臺北市公立安養護機構照顧工作人員執行安寧照顧經驗分享

Hospice Experience among Care Workers in Public Senior Citizens Home

黃秀梅(Hsiu-Mei Huang)

指導教授 ： 楊培珊

國立臺灣大學/社會科學院/社會工作學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201602257

摘要

2014年底在臺北市長柯文哲及聯合醫院總院長黃勝堅新政的推動下，敬老院與臺北市立聯合醫院陽明院區安寧共照團隊，於2015年3月在機構內展開「機構居家安寧療護計畫」。而本研究即是藉由訪問投入此計畫的機構工作人員，包括護理人員、照顧服務員及輔導員，試圖了解敬老院目前機構執行安寧照顧的實際情況、所面臨的各種挑戰，並整理出工作人員提供給機構改善現況的建議。
本研究發現，不同於醫院的緩和醫療模式，敬老院的安寧工作主是由與院民生活息息相關的第一線工作人員，包括護理人員、照顧服務員與輔導員等負責，他們所扮演的角色如同個案的「家人」，且所提供的安寧服務也著重於個案的生活照顧而非醫療照顧。然而，本研究也發現敬老院在執行安寧照顧上面臨許多挑戰，包括硬體方面，安寧病房的設置地點緊鄰失智照顧區域、缺乏緊急通訊設備，以及制度層面，如醫學的社會地位優先於社福，導致機構的安寧工作分配喪失自主性。在實務工作面上，缺乏全面且完整的安寧照顧工作流程與內容，增加安寧照顧執行的複雜度。在工作人員的部分，則包含工作人員對死亡事件的忌諱、人力不足、工作壓力增加及缺乏專業能力等，不僅削弱工作人員對機構推動安寧照顧的支持度，同時也影響機構的安寧照顧的品質。最後，研究者根據上述發現提出若干建議，包括：凝聚機構工作人員推動安寧照顧的共識、積極宣導並輔導院民具備安寧療護觀念、設立機構安寧照顧工作目標、與安寧共照團隊目標結合，並投注充分照顧資源、協助機構工作人員具備安寧照顧工作能力等，作為敬老院持續推動安寧照顧計畫之改善參考，有利於機構長者實現善終的理想。

關鍵字

公立安養護機構 ； 安寧照顧 ； 機構安寧 ； 機構工作人員

並列摘要

Taipei City Senior Citizens Home(TCSCH) has cooperated with Taipei City Hospital Yangming Branch to run a project in March of 2015. This idea is come out by the major of Taipei City Ko Wen-Je and the Superintendent of Taipei City Hospital Huang Sheng-Jian, after the new government take over Taipei City, they try hard to implement hospice service in Taipei City. This Study is to explore the current implementation, to furtherly understand the difficulties and to finalize staff members’ suggestions on improvement in TCSCH via in in-depth interviews with four nurses, two nursing assistants and three counselors.
In the study, the institutional hospice in TCSCH is found different from hospital where is mainly in the perspective of medical care, and the hospice care workers in the institution are the nurses, the nursing assistants and the counselors. On the one hand, the perspectives from TCSCH are not only medical care but also elder's daily care because the staff members are playing daily roles as family. Furthermore, the study also reveals the challenges and difficulties in TCSCH from the aspects as follows:
1.Hardware facility: unclear area separation (ex: hospice room is nearby the dementia zone) and insufficient emergency communication facility.
2.System: medical science institution's social standing is in higher position than social welfare institution, which leads to hospice care resources allocation in TCSCH lost its autonomy.
3.Pragmatic practice: it is lack of comprehensive and standardized hospice care definitions and processes, which increases practice complexity.
4.Institutional staff members: the concept of death as a taboo, insufficient manpower, increasing work pressure and insufficient profession proficiency, which would not only wear down staff members' hospice passion and supports, but also impact the care quality.
In the end, based on the research findings, it finalizes the following improvement actions: to consolidate the consensus on institutional hospice care promotion; to actively educate the public senior citizens with the hospice care conception; to establish institutional hospice care objectives; to enhance and increase hospice care resources through objective consolidation with Taipei City Hospital Yangming Branch; to train the staff members with hospice care profession and skills etc. The above is for the public senior citizens home as sustainable hospice care project reference and fulfillment.

並列關鍵字

public senior citizens home ； hospice care ； instituonal hospice ； institutional staff members

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