Title

喘息服務之評估研究-以台北市為例

Translated Titles

Evaluation of Respite Care Service in Taipei

Authors

陳怡君

Key Words

喘息服務 ; 評估 ; 質性研究 ; respite care ; evaluation ; qualitative research

PublicationName

臺北醫學大學公共衛生學系暨研究所學位論文

Volume or Term/Year and Month of Publication

2001年

Academic Degree Category

碩士

Advisor

莊坤洋;馬藹萱

Content Language

繁體中文

Chinese Abstract

中文摘要 隨著台灣地區人口的老化,長期照護的需求也相對增加。據調查,在台灣有九成以上身體功能障礙老人其長期照護的需求是由家庭照護者提供,所以提供適當的休息機會給予家庭照護者是規劃一個完整的長期照護體系不可或缺的服務之一。台北市於民國八十七年首創台灣省之先試辦喘息服務至今已近三年,投入數以百萬的政府資金,其服務的施行狀況如何?是否能達到預期的目的?因此,喘息服務的成效評估,是不論執政者、或一般民眾都迫切想要知道的答案。 目前國內喘息服務仍屬初期萌芽階段,相關的文獻資料著重於概念性的學理介紹,屬於本土性的評估研究為數甚少。因此,本研究擬針對台北市施行之機構式喘息服務補助政策為目標,採用質性研究法,以半結構式問卷,深入訪談十五位服務使用者,並進行九家喘息機構的參與觀察。透過了解使用者的實地使用經驗、感受,喘息機構提供服務的情形,深入性探知喘息服務的施行全貌,進行評估。主要探討內容包括(1)了解台北市政府施行的機構式喘息服務其使用者之使用動機為何?(2)探討喘息服務的使用對主要照護者與被照護者的影響。(3)探討主要照顧者對喘息服務的使用評價。 本研究結果發現,喘息服務的使用動機包括二個主要範疇:「一段較長時間的脫離」、「專業照護的需求」。所有的使用動機都存在一個前置因素:「缺乏替代照護者」。使用動機與照顧經驗中的「照顧困境」、「資訊取得」以及「鼓勵」等範疇有相當大的關連性。照顧困境會造成使用動機,資訊取得與鼓勵則引發使用動機。 而喘息服務的利用對照護者產生了正面及負面影響,正面影響包括了「解除時間限制」、「紓解照顧壓力」、「得到休息」、「減輕身體照顧負荷」,而負面影響與機構使用經驗有直接的相關。喘息服務的使用對被照護者以負面影響居多。 使用者對於喘息服務的使用評價包含了對喘息機構、喘息服務兩方面的評價,照護者對於喘息機構的評價著重於其「專業性」、「照顧功能」、「環境安排」等面向上。對於喘息服務的評價則以「獲益性」、「補助方式」、「可近性」等方面進行。此外,喘息服務使用者的使用態度具有緩和不良照護品質的效果,而同時他們認為喘息服務與機構化之間並無關連性存在。喘息服務的使用經驗並不影響再次使用喘息服務的選擇。在喘息機構參與觀察的結果發現,喘息病房的配置皆以機構本身的性質來做安排。服務人員在對於喘息服務的認知上呈現各機構參差不齊的情況,而各機構所提供的服務內容大致相同。 最後,本研究依研究結果及實地訪談所洞察的問題,提出對於政策主管機關、喘息機構與未來研究的建議。對於政策主管機關,本研究提出以下七點建議:(1)宣導家庭照護者休息的概念(2)增加資訊傳遞的功能(3)明確的喘息服務使用條件(4)喘息服務可近性(5)合約機構的品質監控(6)喘息服務的多樣性(7)失智症患者之喘息服務。對於喘息機構提出以下四點建議:(1)加強醫院員工對喘息服務認知(2)加強替代照護功能(3)被照護者心靈支持(4)人性化的喘息環境。另外,本研究也提出三點對未來研究的建議:(1)不同地域的比較(2)範疇的運用(3)縱貫性研究的利用。 關鍵字:喘息服務、評估、質性研究

English Abstract

Abstract The demand for long- term care has increased greatly in Taiwan as the population ages recently. Previous studies have pointed out that family caregivers accounted for over 90% of long-term care provided. Consequently, it is imperative to establish a mechanism for providing relief to caregivers. The respite care program funded by the Taipei City Government since 1998 is the first program in Taiwan to address the need of caregivers. However, respite care program is still at its infancy in Taiwan, with only few studies trying to examine its practice. Up to date, the effectiveness of the program has not been evaluated and it is still not clear if it has achieved its designated goals. A qualitative approach was used in this study. A semi-structural questionnaire was developed, and fifteen in-depth interviews were conducted. In addition, participant observations were carried out in nine institutions. The interviews and analyses focus primarily on identifying the following aspects: motives for using respite care; effects of respite care on caregivers and care recipients, the overall assessment of respite care by the primary caregiver. This study found two main categories of motives for using respite care: the need to escape form the role of caregiver for a while; and the need for professional care. In addition, a prior condition of “lacking substitute caregivers” is a common factor. The study also found motives for using respite strengthened by the three factors: difficulties experienced by caregivers during the process of care; information concerning the availability of respite care; and encouragement by others to use respite care. Positive effects on caregivers include “have their own free time”, “relief from care pressure”, “able to rest”, and “relief of physical burden”. Some negative effects on caregivers were also found. As for the care recipient, more negative effects wew identified than positive effects. Caregivers tend to assess respite care from two perspectives: the institution, and the respite care per se. Institutions tend to be evaluated based on its “professionalism”, “extent of care provided”, and “environmental accommodation”. Respite care program is ingeneral evaluated based on its “potential benefit”, “financial subsidiary”, and “accessibility”. Financial subsidiary tends to make caregivers less critical of low quality of care. Negative experience does not deter caregivers’ willingness to use respite care again. Based on the finding, suggestions were proposed to policy makers and institutions providing care, regarding how to promote and to improve the quality and accessibiling of respite care. It is also recommended similar studies be conducted outside of Taipei city, and longitudinal data should be collected to evaluated the long-range effects of respite care. Keywords: Respite care, Evaluation, Qualitative research

Topic Category 醫藥衛生 > 預防保健與衛生學
公共衛生學院 > 公共衛生學系暨研究所
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