顏面燒傷者就業歷程與職業重建

Abstract

本研究旨在探討顏面燒傷患者傷後之就業歷程影響因素，以及使用身心障礙者職業重建服務之經驗。研究者以立意取樣方式選取四位顏面燒傷患者，並依據其是否有接受職業重建服務各選擇一位男性及一位女性，二組共四位。兩位男性研究參與者中一位有使用職業重建服務、一位則否；兩位女性亦同。本研究資料收集方式以深度訪談方式，針對研究參與者的受傷及其後續重建歷程進行訪談，同時也訪談專業服務提供者，以增加資料的豐富性，研究設計主要是以詮釋現象學理論為基礎，並輔以現場觀察、省思日誌、訪談重要他人及訪談後筆記等方式進行。研究者分析方法主要採Dey（1993）的質性資料分析方法，從所蒐集到的原始資料著手，由下到上的概念，搭配電腦軟體NVIVO第8版質性分析軟體的運用。對於研究的嚴謹度從可信任性(credibility)、可轉換性(transferability)、可靠性(dependability)及可確認性(confirmability)，來掌握資料的信效度(胡幼慧、姚美華，2008；潘淑滿，2008)。根據研究結果發現，四位研究參與者因損傷所導致的生、心理狀況對就業的影響，在生理方面主要有燒傷的程度、其他器官功能受損狀況（例如：手部功能、視力、排汗功能）、疤痕造成的癢與痛等；在社會心理方面則主要是因顏面毀損所產生的自我接納調適問題，尤其女性又較男性顯著。研究中也發現社會資源的挹注，對於顏面燒傷者傷後重建與調適有重要的正面影響。除了因生、心理狀況所造成的影響之外，個人、環境及其中的歷程發展因素也會與其損傷產生的影響因素交織，其中個人的信念、人格特質、家庭支持與經濟狀況對於其就業歷程的影響最顯著；而個人的教育程度與受傷前工作經驗則會影響其傷後所需要的職業重建服務支持程度。在環境面則主要是職場環境的接納度會直接影響顏面燒傷者的就業穩定度，其中雇主的態度影響工作機會的獲得，而同事的態度則會影響就業的適應跟穩定。在歷程發展因素中，疤痕的持續發展、自我決策的充能，都須要相關專業資源的適時支持；政策及工作機會對於顏面燒傷者的就業歷程及資源的獲得影響最顯著。而職業重建在顏面燒傷者就業歷程中扮演的角色功能，主要為下列幾個重要定位：是顏面燒傷者職涯接續的契機、提供就業前的調適與緩衝、全人化服務的表徵、長期的陪伴與支持者。This research aims to examine the factors influencing the course of employment of burn survivors with facial scars, and their experience with vocational rehabilitation services for people with disabilities.

Purposive sampling was used to select four burn survivors, who were then grouped based on whether or not they had access to vocational rehabilitation services. Two men and two women were thus selected, and for each gender, one had access to vocational rehabilitation services and the other had not. Data for this research was collected through in-depth interviews, which focused on the injuries and the subsequent rehabilitation process of the participants. Furthermore, interviews were carried out with professional service provider to enrich the data. The research is mainly based on phenomenological theory, further supported by field observation and notes after interviews. Research analysis used the qualitative data analysis method of Dey (1993), and the qualitative analysis computer software Nvivo (8th Edition).

The research found that for the four research participants, the impact of burns on employment was first felt a the physiological level, in terms of the degree of burns, damage to the function of other organs (for example: the degree of impairment of hand function, vision and perspiration), and itch and pain caused by scars. Impact was also felt at the psychosocial level, in terms of self-acceptance and adjustment issues caused by disfigurement, which was especially obvious in the case of female participants, as compared to make participants.

The research also found that the input of social resources has a positive effect on rehabilitation and adjustment after burn injuries. Apart from the physiological and psychological status of participants, personal, environmental and process-related factors interacting with the injury will also affect employment after injuries. Particularly, personal beliefs, personality traits, family support and economic status will significantly affect employment. Furthermore, level of education and work experience before the injury will influence the extent to which vocational rehabilitation service support is needed. In terms of environmental factors, acceptance in the workplace will directly affect the employment stability of people with facial burns, in which employers' attitudes affect access to job opportunities, and attitudes of colleagues will affect adaptation and the ability to maintain stable employment. In terms of process-related factors, the evolution of scars and self-empowerment in decision-making all require timely support of relevant professionals. Employment policies and job opportunities for people with facial burns have a significant impact on the employment process and access to resources. Professional vocational rehabilitation of people with facial burns plays an important role in the course of employment, mainly because it is an opportunity to follow a career, it offers a period of transition and adjustment before employment, it offers comprehensive services and long-term accompaniment and support.