外籍看護聘僱照顧者之過度介入行為改善的學習方案

The Learning Program for Employers Who Overly Control the Jobs of Their Foreign Caregivers

研究目的：「聘請外籍看護」是臺灣社會許多無法親自提供照護的子女們，解決父母安養問題的首要方法。許多聘僱照顧者（下稱雇主），雖然聘請外籍看護幫忙，卻無法信賴對方的工作能力，因此過度介入外籍看護職權內的事務。不僅使外籍看護感到處處受限，還導致雇主個人身心俱疲。本研究認為雇主的過度介入行為是由於「完美主義」、「孝道焦慮」、「認知信任不足」所致。因而以心理學的「理情行為治療法」為基礎，搭配「心理位移書寫」理念，設計一套能夠改變雇主非理性想法的學習方案。研究方法：學習方案招募具有過度介入行為傾向的雇主為參與者，方案全程以線上書寫方式進行，持續三週，過程分三大部分：「洞察導致負面情緒背後的想法」、「駁斥非理性信念」、「宏觀看待事件始末」，藉以降低參與者的過度介入行為。研究結果：分析前、後測與追蹤三週資料後，顯示學習方案確實能減少參與者之過度介入行為、孝道焦慮感受，並提升雇主對外籍看護的信任程度。研究結論：結合「理情行為治療法」與「心理位移書寫」理念的學習方案是可行的，未來可推廣應用。

Purpose: Taiwan’s population is aging at an extremely fast rate, and a great number of families are faced with long-term care needs. Many Taiwanese adult children hire foreign caregivers to take over their responsibility for caring for their older parents. However, this phenomenon has provoked widespread concern about how these employers establish mutual trust and cooperate with their foreign caregivers. With high filial anxiety, many employers distrust foreign caregivers’ abilities. As a result, they overly control foreign caregivers’ jobs and cannot tolerate any mistake. This behavior not only makes the foreign caregiver feel restricted, but also exhausts employers themselves. We assumed that an employer’s controlling behavior reflects the characteristics of perfectionism, filial anxiety, and cognitive distrust. Based on rational-emotive behavior therapy and psychological displacement writing, we designed a learning program to address these employers’ irrational ideas. We hypothesized that no matter at the end stage of the learning program or 3 weeks afterwards, this program would be able to decrease employers’ over-controlling behaviors, perfectionism, and filial anxiety. We also expected this program would be able to effectively assist participants in boosting their trust of their foreign caregivers. Methods: We targeted employers who overly controlled their foreign caregivers as participants. All participants took part in a 3-week learning program online. The first week, participants focused on a recent negative care experience. Through case guidance and intervention activities, this stage helped participants to detect and reflect on their intrinsic thinking that had aroused the negative emotions. In the second week, participants engaged in role-playing to separate themselves from their original positions. They were then asked to follow the cues to identify the irrational ideas in their replies from the first week. Next, participants tried to take the perspective of the opposing party, and reflected on their initial irrational beliefs by focusing on 3 aspects (rationality, reality, and emotion). In the third week, the participants examined the ins and outs of their negative experience macroscopically. This stage guided participants in thinking about other factors (aside from the negligence and laziness of foreign caregivers) that might have caused the negative event. By weakening the link between the negative experience and the foreign caregiver, this stage helped participants to adjust their initial over-simplified thinking and build trust with their foreign caregivers. The learning program lasted for 2 months, including a pretest, three-week learning program, posttest, and follow-up test (taken three weeks after the posttest). A total of 15 adults who were the primary caregivers for their older parents took part in the learning program, and 9 of them completed it. Results: We examined the differences between the pretest and posttest scores, and between the pretest and follow-up scores. The learning program significantly reduced participants’ tendency to over-control their foreign caregivers and their filial anxiety when they interacted with their foreign caregivers. The score of the follow-up test also showed that the learning program could help participants improve their cognitive trust of their foreign caregivers and it decreased their perfectionism ideology regarding care for their parents. Conclusions: A learning program combining rational-emotive behavior therapy and psychological displacement writing is feasible. It is worthy to be promoted and applied in the future.