COVID-19期間長照機構實施探視管制措施對孝道信念、孝道焦慮與探視行為衝擊之研究

Abstract

研究背景與目的 COVID-19的疫情在全球延燒將近3年的時間，長照機構屬於人口密集的生活圈，住民多半年老、免疫力低或有共病症，若感染病毒，死亡風險將大為提高，針對長照機構的感染控制更需要嚴格落實。為了保護這群易受感染者，臺灣在疫情期間滾動式調整長照機構探視規定。「探視」對孝道觀念濃厚的華人子女來說是盡孝道責任、彌補自身內疚感、表達孝心的行為。如今長照機構調整探視措施，可能對子女孝道信念、孝道焦慮與探視行為造成衝擊。因此本研究希望藉由了解長照機構住民子女對於實施探視管制造成之孝道信念、孝道焦慮與探視行為之衝擊及相關因素，未來提供更適當的探視方式。 研究方法 本研究採用橫斷式調查研究法，從立意取樣方式收集中部某縣市的24小時住宿式長照機構，其中包含小型老福機構養護型或長照型（49床以內）、護理之家（200床以內）與法人附設之住宿長照機構（200床以內）的住民子女，以線上問卷填寫收集資料，並以IBM SPSS 26.0版套裝軟體進行統計分析。 結果 共有300位長照機構住民子女參與本研究，平均年齡為53.96 ± 9.05歲、多數為女性、已婚、家中排行長子/女、全職工作。其父母以入住護理之家最多（56.7%）、多數坐輪椅（52.6%）、入住機構前為非獨居（78.3%）。子女於疫情前每週2-4次探視（43.4%）、探視時間以31-60分鐘為最多（41.0%）；疫情後探視次數減少，以每週1次（30.7%）、時間以少於30分鐘（42.3%）為主。禁止探視後，使用視訊探視（64.3%），每週2-4次最多（41.5%）。長照機構住民子女以相互性孝道信念、孝道情感焦慮平均分數較高、對探視行為改變有中度以上衝擊。孝道信念與孝道焦慮各層面均呈現顯著正相關。以多元線性迴歸分析發現：父母住在住宿式機構、入住機構年數越久、子女的權威性孝道信念、孝道情感焦慮越高時，受到探視行為衝擊就越高。在禁止探視後有使用替代方案的預測因子為：「父母聽覺障礙」(OR=15.03, P<.01)、「權威性孝道信念」(OR=1.06, P<.01)與「孝道情感焦慮」(OR=1.14, P<.05)。會使用電話探視的預測因子為：「探視行為衝擊」(OR=1.06, P<.01)、「父母入住前為獨居」(OR=6.21, P<.001)、「疫情前未住機構」(OR=9.57, P<.05)。會使用視訊探視的預測因子為：「權威性孝道信念」(OR=1.05, P<.01)、「家管」(OR=3.82, P<.05)。疫情後成為高探視組的預測因子為：「家中排行長子/女」(OR=3.89, P<.05)、「家中排行居中」(OR=6.11, P<.01)、「家中排行老么」(OR=4.47, P<.05)、「探視行為衝擊」(OR=1.05, P<.001)與「疫情前探視每週2次以上」(OR=21.69, P<.001)。 結論 本研究結果發現權威性孝道信念、孝道情感焦慮較高的子女較容易使用視訊或電話替代親自探視，而相互性孝道信念較高的子女可能原不以探視行為作為表達孝道的方式，因此造成之衝擊較不顯見。在長照機構中，實施以家庭為中心的護理對住民健康有正向影響，如何維持家庭間的情感連結是項重要的護理措施。在無法親自探視的情況下，護理人員必須另尋方式確保家庭成員能夠以替代方案繼續參與住民的照護，例如開放遠端視訊或增加通話的頻率等。因此，機構應根據疫情變化，彈性調整探視規定，提供更靈活的探視時間安排，鼓勵視訊探視，主動提供住民的即時信息。透過機構作為溝通橋樑，間接促進子女與住民間的聯繫，協助他們適應新的探視模式，以另種方式接續以家庭為中心的護理模式。

