照顧服務員職業倫理、工作滿意度與留任意願因素探討

台灣老年人口快速增加及老年壽命延長，長期照護服務需求快速成長，面臨照顧服務人力不足的問題。衛福部2018年起推出長照2.0支付給付新制，提高照服員薪資達到吸引人力投入照顧服務工作的效果，期使人力投入後繼續留在職場，且留任時間加長。照顧服務的特性是以人為中心的照護計畫視為人倫之間的情理。倫理基本上是建構在道德觀點上，照服員在面對工作的挑戰下，具備扎實的職業倫理背景，對於堅持繼續留任照服工作之影響因素為何? 照顧服務員相關文獻中，缺乏倫理困境量化分析，量化可提高研究廣度和深度，透過不同以往研究分析的方法觀察社會現象，其可信度更高是本研究的獨特性。試圖透過照顧服務員的「個人背景」、「工作滿意度」及「職業倫理」三種變項，探究照顧服務員的「服務任期」包含過去既有的「服務年資」和未來持續的「留任意願」可能影響的重要因素。研究問題如下: 1.了解照顧服務員的個人背景以及對工作滿意度和職業倫理的看法。 2.了解照顧服務員個人背景、工作滿意度、職業倫理和服務年資、留任意願的關係。 3.預測照顧服務員服務年資與持續留任意願的重要因素。本文採便利抽樣法，以台北市和新北市照顧服務員為研究對象，使用Google表單進行問卷調查，總計回收數量223份作為本研究之依據。運用SPSS統計軟體進行敘述性統計分析、因素分析、及存活分析(Cox Proportional Hazard Model)。分為全部組、男性和女性組、有證照和無證照組、居家和住宿+社區組，各組比較受訪者影響的差異。本文實證研究結果如下: 以因素分析適配性，工作滿意度的信度和效度極佳，職業倫理有中度的信度和很可信的效度，表示問卷測量結果具代表性。Cox迴歸分析出受訪者對於「工作場域」、「認同肯定」、「掌控工作」、「成就滿足」、「升遷機會」、「學習成長」、「化解衝突」、「褥瘡傷口」、「不收餽贈」等因素，其存活機率與服務任期有正向顯著機率的影響，表示上述因素增加存活期間比較長。「語言暴力」、「不留電話」等有負向顯著機率的影響，表示因素增加存活期間會縮短，以上符合預期假設。另外，「年齡」、「婚姻」、「工作性質」、「收入」、「服務資格」、「工作福利」、「工作保障」、「主管對待」、「危機處理」、「受到重視」、「受到尊重」、「人格尊嚴」、「主動回報」有負向顯著機率影響，而「學歷」和「性騷擾」有正向顯著機率影響。上述因素不符合預期假設。其原因可能為年齡高受到健康因素的影響無法持續留任，有證照對開業有影響但證照加給誘因不大，未婚和兼職的時間彈性大而且年輕高教育程度者投入居家照顧的意願已見提升。政府調高薪資條件所以收入差異不大，在乎內在滿意的成就感和專業職能的提升高於外在滿意的條件，因而會影響照顧服務員的存活機率。本研究加入照顧服務員相關文獻中，缺乏的職業倫理量化分析，並用不同以往的研究工具Cox迴歸分析，使用存活模型分析服務任期長短，並且跨組別分析了解各組影響的重點。根據以上研究發現，提供政府機關未來培育人力資源和照顧服務相關單位教育訓練計畫，以及未來長期照顧展望的參考，此為本研究獨特的貢獻。

關鍵字

照顧服務員；職業倫理；服務年資；留任意願； Cox 迴歸分析

並列摘要

Taiwan's elderly population is increasing rapidly, and life expectancy is prolonged. The demand for long-term care services is growing rapidly, and it faces the problem of insufficient human resources for care services. The Ministry of Health and Welfare launched a new payment system for long-term care 2.0 in 2018. The government tries to increase the salary of caregivers to attract manpower to invest in care services, continue to stay in the workplace after manpower input, and stay longer. The characteristic of care services is that people-centered care plans are regarded as relationships between human relationships. Ethics is based on a moral point of view. Facing the challenges of the work, caregivers have a solid professional ethics background. What are the factors that influence the persistence of the care and maintenance work? The literature on caregivers lacks quantification of ethical dilemmas analysis. Quantification can increase the breadth and depth of research. The uniqueness of this research is to observe social phenomena through different methods of previous research and analysis. Attempting to explore the "service tenure" of care attendants through the three variables of "personal background", "job satisfaction" and "professional ethics" of care attendants, including the existing "service years" in the past and the possibility of continuing "willing to leave" in the important future factors affecting. The research questions are as follows: 1. Understand the personal background of the attendants and their views on job satisfaction and professional ethics. 2. Understand the relationship between personal background, job satisfaction, professional ethics, length of service, and willingness to stay. 3. An essential factor in predicting the length of service of care attendants and their willingness to continue. This paper adopts the convenience sampling method, focusing on long-term care workers in Taipei City and New Taipei City as the research object, and uses Google form to conduct a questionnaire survey. The total number of collected 223 is the basis of this research. This paper use SPSS statistical software for narrative statistical analysis, factor analysis, and survival analysis (Cox Proportional Hazard Model). This study is divided into all groups, male and female groups, licensed and unlicensed groups, home and accommodation + community groups, and each group compares the difference in respondents' impact. The empirical research results of this paper are as follows: Analyzing the adaptability by factors, the reliability and validity of job satisfaction are excellent, and professional ethics has moderate reliability and very credible validity, indicating that the survey results of the questionnaire are representative. Using Cox regression analysis, the interviewees' perceptions of "work field", "recognition affirmation", "controlling work", "satisfaction of achievement", "promotion opportunity", "learning and growth", "resolving conflicts", "bedsore wounds", and "no gifts" have a positive and significant impact on the survival rate and the term of service. It means that the above factors increase the survival period for a longer period. "Language violence" and "no call left" have a negatively significant probability effect, indicating that the survival period will be shortened when the factor increases and the above is in line with the expected assumption. In addition, "age", "marriage", "nature of work", "income", "service qualification", "work benefits", "job security", "supervisor treatment", "crisis management", "valued", " "Respect", "personal dignity", and "active return" have a significant negative impact, while "education" and "sexual harassment" have a significant positive impact. The above factors do not meet the expected assumptions. The reasons may be that the high age is affected by health factors and the inability to stay in the job continuously, the license has an impact on the business's opening. Still, the licenses' incentives are not large, the time flexibility of unmarried and part-time jobs is large, and the willingness of young and highly educated to invest in-home care has increased. The government raises the salary conditions, so the income difference is not big. It cares that the sense of accomplishment of internal satisfaction and the promotion of professional functions will be higher than the conditions of external satisfaction, which will affect the survival rate of caregivers. This study adds a quantitative analysis of professional ethics due to lacking relevant literature on care attendants. By using Cox regression analysis, a different tool uses survival models to analyze the length of service tenure and cross-group analysis to understand each group's impact's critical points. Based on the above research findings, it is a unique contribution to this research to provide government agencies regarding future human resources and care services-related education and training programs and long-term care prospects in the future.