以社會網絡觀點探討外籍監護工之健康求助行為-以南部某地區醫院為例

The Exploration on Health Help-seeking Behaviors of Foreign Aides in View of Social Network – Taking a Southern Hospital in Taiwan for Example

林秀慧(Hsiu-Hui Lin)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學研究所/碩士(2009年)

https://doi.org/10.6833/CJCU.2009.00158

摘要

目的：機構與居家外籍監護工勞動條件不同，差別在於生活環境不僅侷限於雇主家、就醫可近性、交友廣。雖與本國籍看護工工作場域一樣，形成社會網絡卻是不同的。站在護理管理者的立場，重視醫療照護品質，但過去管理者在乎她們是否偷懶、照顧技巧是否正確、是否有傳染病；但在此勞動條件下如何期許她們？我們是否深入去理解、關心長住的她們的需求。過去研究亦大多侷限個體部分，過多的關注於工作壓力、負荷、適應情形、照護品質等，並且彰顯居家外籍監護工負面的。甚少以社會網絡的發展脈絡、關係結構的觀點去了解；以社會網絡關係來看她們網絡如何聚集，擅用就醫可近性。故本研究希望以社會網絡觀點檢視勞動環境及機構外籍監護工的健康行為。
方法：採用田野研究方法，場域為某榮民醫院，以參與觀察、半結構式深度訪談收集資料；訪談對象七位（越南籍、印尼籍各三位、菲律賓籍一位），平均來台4年；訪談大綱為來台後人際互動之關係網絡；如何在人際網絡中尋求支援；藉此再現外籍監護工在醫院內之社會網絡型態，與發展機制。個體在結構中相對位置及彼此相互關係，如何使用社會網絡來尋求健康行為。
結果：採開放、接受、相信、彈性、積極態度，或採封閉、拒絕、懷疑、偏見、消極態度面對新環境，建立的社會網絡不相同。在「醫院工作網絡」上所建立屬於正式或階級之網絡，但也會建立有別於固有觀念的，屬於於情感的網絡。與同家鄉團體間網絡建構，自然而然形成的非正式網絡結構，成員互動緊密與鬆散而不同，連結緊密度的不同，也視成員成員的多寡，而有不同網絡的大小。與外部建立之延伸網絡，因工具性或情感性支援所建立不同的網絡。
從網絡建構時間序列角度來看，初期是個孤立者，而其處境是從零開始，陌生環境之互動的磨合期，在環境、人際、社會資源皆是非常孤立的，一切都需要支援。漸漸對週遭環境熟悉，當過磨合期便開始有能力擴展結界，並從異國文化下找到自己。當然時間更久，在團體中自然有一個位居網絡高度中心位置，是個橋樑與明星的角色，或成為溝通的橋樑。
另外從網絡建構觀點看健康行為時，外籍監護工有健康問題時會向最親近的人求助，通常會尋找網絡中與自己最親密接觸的人，如果最親近的人無法解決，也許會轉向在異鄉結交新朋友的協助，像是在這環境中相處密切的婆婆媽媽等，或是回歸尋找雇主的幫忙，另一個管道便是向專業人士求助，雖然醫療的可近性，但醫療的運用率卻不一定是方便的。
結論：這幾年來，不僅僅是在醫院，在社區中，我們可以看見越來越多的外籍監護工在照顧我們的國人，甚而在醫院各角落，可以聽到她們成群的以自家語言交談著，其實她們已經成為我們社會中不可或缺的角色。而如我們能與這群「邊緣性」之族群真誠接觸和認識，以平等的角度培養互相尊重態度，降低她們感受「社會排斥」感，增加「融合度」，融入我們的醫療團隊中，才能讓我們被照顧的國人會更好。
本研究建議：醫療機構及醫療工作者觀察外籍監護工網絡建構模式，可從事充權行動，內部分享；深入其組織團隊中取得信任，透過充權了解並行動自我照護能力，外籍監護工好的健康狀況，才會有好的照護品質、家屬更好的滿意度，醫院口碑才能的迴響，達到三贏局面。

關鍵字

外籍監護工 ； 社會網絡 ； 健康求助行為

並列摘要

Purpose: The working conditions at nursing organizations and homes are different. The major differences mainly lie in employers’ homes, the accessibility of medical care and extensive social friendship networks. Although, the working sites of foreign aides are the same as native nursing aides. In the stance of medical care administrators, nursing quality of medical care is highly emphasized. However, it is worthy of insightful expectation whether foreign aides are hard-working, well-experienced in nursing care or infected with contagious diseases whenever foreign nursing aides under such working conditions. We should reflect whether we have insightfully understood, care about their demands and highlight the negative sides for the working conditions of home-stay foreign nursing aides. Most researches in the past are confined to individuals with excessive effort focused on personal work stress, burden, adaptability and nursing care quality. There has been less effort on the awareness in view of social network development by exploring their capability in gathering social networks and the proficiency to reach medical care accessibility in view of social network. Therefore, it is hoped by using this research, the perspective of social network relationship can be operated to inspect healthy behaviors of foreign nursing aides surrounded by nursing environment and organizations.

Methods: This research is operated with field research at a veteran hospital. Data is collected through participating observation and semi-structured in-depth interviews. There are totally 7 interviewees (3 Vietnamese, 3 Indonesian and 1 Filipino, a) and their Taiwan-stay duration is 4 years. The interview issue is about their interpersonal relation network in Taiwan and the ways how they search for Chinese assistance. By using such methods, the patterns of social network and development mechanisms for foreign nursing aides in hospitals can be recurred. The mutual relationship for individuals with relative structural positions and interactive relationship can be explored and the ways how social networks used to seek healthy behaviors can be evaluated insightfully.

Results: The difference used to construct various social networks include some attributes like open mind, acceptance, trust, flexibility, aggressiveness in positive sides or close mind, refusal, doubt, prejudice and passiveness toward new environment. In view of the formal and hierarchical networks constructed by the “Hospital Working Network”, there are some emotional networks different from inherent concepts established. The networks constructed among homeland peers can naturally form an informal network structure with different companion intimacy. The companion intimacy depends on the number of network members. Various extensive networks established externally are formed due to the features of utility and emotion.

In view of time sequence for network consideration, foreign nursing aides are initially isolated from their environment and experienced zero interaction and adapting interpersonal interaction. They are quite isolated from environmental, interpersonal and social resources. Everything is required for support. After foreign nursing aides have been acquainted with surrounding environment and adapting periods, they are capable of establishing and expanding their own social networks to find themselves from exotic cultures. When time elapses longer and longer, there have been always a bridging star standing high beyond social networks for their own communication.

In addition, when we inspect healthy behaviors in view of network construction, foreign nursing aides troubled with health problems will seek help from their intimate companions among their social networks. If intimate companions cannot solve the problems, they will seek help from new friends they made in exotic lands such as employers of neighboring aunties and sisters. There is another channel of medical care experts. Although this is an accessible medical care channel, yet it is not as convenient as people suppose.

Conclusion: For past few years, there have been increasing numbers of foreign nursing aides around the corners not only hospitals but also communities. We can see the crowds speaking their own languages and they have become imperative roles in our society. We should express our sincerity to this “marginal” group and know them well in good faith. They should be treated in equality and mutual esteem to reduce their "social exclusion" but increase their “integration” sense in mind. Let them be a part of our medical care teams and our people can be well nursed resultantly.

並列關鍵字

Foreign Nursing Aide ； Social Networks ； Health Help-seeking Behavior

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