社會工作者在社區安寧療護之角色

The Role of Social Workers in Community Palliative Care

10.6200/TCMJ.2015.12.SP.05

田麗珠(Lih-Chu Tien)；吳怡伶(Yi-Ling Wu)；劉靜女(Ching-Nu Liu)；林素妃(Su-Fei Lin)；陳靜琳(Ching-Lin Chen)；林欣儀(Hsin-Yi Lin)；李慶真(Ching-Chen Lee)；王實之(Shih-Chih Wang)

社會工作 ； 安寧居家 ； 跨領域團隊 ； 以家庭為中心的工作取向 ； 照顧品質 ； social work ； home palliative care ； interdisciplinary team ； family-centered approach ； quality of care

北市醫學雜誌

12卷附冊（2015 / 06 / 30）

35 - 45

繁體中文

目的：社會工作者在安寧療護團隊中扮演重要角色，透過尊重差異與以病人為中心等特質，支援照護需求的滿足與品質的提升。隨著安寧療護服務模式逐漸從住院轉變到社區／居家，其間社會工作的轉變尚待探討。方法：本研究透過文獻與會議資料回顧的方式，探討臺北市立聯合醫院在推動安寧居家療護過中，社會工作者在團隊中功能與角色的轉變與反思。結果：研究發現社會工作者在安寧居家療護模式中，同樣扮演評估、諮詢、情緒支持、團隊支援等重要角色。但社會工作者在安寧居家模式中，可以更早投入服務，並因此具備社會心理層面的優勢。臨床上發現安寧居家決策上病人與家屬有較多的猶豫，主要顧慮返家後照顧者壓力的問題，因此社工溝通者的角色與功能更形重要。社會心理需求、增進專業知能、提供組織性支持及推廣生命教育是目前主要需要加強的部分。結論：在推動新發展的都會型社區安寧居家療護時，我們必須尊重末期病患與家屬感受與需求的差異，增進團隊內部以及與病患及家屬的溝通，以達到維護生活品質、尊重生命尊嚴的目的。

Objective: Social work plays an important role in palliative care. The quality of this profession, including the features of respecting diversity of clients and patient-centered principle, satisfies the need of support and improves the quality of care. While the service model has been gradually transferred from hospital to home, the changes of social work need further study. Methods: Through the review of literatures and meeting minutes, this study discusses the transformation and reflection of the roles and functions of palliative social workers in Taiwan. Results: This study finds significant roles and functions of social workers in assessment, counseling, emotional management and team support in home palliative care. Social workers can provide service earlier with psychosocial advantages in the home palliative model. Clinical observations find patients and family members hesitate in deciding the choice of home palliative care, mainly because of the concerns of caring stress. As a result, the roles and functions of a communicator for social worker become even more important. At this point, psychosocial care, professional knowledge, organizational support and lean management are to be strengthened. Conclusion: In order to maintain the quality and respect the dignity of life, a palliative care team should respect the diversity of feeling and need of the terminally ill patients and their families, and enhance the communication within the team and with patients and their families.