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| 研究生： |
陳佩妤 Chen, Pei-Yu |
|---|---|
| 論文名稱： |
失智長者之照護溝通: 聚焦台灣居家照顧服務員之觀點 Long-Term Home Care Communication for Older People with Dementia: A Focus on Taiwanese Professional Care Workers' Views |
| 指導教授： |
陳錦慧
Chen, Chin-Hui |
| 學位類別： |
碩士 Master |
| 系所名稱： |
人文暨社會科學院 - 應用外語系所 Department of Modern Language |
| 論文出版年： | 2022 |
| 畢業學年度： | 110 |
| 語文別： | 英文 |
| 論文頁數： | 113 |
| 中文關鍵詞： | 失智長者 、溝通策略 、居服員 、老年社會語言學 、失智照護溝通 |
| 外文關鍵詞： | older people living with dementia, communication strategies, long-term home care workers, gerontological sociolinguistics, dementia care communication |
| 研究方法: | 深度訪談 、 問卷調查 |
| DOI URL： | http://doi.org/10.6346/NPUST202200122 |
| 相關次數： | 點閱：80 下載：34 |
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失智症影響長者的認知和語言能力，導致居服員在照顧失智長者時面臨溝通困難。現有文獻關於如何與失智者溝通互動多以醫學及機構為研究背景。因此，本研究聚焦居家照護情境，探討台灣居服員對失智長者的看法和他們對失智的照護溝通適應策略。
本研究分為兩個階段，第一階段為深度訪談，邀請三十五位長照居服員為受訪者，了解他們對於失智長者的看法及他們所使用的失智照護溝通策略；第二階段為問卷調查，透過四百零二位居服員參與者，了解他們對於第一階段研究結果的同意程度。
研究一訪談居服員依據其照顧經驗共分享二十一種對於失智照護溝通的認知；此外，研究結果顯示出台灣居服員經常遇到四種情境(包含幻覺、拒絕服務、誤解及表達不清)及提出四十種的溝通策略，例如:以人為本的溝通策略和非言語交際溝通。
研究二的問卷調查顯示出，並非第一階段所得的結果皆被第二階段的參與者所認同，例如:面對失智長者的失語症或誤解，居服員仍要積極面對失智長者的需求，而非直接忽略；面對失智長者幻覺或妄想，居服員應避免直接糾正以顧全其自尊需求。
本研究的結果可供居服員溝通訓練課程的設計與規劃，幫助新進居服員更進一步認識失智長者，共同打造友善的居家失智照護環境，提高失智長者的幸福感與生活品質。
Dementia has been characterized by several language-related disorders in addition to the decline in cognitive abilities and these result in communication difficulties that professional care workers could face in care for those with dementia. Existing literature on how to communicate and interact with people with dementia was mainly based on medical and institutional contexts. Given this, this thesis extended relevant research by focusing on Taiwanese long-term home care contexts with special attention given to professional care workers’ perceptions about those with dementia and their communication accommodation strategies for dementia care.
The first stage of this research (Study 1) is to obtain Taiwanese long-term home care workers’ views on older people with dementia as well as dementia care communication strategies by inviting 35 long-term care workers to participate in-depth interviews. The second stage (Study 2) is a survey using a questionnaire designed to verify the degree to which the results derived from Study 1 were endorsed by a total of 402 long-term home care workers as participants of the survey.
The results of Study 1 showed that hallucinations, resistance, misunderstandings, and aphasia were scenarios which Taiwanese home care workers often encountered in long-term home care service to clients with dementia. To cope with communication in the abovementioned scenarios, a total of 40 communication strategies were recommended, generally categorized into person-centered communication and non-verbal communication strategies.
The results of Study 2 indicated that some communication strategies as recommended by interviewees in Study 1 were not fully endorsed by the survey participants, such as ignorance as responses to aphasia and misunderstanding or direct correction of hallucination due to its face-threatening impact.
