推動「生命回顧」活動方案的決策歷程與執行關鍵的探討

為協助老人在溝通、行動、自我照顧、居家生活、人際互動與關係能得到社會支持，國內已發展出不同類型之結構性團體活動方案，現已成為常見的老人活動照顧模式。在強調各式活動方案效益之研究中，鮮少針對決策者如何對老人活動方案在決策、執行、評估等面向的探討。為此，本研究以五個不同的老人服務單位的決策者、執行者為主，抽取七位作為研究對象，經個別深度訪談為研究方法，分析各單位推動以生命回顧為活動方案的決策歷程與影響生命回顧活動方案結果的關鍵。經過三角驗證整理出推動生命回顧活動方案的決策歷程，歸納出「生命回顧的認知價值觀」、「多重考量的起因」、「具有推動心理改變的目的」、「來自過往推動生命回顧的經驗」四個主題涵括十一個決策因素。另外，影響執行生命回顧方案的關鍵歸納出「活動推行的行政管理」、「執行過程的工作內涵」、「執行後的釐清與反思」三個主題十四個影響關鍵。從上述歸納中，針對受訪者對於推動生命回顧活動方案的意義，與過往的文獻相比較的發現如下：一、認同生命回顧的價值、二、參與生命回顧後有正向的改變、三、讓面臨人生困境者重新發現新意義、四、需有經嚴謹訓練的合適帶領人。另外，針對來自多元的影響因素與過往的文獻相比較的發現如下：一、應避免簡化決策的步驟、二、須經一段行為改變的階段、三、觀察是否有「為做而做」的決策、四、「為做而做」不見得不好。基於上述研究發現，建議在生命回顧活動方案決策前，可留意相關工作人員「提升認知意識」和「培力準備」；執行生命回顧活動方案的決策因素與影響關鍵分為許多範疇，未來可以帶給老人的活動類型多元，因此需要更嚴謹地進行或測試質、量性研究再次驗證本研究所發現的結果。因生命回顧效應於課程結束才開始，一些人生「卡」點因循序漸進的探索漸漸釋懷，不斷的接受現狀，不做更多的討價還價與遺憾。這些發酵一直持續在發生，甚至影響於參與者往後的時光中。故活動方案執行完畢後，除紀錄活動執行後的成效外，如何延續參與者漸進的延續與發酵？能否讓這些發酵能夠持續？是值得再去投入的。

關鍵字

決策者；老人；活動方案；決策因素

並列摘要

Taiwan has developed many different types of group activities that have become common models of care for older adults in order to help them in communication, mobility, self-care, home life, interpersonal interactions and building relationships. In those studies that emphasize on effectiveness of the activities or programs, few research have explored how decision makers make decisions, implement and evaluate programs for older adults. Therefore, this study recruited seven decision makers or executors from five senior service organizations as interviewees. Through individual in-depth interviews to analyze the interviewees, this study was conducted with two purposes: (1) why did the decision makers use the "Life Review" as the activity program? and (2) what are the key factors affecting the outcome of the Life Review Program? The results showed that the reasons for decision makers to make decisions on the life review activities can be summarized into four categories: ”cognitive values”, ”causes”, ”purposes” and ”experiences”. In addition, the key factors affecting the decision makers' implementation of the life review program resulted in three categories: “administrative management”, “work connotation” and “results and reflection”. Based on the analysis and existing literature, what we understood about the rationale behind making decisions on implementing life review programs can be explained as the followings: ”recognizing the value of life review ”, ”positive experiences after joining life review”, ”new found purposes in facing life stages and challenges” and ”needing trained group leaders for life review”. In addition, the key factors affecting the implementation of life review program resulted, as compared with current literature, showed the followings: “avoid simplifying decision-making process”, “behavior changes from life review must take a while”, “avoid doing for the sake of doing”, “doing for the sake of doing may have additional values.” Based on the above, it is important to caution that service provides have to increase the basic knowledge about life review and to empowering staff to prepare for conducting life review programs. There were many reasons for why life review programs were implemented by decision makers, thus, knowing the diverse of older adults programs, rigorous testing and evaluation will make results more grounded. Furthermore, some participated in life review programs may need time to process or require more probing for life meanings. Thus, thinking ahead of time on how to evaluate the effectiveness and how long for participants to process their new found changes after the life review programs should be keys in making decisions to implement life review programs.