精神醫療社會工作者專業倫理之探討

Abstract

本研究主要以社會心理理論（psychosocial theory）為架構，探討精神醫療社會工作人員在實際提供專業服務的不同階段中，對專業倫理的認知度與敏感度，及其在實際經驗中遭遇到的倫理進退兩難的類型與頻率。 本研究採用結構式郵寄問卷調查，針對79位服務於不同地區之精神醫療院所的專任社會工作人員，進行有關專業論理認知與經驗資料之收集。研究結果發現：（一）目前在臺灣從事精神醫療之社會工作人員，普遍有年輕化及女性化的趨勢。其中94％為女性，男性僅佔少數；平均年齡為30歲：有89％的社會工作人員來自專業教育背景，但仍有11％的社會工作人員，沒有接受過專業教育訓練。整體而言，工作的穩定度頗高，平均已在精神醫療院所工作了四年之久；大多數的社會工作人員在臨床上，承受很大的工作壓力與負荷量，平均每週接32個個案，每天與案主進行兩個小時會談工作。（二）在瞭解精神醫療社會工作人員對專業倫理的認知度時發現，社會工作人員在提供專業服務的初期與結束階段之專業倫理的認知較為一致。在初期階段，對於案主生病的原因，社會工作人員往往會因人而異，同時也會考量案主個別的需求與期待。在結案階段，社會工作人員普遍都能為案主做好出院的心理建設，並能依實際情況與需要，做適當的轉介。（三）精神醫療社會工作人員在提供專業服務過程，經常會遭遇專業倫理進退兩難的情境包括：保密原則、案主福祉、自我抉擇、與機構政策等。在所有專業倫理的衝突情境中，以服從『機構政策』與遵守『專業價值』間所形成之衝擊為最大；其次為服從『機構政策』與考量『案主福祉』之衡突；最後為對案主的『保密原則』及『自我抉擇權』。整體而言，本研究結果支持國外相關研究之結論。經由本研究進一步瞭解精神醫療社會工作在提供專業服務過程中，對專業倫理認知的敏感度與實際工作經驗與問題。研究結果不僅可提供社會工作人員在從事專業助人工作時之參考。並希望能進一步豐富專業教育訓練的內涵，提升未來社會工作專業助人的品質。

This study, based on psychosocial theory, applies mail survey to invesigate ethical dilemmas at each phase of practice identified and experienced by clinical social workers. Results indicate that the majority of social workers in psychiatric hospitals are young female with a stressful working condition. Of 79 clinical social workers, 94% are female; mean age is 30 years old. Each social worker has 32 cases per week and spent 2 hours per day interviewing with patients and families. Most of the samples (89%) come from social work education background, however, there are still 11% of the samples from non-social work education background. The findings related to the focus of the study are several. As expected, social workers experienced ethical conflicts at all phases of the psychosocial process. Ethical issues identified at the initial phases are more consistent than at the intervention and termination phases. In the initial phase, most social workers can respect the clients' needs and explanations of being sickness. Social workers, in the termination phase, also prepare clients for discharge and refer clients to appropriate agencies if needed. Clearly, ethical issues related to the organizational policies, clients' autonomy, and clients' welfare are the most serious dilemmas facing clinical social workers in the intervention phase. Conflicts between organizational policies and professional values are the most serious experience that interferes with the implementations and functions of social work, followed by conflicts between confidentiality, client's self-determination, and professional values. Results have important implications for preparing social work practitioners to deal with ethical dilemmas in a knowledgeable way. Results can also enrich the knowledge of social work education and training in the future.