Background and purpose The COVID-19 pandemic has raged globally for nearly three years, with long-term care facilities constituting densely populated living environments. Residents within these facilities are predominantly elderly individuals with compromised immune systems or comorbidities, resulting in a significantly elevated risk of mortality if infected. Stringent infection control measures are crucial in long-term care settings due to the vulnerable nature of the residents. In response to the pandemic, Taiwan has implemented a dynamic adjustment of visitation regulations in long-term care facilities. "Visitation" holds profound significance for culturally-oriented Chinese adult children, representing the fulfillment of filial duty, alleviation of guilt, and the expression of filial piety. The recent adjustments to visitation measures in long-term care facilities may impact filial belief, filial anxiety, and visiting behavior among adult children. Hence, this study aims to understand the impact of implementing visitation restrictions on filial belief, filial anxiety, and visiting behavior among adult children of long-term care facility residents, along with exploring relevant influencing factors. The findings aim to inform the development of more suitable visitation models in the future. Methods This study employed a cross-sectional design and utilized purposive sampling to ccollect data from 24-hour long-term care facilities in central Taiwan. The sample included the children of residents in various types of facilities, namely long-term nursing organizations (up to 49 beds and up to 200 beds), nursing homes (up to 200 beds). Data were collected through online questionnaires, and statistical analysis were performed using IBM SPSS version 26.0 software. Results This study included 300 adult children of residents in long-term care facilities, with an average age of 53.96 ± 9.05 years.The majority were female, married, the eldest in the family, and employed full-time. Most parents resided in nursing homes (56.7%), used wheelchairs (52.6%), and were non-living alone before entering the institution (78.3%). Before the pandemic, children visited 2-4 times per week (43.4%), with visits lasting 31-60 minutes (41.0%). After the pandemic, visitation frequency decreased, with 30.7% visiting once a week, and 42.3% spending less than 30 minutes per visit. Post-restriction, 64.3% adopted video visitation, with 41.5% engaging (2-4 times per week). Adult children reported higher average scores in reciprocal filial piety and filial piety emotional anxiety, indicating moderate-to-high impacts on visiting behavior. Filial belief and filial anxiety were significantly positively correlated. Multiple linear regression analysis revealed that higher impacts on visiting behavior were associated with parents living in residential facilities for longer durations, children holding authoritarian filial piety, and experiencing higher filial piety emotional anxiety. Predictors of using alternative methods after visitation restrictions included "parental hearing impairment" (OR=15.03, P<.01), "authoritarian filial piety" (OR=1.06, P<.01), and "filial piety emotional anxiety" (OR=1.14, P<.05). Predictors of using phone calls for visitation included "impact of visiting behavior" (OR=1.06, P<.01), "parents living alone before entering the institution" (OR=6.21, P<.001), and "not residing in an institution before the pandemic" (OR=9.57, P<.05). Predictors of using video visitation included " authoritarian filial piety " (OR=1.05, P<.01) and "homemaker" (OR=3.82, P<.05). Predictors of becoming a high-visitation group after the pandemic included "first-born/only child in the family" (OR=3.89, P<.05), "middle-born in the family" (OR=6.11, P<.01), "youngest in the family" (OR=4.47, P<.05), "impact of visiting behavior" (OR=1.05, P<.001), and "visiting 2 or more times per week before the pandemic" (OR=21.69, P<.001). Conclusions The study findings suggest that adult children with higher authoritarian filial piety and filial piety emotional anxiety are more likely to resort to video or phone calls as substitutes for in-person visits. In contrast, those with higher reciprocal filial piety may not rely on visiting behavior as a means of expressing filial piety, resulting in less noticeable impacts. Implementing family-centered care in long-term care facilities positively influences residents' health, emphasizing the importance of maintaining emotional connections within families. In the absence of in-person visits, caregivers should find alternative ways to ensure family members can continue participating in resident care, such as facilitating remote video communication or increasing phone call frequency. Therefore, institutions should flexibly adjust visitation regulations based on pandemic changes, provide more flexible visitation schedules, encourage video visits, and proactively provide real-time information about residents. Acting as communication bridges, institutions indirectly promote connections between adult children and residents, assisting them in adapting to new visitation models and continuing a family-centered care approach in alternative ways.