心理衛生社會工作者與照顧者相互期待之角色內涵探討

Abstract

本研究探討心理衛生社會工作者與精神病患照顧者工作之中相互期待的角色內涵、影響角色期待之因素或歷程，以及相互期待之認知、行動如何修正與調整。本研究採質性研究深度訪談法，採立意抽樣選取研究對象，對三十九位受訪者（二十六位心理衛生社會工作者、十三位精神病患照顧者）進行半結構式訪談，主要研究發現如下：\n1. 精神病患照顧者的照顧內容和與角色立場：\n（1）照顧內容：症狀因應、社區生活\n（2）照顧態度：積極主動、合理期待、自我照顧\n（3）與其他家屬互動：聚會交流、自助助人、權益倡導\n2. 照顧者樣態與社會工作者對照顧者之角色期待：\n（1）所見樣態：積極參與、消極參與、不當期待、家庭動力不穩\n（2）對照顧者之角色期待：配合服務、適度支持、個別化期待、如個案需要協助\n（3）影響因素：社經認知條件、家庭文化因素、疾病照顧經驗、社區環境、社工接觸經驗\n3. 社會工作者與照顧者之工作方法，與照顧者對社會工作者的角色期待：\n（1）工作方法：傾聽陪伴支持、協作釐清期待、衛教家屬團體、家庭動力工作、社區資源連結、權益倡導協調\n（2）指導原則：聚焦正向改變、以個案為中心、重視家庭經驗、尊重照顧知識、抱持覺察開放的態度\n（3）照顧者對社會工作者之角色期待：教育引導、家庭陪伴、權益倡導\n（4）影響社會工作者角色因素：個人因素、專業教育、組織因素、結構因素\n4. 照顧者與社會工作者關係：夥伴關係、工作關係、彈性關係\n5. 照顧者與社會工作者相互角色期待調整方式：\n（1）照顧者對社會工作者期待調整：接受現況、調整期待、自立自強\n（2）社會工作者對照顧者期待調整：接納現況、調整期待、擇善固執\n（3）社會工作者挫折因應方法：經驗回饋、自我照顧、團隊支持\n最後，研究者結合上述研究結果，嘗試繪製出心理衛生社會工作者與照顧者相互角色期待內涵與影響因素之概念架構圖，並提出本研究限制與建議，提供照顧者、心理衛生社會工作者和政策制定者、未來研究者參考，期冀本研究有助於減少照顧者可能產生的失望，甚至進而奠定一個基於夥伴關係的服務方式。

The purpose of the study was to explore the content of mutual role expectation for mental health social workers and caregivers, the factors influencing role expectation, and the adjustment process of role expectation. This study used purposive sampling to select thirty-nine participants (twenty-six mental health social workers and thirteen caregivers), conducting in-depth interviews by using a semi-structured interview outline. The major results of the study include:\n1. Care content and role of caregivers: \n(1) Care content: symptom management, community life promotion.\n(2) Care attitude: proactive, reasonably expected, self-care.\n(3) Interaction with other caregivers: family support group and gathering, help others and self-help, advocacy.\n2. Caregiver pattern and role expectation of caregivers: \n(1) Caregiver pattern: actively participated, passively participated, improperly expected, unstable family dynamics.\n(2) Role expectation of caregivers： service adherence, moderate support, individual expectation, potential client.\n(3) Factors influencing role expectation: socioeconomic and cognitive conditions, family and cultural factors, caring experience, community environment, the experience of contacting social worker.\n3. Working methods and role expectation of social workers: \n(1) Working methods: listening and accompanying, cooperating to clarify expectation, group psychoeducation, family systems therapy, mobilizing community resources, advocacy and negotiation.\n(2) Guiding principles: focus on positive changes, case-centered, attention to family experience, respect for caring knowledge, open-mindedness and self-awareness.\n(3) Role expectation of social workers: educator and guide, family supporter, advocate.\n(4) Factors influencing role expectation: personal factors, professional education, organizational factors, structural factors.\n4. Professional relationship: partnership, working relationship, elastic relationship. \n5. Adjustment process of role expectation for caregivers and social workers：\n(1) Role expectation of caregivers adjusted by social workers: accepting the status quo, adjusting expectation, self-reliance.\n(2) Role expectation of social workers adjusted by caregivers: accepting the status quo, adjusting expectation, persisting.\n(3) Frustration coping methods: experience feedback, self-care, team support.\nBased on above findings, researcher drew out the depiction of mutual role expectation for mental health social workers and caregivers, as well as the factors influencing role expectation, proposing the study restrictions and suggestions on policy making, partnership-based approach for mental health social workers and caregivers, and further research.