由家屬的角度探討長期呼吸器依賴患者的照護問題

Care Needs of Long-term Ventilator-dependent Patients from Perspectives of Family Members

陳慧秦(Hui-Chin Chen) ； 鄭文輝(Wen-Hui Cheng) ； 林孟志(Meng-Chih Lin)

《呼吸治療》 7卷2期 (2008/07) Pp. 1-19

https://doi.org/10.6269/JRT.2008.7.2.01

摘要

本研究目的乃想瞭解長期呼吸器依賴患者家屬在整個照護過程中的心路歷程與想法；探討影響家屬選擇照護地點，呼吸照護病房或居家照護之相關因素考量；且從家屬的角度來看呼吸照護病房和居家照護成本的差異；最後預瞭解家屬長期照護的需求和居家照護的意願，作爲以後長照制度政策擬定的參考。本研究採質性、深度訪談的紮根理論研究法，藉由半結構式的訪談指引作資料的收集。研究對象爲中區某區域教學醫院，長期臥床使用呼吸器的氣切病人經呼吸照護中心(RCC)住滿下轉至呼吸照護病房(RCW)和居家照護的長期呼吸器依賴患者之家屬。研究結果分跨案分析及不同照護模式的比較。在考量照護地點的相關因素裡，其家屬的特質、認知，心理情緒負擔，照顧條件、能力，病患的特質，住家環境，社交支持，經濟狀況皆會影響照護地點的選擇。在家屬所花費的照護成本方面，居家照護組每月大約在4萬～6萬5之間；呼吸照護病房組含自請外勞每月約3~4萬元，若單純的機構照護費用則在2萬～2萬5千元之間。明顯居家照護組遠多於呼吸照護病房組。在家屬長期照護的需求和居家照護的意願上，兩組皆認爲現在政府的政策有缺失，且無法落實，社會福利申請不易。根據研究發現，藉由深入的訪談和資料分析，構成一個長期呼吸器依賴患者和家屬的長照需求圖，包含政策整合與落實、現金補助、長期照護保險、居家出院準備服務、居家緊急求救線路。

關鍵字

長期呼吸器依賴患者 ； 呼吸器依賴患者整合性照護系統 ； 居家照護 ； 呼吸照護病房 ； 照護成本

並列摘要

Purpose: The purpose of this study was to understand the thoughts and the psychological impact to the family members who took care of the long-term ventilator-dependent patients during the process of managed care. Firstly, the study examined the factors in choosing the location of care; either Home Care or Respiratory Care Ward. Secondly, the study analyzed the cost of the Home Care or the Respiratory care ward, from the points of the view of patients' families. Finally the study examined the families' needs as regards long term managed care and their intentions as regards home care. The outcome will serve as a reference for the long term care policy.
Method: The methods used to conduct the study included qualitative research, in depth interviews grounded theory, and the semi-constructed interviews as instructions for data collection.
Target: At a local teaching hospital in the central Taiwan, the subject of the study are the families of the patients who were tracheotomy-patients on a ventilator, transferred from respiratory care center (RCC) down to either respiratory care ward (RCW), or to long term mechanical ventilation home care.
Result: The outcomes were divided to cross-case analysis, and the comparison of different medical care models. The factors affect them to choose the location of the respiratory care organization were: the characters, acknowledge, and the psychological emotion burden of the family members; the facilities to take care of the patients; the ability of the family member to take care of the patients; the characters of the patients; living environment; social support; and financial situation. The cost of managed care, Home Care cost was about NT$40, 000 to 65, 000, while Respiratory Care Ward cost was about NT$30, 000 to 40, 000 total each month. This includes the expense of hiring a foreign labor. It paid NT$20, 000 to 25, 000 to the respiratory agent. Clearly, the cost of Home Care group is more than Respiratory Care Ward group. Both the Home Care and Respiratory Care Ward groups claimed the current governments policies was not good enough, lack of reality, it was difficult to apply the social benefits.
Conclusion: The study had used the in depth interviews and data analysis, it had constructed a blue map to reflect the needs of the long-term ventilator-dependent patients and their families. It is hoped that this study will serve as a starting point to examine the possibilities.

並列關鍵字

long-term ventilator-dependent patients ； home care ； respiratory care ward ； cost Analysis