精神醫療社會工作者之角色困境與定位

Tunghai University Institutional Repository > 社會科學學院 > 社會工作學系所 > 碩博士論文 > Item 310901/23959

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Title:	精神醫療社會工作者之角色困境與定位
Other Titles:	The role dilemma and role identification of psychiatric social work in Taiwan
Authors:	張玲如 Chang,Ling-Ru
Contributors:	簡春安 Chien,Chun-an 社會工作學系
Keywords:	精神醫療團隊、健保支付制度、醫事人員、醫院評鑑、綜融權變社工專 psychiatric team, health care payroll system, medical staff, hospital service assessment, comprehensive dynamic social work professional status
Date:	2013
Issue Date:	2014-02-19T04:00:10Z (UTC)
Abstract:	隨著國家政策、醫療生態鉅視環境的改變，素以強調專業團隊合作的精神科醫療模式也隨起變化，社工在此氛圍中，其在醫院的角色地位亦受到影響。本研究旨在探討當階段台灣精神醫療社會工作者的角色困境與定位，並為團隊中逐漸氣消勢弱的社工，尋找出其專業發展途徑。研究結果發現，社工的角色困境有：社會工作師非醫事人員，是團隊中唯一不具醫事人員身分者，形成受訪社工有證照無用論之慨。且因健保支付制度不利社工績效之呈現，在醫院以健保給付收益論專業角色貢獻之指標，社工承受之壓力大。社工壓力大、流動率高，有斷層之現象，惡性循環，社工缺乏專業自信，專業認同低落。醫院評鑑，社工評鑑委員重視服務品質提升之要求，對工作人力少、工作面向廣而工作量大且繁雜的社工更形成壓力。在績效壓力下，社工角色位置到底要服務院內的個案或多承接院外的委託服務案？此亦形成工作倫理兩難。在精神科專科醫院，醫療團隊關係是競爭大於合作，各做各的，團隊成員成為健保生產線上的作業員，缺乏統整、連續之病人治療服務。在綜合醫院，精神科社工之組織編制，逐漸被歸併到社工部門，其最大擔心是精神醫療社工專業養成的困難。研究結論是：社會工作師證照是邁向專業、獲取社會認同之基本條件，是建立社會專業認同的起點。績效要求之適度壓力是激發社工專業成長、建立專業責信、專業自信的必要之重。客觀評鑑指標的建立，有助社工專業服務品質的提升。成為醫事人員角色已是大多數受訪社工認為這是精神醫療社工要在醫院專業立足的必要之路。與團隊他成員的運作關係，應是合作可擴大彼此視野，相互成長。社工應有分階分級繼續教育制度，依專業資歷職級來處理不同業務。精神醫療社工與醫務社工的關係是合則能彼此凝聚力量，共識專業發展。研究建構精神醫療社工為「綜融權變社工專業角色」。其基本條件是大學社會工作系畢業，具有社工師執業執照，在職場有分級進階訓練及評鑑，使其有持續專注職場動力的能量。區隔社工員與社工師之業務內容，並隨年資調整院內及院外服務工作比重。 Driven by governmental changes on medical policies, the once professionalism-focused and teamwork-renowned psychiatric medication model has also been changing among the evolving ecology of medical and health care system. The role and status of social workers in hospital have hence been affected. This research aims to explore the role dilemma and identification of cotemporary psychiatric social workers in Taiwan’s medical system. Furthermore, it seeks to identify further paths of occupational development for frustrated social workers among the teamwork setup.Results of this research reveal that there are multiple causes to the role dilemma of social workers: social workers are non-medical staff and the only member in a psychiatric team possessing no medical professional status, which further leads to the prejudice of uselessness of visiting certificate of social workers. Social workers are further heavily pressurised by disadvantaged performance scoring system due to the way hospital rewards contribution according to health care revenues attributed to members. Social work as a professional is stressful, high of attrition rate and exhibits staffing gap, these shortcomings further develop to a vicious cycle resulting in lack of professional confidence and weak role identification among social workers. On the other hand, hospital assessment and social worker appraisal committee’s single minded emphasis on improving service quality, together also form another source of pressure for social workers who are facing short-staffing, wide variety of job demands and heavy and complicated workload. Under the performance pressure, should social workers identify themselves as exclusively for psychiatric hospital cases or open to undertake cases and commissions outside? This also forms a work ethical dilemma for the profession. Within psychiatric hospital, the relationship within medical team is biased more towards competition than to cooperation; when everyone only does their own assignments, members could become like workers of the assembly line of the health care system, lacking integration and continuity for holistic medical services for patients. In comprehensive hospitals, psychiatric social workers are gradually shifted towards the department of social work in the payroll, under the key concerns of the professional constraints developed in psychiatric social work profession.The research conclusion is that: social worker licence is the basic threshold for social workers to be recognised as professional in the society, is the starting point to establish professional recognition in the society. The pressure from performance requirements needs to be appropriate to motivate social workers professional growth and establishment of professional responsibility and confidence, as it is necessarily critical. The establishment of objective assessment metrics should be helpful to improve social workers service quality. Becoming professional medical staff has become the necessary career path for the majority of the interviewed social workers in order to settle in the hospital industry. A collaborative teamwork relationship with other members in the team should widen each other’s professional horizon and encourage mutual growth. Social workers should have a graded further education system, and deal with different assignments corresponding to one’s professional seniority. The relationship between psychiatric social workers and general medical social worker should be superadditive when together in unity and effectiveness, mutually constructive in professional development.The research is also dedicated to conceptualise psychiatric social work as ‘comprehensive dynamic social work professional status’. The fundamental requirement of this conceptual status should be college social work major graduation, qualified with social worker licence, instituted with graded further training in workplace so to ensure sustainable professional momentum moving forward. The distinction between social worker and social work professional should be established in terms of assignment nature, and the case ratio between in hospital and outside of hospital should be adjusted proportionally to the service tenure.
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