醫院內的照顧問題服務經驗初探

在醫務社會工作的實務現場中，我們觀察到因家庭型態、人口結構的改變，床邊照顧問題逐漸形成社工師的處遇重點之一。此趨勢帶來了若干挑戰，包括照顧問題的界定、需求評估的指標，以及資源運用的考量。本文以規範性、感受性、表達性、比較性等4個需求類別來論述住院病人照顧需求的評估內涵，並據以提出3個評估面向，分別是1.病人身心狀況及自理能力，此面向以醫護人員的評值為主；2.家庭照顧能力，同時評估家庭人口、意願及能力；3.其他特殊狀況，如病人有遭受家庭暴力，或是安寧療護、喘息服務等需另為考量的情境。接下來提出醫院內照顧問題的服務處遇與資源運用，社工師以個案工作方法協助病人處理照顧問題，並連結政府及各基金會、慈善團體等資源。不論是評估或處遇，實務上仍面臨許多挑戰。以需求評估而言，照顧者的照顧能力與意願，在不同醫療團隊中可能存在評估不一致的情形；資源運用上，政府資源或非政府資源均有其使用上的限制；社工專業角色在照顧議題處理上，除了積極與家庭工作之外，如何與醫療團隊達成有效溝通更是不容忽視的工作重點。以上三個議題均以案例輔助說明，並根據實務經驗提出因應策略。

關鍵字

照顧問題；照顧需求評估；醫務社會工作；社工師

並列摘要

In the practice of medical social work, treatment plans for bedside care have gradually become essential because family types and demographic structure are transforming. This trend brings challenges such as recognizing care needs, developing needs assessment indicators and considering resource arrangement. This article reviews the four types of needs: normative need, felt need, expressed need and comparative need. Based on that, three aspects of patients' care need assessment have been developed: (1) the patient's physical, mental condition and self-care ability, which rely mainly on the evaluation of medical staff; (2) caring ability of family caregivers, including the family members, their willingness to care and skills for care; (3) other special conditions, such as domestic violence, palliative care or respite care services, which need to be considered. Furthermore, the treatment plans and resource linking of care needs are also discussed. Medical social workers help clients deal with healthcare concerns, connect patients with the resources such as the government, various foundations, and charities. There are still many challenges in assessments or treatments. In terms of needs assessment, the evaluation of caregiver's ability and willingness by different medical teams might be inconsistent. There are also limits on the amount of government and non-government resources. In addition to taking the initiative to work with the family, social workers should value the communication with the medical team. This article illustrates above three topics with cases in order to present the contexts, and propose intervention strategies based on practical experience.