安寧療護社會工作者的悲憫經驗與因應

Abstract

悲憫疲憊意指由於助人工作者長期付出同理心（empathy），卻無適當途徑紓解自身因應案主苦難時所產生的壓力，因而造成工作者願意付出的同理心程度日益減少，最後終致不願或不能同理病人的狀態。自Figley（1995）正式提出悲憫疲憊以來，國外已有研究探討悲憫疲憊對安寧照顧者、精神醫療社工、醫務社工、醫師、安寧療護社工、安寧療護專業工作者等的影響，但臺灣的研究多來自護理領域，或是針對整個安寧療護團隊。 本研究採立意取樣，考量不同的安寧體系、不同年資以及職位，邀請5位曾於或現於安寧療護體系服務的社會工作者參與半結構式訪談。以主題分析法分析訪談資料後發現同理心是研究參與者建立專業關係的關鍵，但是悲憫和同理心這兩者在概念上的些微差異，卻也讓安寧社工的悲憫經驗與過往研究有差異。悲憫指的是承接以及緩解他人苦難的能力，本次研究參與者的經驗中有部份確實與悲憫他人的歷程相關，但若加上同理所強調的「感受他人整體狀態」、「區別自身與他人的經驗」以及外在工作環境對工作者的影響後，才能更全面呈現安寧社工經驗的實務困境及收穫。 本研究的研究參與者多能以情緒覺察、個人網絡資源應對因同理心而生的情緒，但是過高的工作量、斷裂的安寧經驗傳承還有未臻健全的督導制度依然是安寧社工調適或預防悲憫疲憊時的困境。因此本研究建議：（一）跳脫病床比的限制，以實際工作量安排安寧社工的職務內容、（二）管理安寧社工的人員應有一定時數的安寧訓練，以使管理人員理解安寧服務並制定符合實況的規則、（三）建立醫院內部完整的安寧經驗傳承機制以及（四）增設督導管道以回應安寧社工同理他人還有團隊合作的工作需求。

Compassion fatigue is seen as a cost of empathizing with others, especially when helping professionals continually work with clients’ suffering and while lacking proper coping strategies to relieve the resulting stress or emotions. When helping professionals undergo compassion fatigue, their capacity to empathize reduces. Ever since Figley(1995) proposed the theory of compassion fatigue, there have been increasing research among various professions. The concept has been mostly studied by nursing professions and explored with the experiences of the entire palliative care teams in Taiwan. This, therefore, results in an absence of insights of palliative social workers. With purposive sampling, five social workers specialized in palliative care were interviewed using a semi-structured interview guide. Thematic analysis was then performed to analyze verbatim transcripts. Results suggested that the concept of compassion could only partly explain their experiences when providing palliative care services. The overall work experiences of palliative social workers include their compassion experience toward their clients and supportive and stressful situations in their work context. The empathetic tactics used by palliative social workers are “opening oneself to other’s experience” and/or “distinguish between self- and other-oriented experiences.” Most of the time, research participants adopted the concept of emotion awareness and relied on their personal network to soothe the emotions after empathizing with others. But further steps should still be taken to fully support palliative social workers: (1)It is suggested that the job duties of palliative social workers should be reallocated in line with their actual work-load;(2)The administrators of palliative care departments are recommended to also complete training relating to palliative care so that they could implement reasonable policies;(3)The administrators should set up mechanisms for passing down the experiences of senior staff;(4)Palliative social workers should be able to access their supervisors when needed.