初探居家服務督導員之安寧照顧職能：經驗與挑戰

Competencies of in-home palliative care supervisors: experiences and challenges

目標：隨著長期照顧政策延伸銜接至安寧居家療護，居家式長期照顧團隊的安寧療護能力也需要相應提升。本研究旨在探討居家服務督導員的安寧照顧職能，以提升個案在生命末期接受安寧居家療護的照顧品質。方法：本研究為探索性質性研究，透過立意取樣方法，取樣單位涵蓋北部、中部、南部及東部地區的居家式長期照顧機構，邀請曾協助個案末期照顧的居家服務督導員參加焦點團體，共計25位。結果：居家服務督導的安寧照顧職能包含三面向與十項核心能力：(一)案家面向：提早導入安寧療護理念，且先確認案家安寧共識與準備度，以能進行瀕死評估與專業協作，並提供哀傷陪伴以及追蹤關懷；(二)居服面向：派案與人力媒合首重居服專業性與準備度，且應具備維護居服權益、危機支援與同理陪伴的能力，並能於實務學習與培力居服員；(三)網絡面向：具備跨機構協作與資源整合，以及組織內跨專業團隊合作的能力。結論：居家服務督導員的安寧照顧職能主要通過實務經驗來學習，這過程中強調與案家達成共識、居服員的準備度以及跨專業協作的重要性。這些要素的融合有助於推動居家長照與安寧療護的合作，從而全面提升照顧品質。本研究建議：提供居家長照團隊適切安寧療護訓練與心理支持，透過實務演練與定期舉辦系統化培訓，以促進職能發展。

Objectives: Home-based palliative care has become an increasingly crucial aspect of long-term care plans, and therefore, home care teams must develop greater palliative care capabilities. In this study, the capacity to improve care transitions for individuals receiving home-based end-of-life care was assessed among home care supervisors. Methods: In this exploratory qualitative study, 25 home care supervisors with experience in end-of-life care participated in focus groups. These supervisors were selected through purposive sampling from home-based long-term care institutions across the northern, central, southern, and eastern regions of Taiwan. Results: Three key competencies were identified for home care supervisors, with each involving specific skills: (1) case-family competency, encompassing advocacy for early palliative care to ensure family agreement and readiness and abilities related to end-of-life assessment, professional collaboration, grief support, and follow-up care; (2) home care competency, encompassing case assignment and personnel matching based on professionalism and readiness, protection of home care workers’rights, availability of crisis support and compassionate companionship, and practical training and empowerment; and (3) network competency, encompassing cross-institutional collaboration, resource integration, and effective work within interdisciplinary teams. Conclusions: Home care supervisors play a crucial role in initiating in-home palliative care, promoting integration between general home care and palliative care. Training workshops should be developed to facilitate knowledge exchange among home-based long-term care teams and strengthen the palliative care competencies of home care supervisors in family and community settings.