The main implication of this research can be insights given to help develop training programs for new long-term home care workers because the identified communication strategies were directly derived from practical experiences and can be useful for those who would like to improve the quality of dementia care with more dementia-friendly manners, and to enhance the well-being or life quality of older people living with dementia in any care contexts.
Table of Contents
Chinese Abstract i
English Abstract iii
Acknowledgements v
Table of Contents vi
List of Tables x
List of Figures xi
Chapter One Introduction 1
1.1 Dementia 1
1.1.1 Types of dementia 1
1.1.2 Dementia population 1
1.2 Dementia care: preferences and trends 2
1.2.1 Preference of dementia care 2
1.2.2 Long-term home care service in Taiwan 2
1.3 Long-term home care communication: importance and challenges 3
1.3.1 The tension between care workers and care users in long-term home care 3
1.3.2 The importance of dementia care communication 4
1.3.3 The communicative challenges posed by dementia care 4
1.3.4 Lack of long-term home care communication programs 5
1.4 Long-term home care dementia care communication: the research paradigm and purposes 6
Chapter Two Literature Review 7
2.1 Perceptions about dementia and those with the condition 7
2.2 Dementia care communication strategies 11
2.2.1 General principles 11
2.2.2 Assistance with daily routines 16
2.2.3 Informing of messages regarding surgeries 17
2.2.4 Communication strategies for denial of instructions 18
2.2.5 Communication strategies for aphasia 19
2.2.6 Communication strategies for delusions and hallucination 20
2.3 Research questions 24
Chapter Three Methodology 25
3.1 Study 1: Interview (Qualitative) 25
3.1.1 The design of the interview 25
3.1.2 The information of the interview participants 26
3.1.3 Data collection and analysis 26
3.1.4 Interview questions 27
3.2 Study 2: Survey (Quantitative) 28
3.2.1 The design of the questionnaire 29
3.2.2 The information of the survey participants 33
3.2.3 Data collection 34
3.2.4 Data analysis 35
Chapter Four Results 36
4.1 Perception of older care users with dementia 36
4.1.1 Dementia symptoms 36
4.1.2 Dementia care interactions 38
4.1.3 Positive descriptions of dementia care users 38
4.1.4 Negative descriptions 39
4.2 Hallucination 42
4.2.1 Making correction 42
4.2.2 Ignorance 43
4.2.3 Following the logic 43
4.3 Dementia care communication for resistant behaviors 46
4.3.1 Avoiding enhanced resistance 46
4.3.2 Showing empathy 48
4.3.3 Persuasion based on resisting care receiver’s main concerns 48
4.3.4 Persuasion with light-hearted moods 50
4.4 Misunderstanding and false accusation 53
4.4.1 To explain 53
4.4.2 Not to explain 54
4.5 Aphasia or expressive difficulties 57
4.5.1 Strategies to foster foster understanding of care users with dementia 57
4.5.2 Strategies to help care users with dementia understand 58
4.5.3 Strategies to improve expressive abilities of care users with dementia 58
4.6 General principles for dementia care communication 61
4.6.1 Social relationship orientation 61
4.6.2 Gender orientation 62
4.6.3 Well-being and individual orientation 63
4.6.4 Dementia severity orientation 64
4.6.5 Nonverbal and baby talk communication strategies 65
4.7 The results of study 2 68
4.7.1 Agreement on perceptions of older care users with dementia 68
4.7.2 Agreement on strategies for hallucinations 70
4.7.3 Agreement on dementia care communication for resistant behaviors 72
4.7.4 Agreement on communication strategies for misunderstanding and false accusation 74
4.7.5 Agreement on communication strategies for aphasia or expressive difficulties 75
4.7.6 Agreement on general principles for dementia care communication 77
Chapter Five Discussion and Conclusion 79
5.1 Summary and Discussion 79
5.2 Conclusion and Contribution 85
5.3 Limitation 86
References 87
Appendix 95
Appendix 1 95
Appendix 2 106
Appendix 3 110
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