長者為中心的個別化照顧服務思維～以行動學具車運用於臥床老人服務方案為例

Individualized Care Services Centralized for Seniors: A Program Using a Play-Toy Trolley for Bedridden Seniors

王明鳳

個別化照顧服務 ； 行動學具車 ； 臥床老人 ； Individual care service ； play-toy trolley ； bedridden seniors

社會工作實務與研究學刊

2期（2015 / 12 / 01）

41+43+45 - 71

繁體中文

研究問題：採取以長者為中心的個別化照顧服務思維，乃是著眼機構臥床老人因為無法自行獨立下床，進而失去更多自主權和社會參與的機會，所以希望透過「行動學具車」的床邊服務方式，達到減緩臥床長者生理、心理、社會層面的退化速率，促進長者的機構生活品質之目標。研究方法：本方案採用實驗方法的研究設計，瞭解長者在生理、心理和社會層面的變化，並輔以工作人員的活動觀察記錄表進行研究。研究選取某長照機構符合臥床條件(無法自行獨立下床)的長者共計12名，隨機分配成實驗組與控制組各6名，進行前後測，總計執行了16次單元活動，單元內容包括視、聽、嗅、觸之生理感官、認知圖卡，情緒圖卡之教材暨互動性活動。主要發現：實驗組老人從生理層面來看，「FIM表總分」統計結果達顯著(z=-2.032 ,p=.042)；從心理層面來看，「GDS表總分」後測結果是減少2.33分；從社會層面來看，在「生活品質」分數統計結果達顯著(z=-2.041 ,p=.041)。再者，在個別長者的「活動觀察紀錄表」上，也可看見長者「明顯的與人愛互動說話」、「變的喜歡笑、會主動回答打招呼」等變化。總之，本服務方案在量化評估與質性文字記錄中，皆可顯現出對臥床長者的服務成效，若能有效加以推廣與執行，亦符合社會工作所強調的「案主中心」及「個別化服務」精神，確實達到助人目標。

Research topic: Bedridden seniors in facilities are unable to get out of the bed independently, which causes them to lose ownership of and opportunities for social participation. This study uses the concept of individualized care service that is centralized for and focused on seniors through a play-toy trolley bedside service methods could mitigate the physiological, psychological, and social aspects of this problem. It also helps seniors to improve their quality of life while staying at a care facility. Research method: This case study used a research design that used experiments to understand the changes for s the physiological, psychological, and social aspects for seniors. Additionally, activity observation records made by staff were used in this study. A total 12 seniors who met the requirements as bedridden (unable to get out of the bed independently) at a long-term care facility were selected for the study. They were randomly assigned to an experimental group or a control group each with 6 participants. A total of 16 sets of activities were conducted including senses such as visual, auditory, smell, and touch as well as other interactive activities that involved materials such as cognitive flashcards and emotion based flash cards before and after examinations were performed. Key findings: For seniors in the experimental group, , the statistical results for the FIM total score was significant (z = -2.032, p = .042). The post examination results for the GDS total score was reduced by 2.33. The statistical results for quality of life score was significant (z = -2.041, p = .041). In addition, from the activity observation records gathered by staff about seniors, it was observed that seniors ＂showed obvious willingness to interact with others and talk to others＂, ＂changed and smiled more, and initiated more responses and greetings＂, and other changes were noted. In summary, this service program showed effectiveness in terms of caring and servicing bedridden seniors from quantitative assessments and qualitative document records. If it can be effectively promoted and implemented, it will also be in line with the spirit of being centralized for case owners and individualized service as emphasized by social work and the objective of helping the public is achievable.

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