiritual care in hospice care
Empathic care and listening skills, as well as collaboration between institions and home-based hospice care teams, are used to counsel residents and their families, assist residents in achieving realistic goals and building hope in the terminal stage of illness, and relieve their discomfort and anxiety induced by spiritual distress.
(4) Experience of spiritual care in palliative care
Spiritual care can generate reciprocity effects, enabling long-term care institions and social workers to exhibit their strengths and the value of self-growth. Nevertheless, obstacles such as inadequacies of institutions, environments, attention to professionalization of spiritual care, and resources still confront them.
Based on the aforementioned research conclusions, this study propounds several institutional recommendations, which include the following: consensus on hospice care should be strengthened among the staff of long-term care institions; an indigenized holistic care model should be incorporated; and the professional significance of spiritual care should be enhanced.

Keywords：long-term care, hospice care, spiritual care

並列關鍵字

long-term care ； hospice care ； spiritual care

參考文獻

王英偉(2010)。新安寧運動下的倫理思維。澄清醫護管理雜誌，6(1)，4-11。

Ross, L. A. (1994). Spiritual aspects of nursing. Journal of Advanced Nursing, 19(3), 439-447. doi: 10.1111/j.1365-2648.1994.tb01105.x

一、中文資料

大衛(David R, H.)(2019)。靈性評估：社會工作與心理健康領域之應用(初版)(邱晨馨譯)。高雄市：台灣百香果協會。(原著初版年：2015)

內政部統計處(2021)。人口數三段年齡組。檢自：https://statis.moi.gov.tw/micst/stmain.jsp?sys=220&ym=11000&ymt=11012&kind=21&type=1&funid=c0110201&cycle=41&outmode=0&compmode=0&outkind=1&fldlst=1111&cod00=1&rdm=bbrlNoqi