臨床心理師在安寧緩和療護中的角色

The Role of Clinical Psychologists in Hospice Palliative Care

范聖育(Sheng-Yu Fan) ； 林維君(Wei-Chun Lin)

《應用心理研究》 59期 (2013/12) Pp. 161-202

摘要

安寧緩和療護照顧生命末期的病人，提供身心靈整體性的照顧以提升生活品質。臨床心理師的專業訓練與能力對於心理層面的照護能有所貢獻。本研究之目的為描述與探索台灣臨床心理師在安寧緩和療護領域的角色與工作現況。採用質性研究法，九位臨床心理師參與訪談，訪談時間從43分鐘到2小時17分鐘。以半結構式訪談進行資料收集，訪談大綱包括：工作內容、工作歷程或模式、團隊合作、工作的困難與因應方式，以及所需能力及教育需求。共有四個主題被提取，包括：（1）面臨死亡與結構彈性的工作場域：工作環境中面臨生命終點，且提供心理照護的方式差異性很大。（2）多樣化的工作內容，包括病人、家屬、團隊、社區以及研究。（3）動態照護歷程：心理照護的歷程分成衡鑑、介入與成效評估三階段，依據的是心理學的知識與技巧。除了心理學專業能力外，心理師應該具備有彈性、關懷的人格特質、以及轉化的能力。（4）自我省思與工作挑戰：臨床心理師反省專業的有限性，以及人性化的樣貌來面對所照顧的對象。工作挑戰則來自於「外在／他人或環境」與「內在／個人」二方面。未來研究可針對工作模式、特定的心理社會照護介入方式與成效加以探討。

關鍵字

安寧緩和療護 ； 生命末期照顧 ； 臨床心理師 ； 臨床心理師的角色

並列摘要

Hospice palliative care provides biopsychosocial care to terminal patients for improving their quality of life. Clinical psychologists may make significant contributions in this field. The aim of this study was to describe and explore the role and work of clinical psychologists in hospice palliative care in Taiwan. Nine clinical psychologists participated this qualitative study and a semi-structured interview was used to collect data (range: 43 minutes to two hours 17 minutes). The interview guidelines included job contents, working approaches or processes, teamwork with other medical staff, difficulties in work and methods of coping, and the essential abilities and educational needs. Three themes were identified: First, flexibility of structure in facing the impedance of death. Clinical psychologists provide care in various patterns in hospice palliative care. Second, variety of working content: the work of clinical psychologists include the care of patients, support of families, collaboration with other medical staff, promotion of hospice in communities, and research. Third, the dynamic care process: three stages of care processes were identified, including assessment, intervention, and evaluation. In addition to professional abilities, clinical psychologists need to be caring and flexible and possess the ability of transformation. Fourth, self-reflection and challenges: the participants reflected on their limitations of professional abilities, and how they overcome them. In addition, they also face challenges from the external environment and through personal issues. Future research may focus on the effectiveness of the working model, specific skills of psychosocial interventions in this field.

並列關鍵字

hospice palliative care ； end-of-life care ； clinical psychologists ； role of clinical psychologists

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