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Title: 醫務社工師參與撤除維生醫療之經驗初探
A Preliminary Study on Experiences of Medical Social Workers Participating in Withdrawal of Life-Sustaining Treatment
Authors: 王永慈
Chiu, Shu-Chen
Keywords: 末期病人
terminal patients
withdrawal of life-sustaining treatment
family conference
Issue Date: 2017
Abstract: 高水準的生命末期病患照顧應符合以病人及家屬為中心之決策模式,有良好的溝通機制、維持繼續的照顧、給予病患舒適之處理及避免痛苦發生、給予情緒之安撫與實質照顧及靈性之支持。本研究針對四位在醫務社工領域工作達14年以上的資深社工師針對醫務社會工作師在參與醫療團隊執行撤除維生醫療時,在團隊與家屬的角色與互動經驗、執行業務上所面臨的倫理兩難以及如何處理進行深度訪談。 本研究結果,首先研究者將撤除維生醫療過程分成啟動階段、決策過程階段、撤除或終止前準備階段及臨終階段。團隊工作角色功能中有:溝通協調過程中釐清家庭成員間的立場,病患/家屬、團隊成員的情緒安定者,協助評估執行過程的適法性以及「撤除維生醫療」團隊成員的教育者。與家屬工作的主要內容有擔任決策過程中醫病溝通的橋梁、陪伴病人及家屬的疾病適應歷程以及家屬的悲傷關懷。而醫務社工師所面臨的倫理兩難為不捨病人受苦、家人因醫療決策、經濟能力而難過。最後為能提供適切服務、知能建構與提升,除了全院或單位性的訓練外,醫務社工師常自學相關醫學知識以及院外自我成長主動學習。同儕督導及自我學習是支持方式。 需要一定的工作年資團隊工作較順暢,主動學習才能累積經驗、專業工作成就感的來源是這幾位資深醫務社工師對於從事撤除維生醫療的工作經驗談,期許能提供給相關人員參考。
High-standard end-of-life patient care should be in line with the patient and family-centered decision-making mode, including a good communication mechanism, continuous care, comfortable treatment, avoidance of pain, emotional comfort, substantial care and spirit support. In this study, we conducted in-depth interviews with four senior social workers with over 14 years of experience in the medical social work field about ethical dilemmas they faced when the medical team removed life-sustaining treatment, their role in this process, their interaction with the medical team and family members and how they dealt with the issues. First, we divided the life-sustaining treatment withdrawal process into four phases: initiation phase, decision-making phase, removal or termination preparation phase and the final phase. With respect to the functions of a medical social worker provided in the team, the social worker needs to clarify the position of family members by communication and coordination, stabilize the emotion of patient/family and team members, assist in assessing the legality of the implementation process and educate the members of the life-sustaining treatment withdrawal team. In terms of the work with family members, the social worker’s main job is to serve as a communication bridge between the medical team and the patient/family, accompany the patient and family during the adaptation process and be attentive to the family’s sorrow. The dilemmas faced by the medical social workers were their reluctance to see the patients suffering and the family struggle on making medical decisions and worry about their financial ability. Finally, in order to provide appropriate service, and establish and enhance knowledge and ability, the medical social workers usually studied medicine-related knowledge on their own and actively participated in self-growth learning in addition to the training provided by the hospital or the department. Peer supervision and self-learning provided great support. Based on the experience in the withdrawal of life-sustaining treatment, these senior medical social workers agreed that it requires a certain degree of work experience to work more smoothly in the team and experiences are accumulated through active learning. The findings of this study can be the recommendations for medical and other related team members.
Other Identifiers: G060038014F
Appears in Collections:學位論文

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