居家醫療服務體系醫事人員的工作狀況及職業安全健康風險探討

Abstract

根據全民健康保險居家醫療照護整合計畫，長照醫療整合服務由保險特約醫事服務機構組成整合性照護團隊，提供含括「居家醫療」、「重度居家醫療」及「安寧療護」三照護階段，並依執業人員專長提供各階段之服務項目。為提供多元而連續的服務，健保給付居家整合照護團隊納入更多的醫事人員，如牙醫師、中醫師、藥劑師、呼吸治療人員等。 本研究的目的在於了解不同職業類別的專業醫事人員於居家特殊場域工作的概況，及主要的職業安全及健康風險。以深度訪談方式進行資料收集及分析，訪談對象為隸屬於某大學附設醫院的居家護理所之居家醫療專業醫事人員，包括3位家庭醫學科醫師、1位精神科醫師、1位中醫師、1位牙醫師、1位營養師與11位護理師（其中包含一般及重度居家護理師、居家安寧護理師、精神居家護理師）。錄音內容經整理形成逐字稿，進行重點摘錄，並作來回比對與分析。 本研究透過訪談，發現居家醫療工作中所有職業類別的醫事人員都會面臨居家醫療工作中特有的人身安全與交通問題，其他還有社會心理危害、菸害、骨骼肌肉傷害、交通、生物性危害等多重職業危害。此外，需要獨自前往訪視的護理師在各方面都具有較高的職業風險危害。研究者將研究結果分為兩類，分別為「獨自訪視」的護理師，與「結伴訪視」的醫師、中醫、牙醫、營養師等醫事人員。研究發現，若是必須單獨訪視，不分職業類別、不分性別，都會有較高的人身安全壓力，以及較低的工作意願，因此若欲管控風險建議結伴訪視。此外，居家場所的菸害屬嚴重的職業危害，建議納入法規加以規範，並要求機構約束服務對象，以保障居家醫療工作者避免菸害暴露。人因性危害則存在職業別的差異，常見於護理師及牙醫師。本研究並進一步探究職業傷病預防策略以及實際職業災害補償的情形，發現醫事人員普遍不了解制度現況，也少有積極的預防行為。 為確保居家照顧醫療體系的永續性，我們除了關注被照顧者的權利與福利之外，也要重視居家專業醫事人員的工作條件與職業安全健康。完善的職業傷病預防以及遭遇職業災害事後的補償系統才能保障居家醫療工作者的工作安全與職業健康。

Home-based Medical Integration Program includes three stages of care: home-based medical care, severe home-based medical care and hospice care. To provide better care for the frail and disabled elderly people, continuous medical care encompassing nursing care to specialized medical services is provided by various types of health care professionals, including nurses, physicians, dentists, traditional Chinese Medicine physicians, pharmacists and respiratory therapists. This research was designed to understand the working conditions and occupational safety and health risks of healthcare professionals in the home-based medical care system. In-Depth interviews were conducted with health care professionals of an university-affiliated home-based institute, including 11 nurses, 3 physicians, 1 psychiatrist, 1 dentist, 1 traditional Chinese medicine physician, and 1 nutritionist. Verbal records were taped and transformed into transcripts for analysis. Based on the interviews, the researcher presented the findings by two groups: the first was nursing staff who had to go out for visits alone, and the second consisted of physicians, traditional Chinese medicine physician, dentists and nutritionist, who provided services as a team. Major occupational health problems included psychological stress due to psychosocial hazards, musculoskeletal disorders due to ergonomic hazards, safety concern from commuting-related traffic, and infectious disease risks caused by biological hazards. The nurses who had to visit the clients alone had higher occupational safety and health risks. Thus, the research suggested that team work could be a way to reduce the risks of working alone. Secondhand smoke exposure was prevalent and presented as an important occupational health concerns. The researcher suggest to adopt regulations to make home-based working place smoke-free. Musculoskeletal disorders were common among nurses and dentists. The research further explored workers’ preventive measures and insurance utilization for workers’ injury compensation. The results indicated that health care professionals were not aware of the systems and few had taken active preventive measures. . To ensure the sustainability of home-based health care system, we should pay attention to the working conditions and occupational safety and health risks of healthcare professionals. Hazard prevention and compensation systems are needed to protect healthcare professionals and safeguard their occupational safety and health.