生命樂章之合奏-專業團隊成員為燒燙傷者提供服務之研究

Abstract

本研究旨在探討提供燒燙傷者的專業團隊服務合作模式、各專業人員的角色功能與協助燒燙傷者就業的經驗。專業團隊服務模式可分為多專業整合模式(multidisciplinary)、專業間整合模式(interdisciplinary)、貫專業團隊模式(transdisciplinary)三種向度，研究者依此概念採立意取樣方式，選取在同一機構下的五位不同職務、但五位專業人員有服務相同燒燙傷者的合作經驗。本研究資料收集方式以深度訪談方式，針對研究參與者的服務經驗及其在機構的角色功能進行訪談；同時蒐集被服務者的資料，以增加資料的豐富性。研究設計主要是以現象學方法為主，並輔以現場觀察、省思日誌、訪談重要他人及訪談後筆記等方式進行。 研究者分析方法主要利用質性資料分析方法，從所蒐集到的原始資料著手，先閱讀個別的文本內容，寫下研究者最初的看見及反思，並獲得初步的整體輪廓。再依主要的議題將資料分類形成範疇，往上形成主題。對於研究的嚴謹度從可信任性(credibility)、可轉換性(transferability)、可靠性(dependability)及可確認性(confirmability)，來掌握資料的信效度(胡幼慧、姚美華，2008；潘淑滿，2008)。 根據研究結果發現，五位研究參與者，因職務屬性不同，且並非同時介入燒燙傷者復健服務，故對專業團隊服務合作模式各有不同觀點。機構中燒燙傷者專業團隊服務以生理復健為主軸，故治療師認為專業團隊服務模式為貫專業團隊模式，社工人員雖為貫穿整體服務的個管員，但卻認為服務模式介於多專業整合模式與專業間整合模式，心理師則覺得介於多專業整合與貫專業團隊間，而庇護就服員與就服員則認為是多專業服務模式，研究發現服務模式的調整乃因機構評鑑後，組織調整人力安排而有決定性的影響。 各專業人員對其角色與功能也有不同的感受描述，社工專業人員如生命藍圖經紀人，復健治療師是指導老師，而心理師則像個隱者，默默在燒燙傷者內在提供能量，就服員是協調者，而庇護職場就服員則為看顧者與保育員。研究中也發現機構提供的工作調適服務方案，讓燒燙傷者在重返就業的過程中得以有生心理調適與獲得經濟協助的緩衝時間。The study aims to explore among the cooperative models of the professional team for the burned, the roles and functionalities of each profession in the burn field, and the experiences of the vocational guidance. The cooperative models of the professional teams consist of multidisciplinary, interdisciplinary, and transdisciplinary dimensions, by which ideation the study recruits five different professions from an organization who serve the same clients cooperatively. A depth interview is conducted on the service experiences, roles, and functionalities of each profession. The information of the clients is included to enrich the analysis that is based on the phenomenological method. Besides, the analysis comprises as well the onsite observations, reflection journals, interviews of the significant others, and post-interview retrospections. The qualitative analysis method starts with the original information by reviewing the texts from the interviews, writing the initial recognitions and reflections, and drawing a rough overall conclusion. The analysis further classifies into categories and themes according to the main issues. The reliability and validity of the study depend on the credibility, transferability, dependability, and confirmability of the information (Hu& Yao, 2008; Pan, 2008). The study discovers that each of the five professions gets involved in the rehabilitation services in a different time period which results in distinct perspectives regarding the cooperative models of the professional team. Since the service in the rehab organization mostly focuses on the physical part, the physiotherapist considers the team in the transdisciplinary model while the social worker as a case manager takes a view between the multidisciplinary and interdisciplinary models. For the psychotherapist, the team works in the multidisciplinary and transdisciplinary models. The perspective of the employment specialist and the shelter coach falls into the multidisciplinary model. The study also finds out that the models adjust to the occupational rearrangement after the agency evaluation. Moreover, each profession describes their own role and functionality in a different term: social worker as life script manager, physiotherapy as instructor, psychotherapist as hermit who provides inner energy, the employment specialist as coordinator, and the shelter coach as caregiver. The vocational rehabilitation project provided by the organization is also found to allow time during the process of reemployment for the postburn adjustment physically, psychologically, and economically.