以紮根理論探索投身社區安寧靈性關懷志工之動機與心路歷程

Abstract

研究背景:台灣已於1993年成為高齡化社會，推估將於2025年邁入超高齡社會。如同世界趨勢，台灣因人口老化，慢性病及癌症導致之高齡失能及死亡增加，進而增加社區安寧照護需求與趨勢。安寧療護之宗旨為提昇末期病家生活品質並捍衛其生命尊嚴；其場域從早期的醫院，逐漸延伸至慢性照護，以及近來需求量大增之社區照護。安寧療護之照護模式，仰賴跨團隊之合作；其中安寧靈性關懷志工之角色，在社區照護中尤其獨特與重要。在社區中，志工以介於專業醫療人員，以及朋友家人間的角度來陪伴，除了補足醫療人力不足的部分，也提供銜接急性醫療照顧，與返回社區間的橋梁。然而，安寧靈性關懷志工團隊的招募、組織管理與運營面臨許多挑戰，鮮少有研究能系統性的探討。研究者為社區安寧居家護理師，時常與社區安寧靈性關懷志工合作照顧病人，深感志工角色之重要，也觀察到志工招募及留任等困境，故引起研究動機。 研究目的:以紮根理論探索成為社區安寧靈性關懷志工動機及過程，辨識相關概念，建立一理論架構，作為未來社區安寧靈性關懷志工之招募、培訓要件及留任參考。 研究方法：採質性研究中之紮根理論法，於台灣北部一社區靈性關懷培訓機構招募潛在研究參與者。招募條件為年齡18歲(含)以上、服務滿一年以上(含一年) 、可講國語或是台語、目前正在服務志工或停止服務志工。本研究以半結構式訪綱，採一對一方式，深度訪談來收集資資料。 研究結果:於2023年4月至2024年5月間，共完成21人次之訪談並納入分析。參與者均為大悲學苑之志工，平均年齡為59.2歲（SD=8.8），95.2%為女性，90.5%為現職志工，平均訪談時間為44分鐘。研究結果顯示一主要概念為：「從自我動盪裡動念，自他人受苦中蛻變」，其下包含四個歷程主題及十個次主題。四個歷程主題分別為「看見自己以及死亡幽谷」、「抓住探索的繩索」、「深入苦境時之斷裂與緩衝」、以及「轉身見光，翻轉心境」。此四個歷程主題描述志工從動機萌芽，到投入志工工作並面臨挑展與自身變化之歷程。 研究結論:本研究為第一篇探討社區安寧靈性關懷志工服務動機與歷程之研究，呼應世界衛生組織「慈悲關懷城市/社區」之中心思想。研究結果系統性描述安寧靈性關懷志工歷程之開始與延續，發現其動機及挑戰均不同於一般志工。例如其動機受人生階段之影響，信念受宗教教義中「利他」概念之啟發。而安寧靈性關懷志工的挑戰來自內在及外在，需要自我調適，也需外援。最終安寧靈性關懷不僅影響病人，自己也產生變化，在靈性上有所成長與轉化。研究結果有助於更了解社區安寧靈性關懷志工服務意願與挑戰，可做為未來招募與維持社區安寧靈性關懷志工之參考，藉此降低病家對醫療機構的依賴，發展永續經營的社區支持體。未來研究可進一步針對流失之志工，調查流失的關鍵因素，也應追蹤志工心理情緒壓力及靈性健康狀態，以及其與醫療團隊之合作模式及成效。

Background: The population of Taiwan, like the global situation, has been aging since 1993 and is estimated to transition into a super-aged society by 2025. In light of the aging population, the increase in diagnoses of chronic diseases and cancer led to a rise in elderly disability and mortality, thereby increasing the demand and trend for community hospice care. Previously available primarily in hospitals, hospice care features a holistic approach that aims to enhance the quality of life and dignity of end-of-life patients, which has now transitioned to chronic care and community care services as demand soars. Such a model relies on teamwork, in which volunteers working in the community hold a unique role as they bridge the gap between the medical team and families or friends of patients, as well as between the medical environment and the community by providing acute care services. However, the recruitment, organizational management, and operation of hospice volunteer teams face many challenges, yet little research has explored relevant issues. This researcher, a community hospice home care nurse, has collaborated with community hospice spiritual care volunteers to care for patients. In her role, the researcher has noticed the importance of community hospice volunteers but also observed the aforementioned challenges, which has sparked motivation for the research. Aims: This study explores the motivation and process of becoming a hospice spiritual care volunteer, including identifying relevant concepts and establishing a theoretical framework based on grounded theory. Findings may serve as a reference for the recruitment, training, and retention of community hospice spiritual care volunteers in the future. Method: This study adopts the grounded theory approach, with potential participants recruited from a community hospice spiritual care training institution in Northern Taiwan who are aged 18 years or above (inclusive), have served for more than one year (inclusive), speak Mandarin or Taiwanese, and are currently serving as a volunteer or have stopped volunteering. The data of this study were collected via one-on-one semi-structured interviews. Results: From April 2023 to May 2024, a total of 21 interviews were conducted and analyzed. The mean age of participants was 59.2(SD=8.8), with 95.2% being female and 90.5% being current volunteers. The average interview time was 44 minutes. One core concept emerged from the results, with four themes and ten subthemes describing the process of finding motivation and joining the workforce, as well as facing challenges and changes in oneself as a community hospice spiritual care volunteer. The core concept is “motivated by self-turmoil, transforming through the suffering of others,” under which the four themes are “seeing the valley of unsettling,” “grasping the rope of exploration”, “embracing brokenness and buffering in suffering,” and “turning to see the light and convert to acceptance.” Conclusions: This study is the first to explore the motivation and journey of community hospice spiritual care volunteers, echoing the core idea of the World Health Organization’s “Compassionate Cities/Communities” initiative. The findings systematically outline how these volunteers initiate and sustain their service, revealing that their motivations and challenges differ from those of general volunteers. For instance, their motivations are influenced by life stages, and their beliefs are inspired by the concept of “altruism” in religious doctrines. The challenges they face are both internal and external, requiring self-adaptation as well as external support. Ultimately, hospice spiritual care not only impacts the patients but also brings changes to the volunteers themselves, leading to spiritual growth and transformation. The findings help elucidate the willingness and challenges of these volunteers, which can serve as a reference for future recruitment and retention efforts. Furthermore, this helps reduce the dependence of patients’ families on medical institutions and develop a sustainable community support system. Future research could further investigate the key factors behind volunteer attrition. It is also advisable to track the psychological, emotional, and spiritual well-being of the volunteers, as well as their collaboration models and effectiveness with the medical team.