健康醫療治理中護理人員實作的困境與矛盾：以大腸癌篩檢為例

南華大學機構典藏系統 > 社會科學院 > 應用社會學系(社會工作與社會設計碩士班,教育社會學碩士班) > 博碩士論文-社會學碩士班(停招) > Item 987654321/28897

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題名:	健康醫療治理中護理人員實作的困境與矛盾：以大腸癌篩檢為例
其他題名:	Dilemmas and Contradictions of Nurse Practitioners under Healthcare Governance: A Case Study in Colorectal Cancer Screening
作者:	蔡春美 TSAI, CHUN-MEI
貢獻者:	應用社會學系社會學碩士班蘇峰山 SU, FONG-SAN
關鍵詞:	醫療治理;新管理主義;大腸癌篩檢 healthcare governance;new managerialism;colorectal cancer screening
日期:	2021
上傳時間:	2022-08-18 14:40:49 (UTC+8)
摘要:	衛生福利部國民健康署 2019年公佈國人十大死因，癌症已連續38年位居第一，對整個社會來說，國家需要耗費極大的治療費用與精力來治理癌症所產生的問題。有鑒於此、國民健康署自民國99年起全面推廣四大癌症篩檢服務，立意良善的癌症篩檢政策，在實作層面與推廣過程並非毫無阻力地被廣為接受，文化因素與社經條件，往往影響癌症篩檢的推廣。此外、也不乏因績效考量帶來許多值得反省的問題。本文以大腸癌為例，從第一線護理人員的視角，探索民眾不願意接受篩檢的因素以及相關政策所引發的非預期效應。本文以質性研究方式，採半結構、深度訪談，呈現第一線護理人員的真實感受及其衍生的相應對策及態度。研究結果發現大腸癌篩檢政策於實作場域產生以下問題(一)民眾因知識面、文化面、與社會面的限制與框架，而影響其受檢意願(二)大腸癌篩檢的治理政策衍生出專業形象扭曲，浮動計分所致人為操作的健康不平等，送禮文化扭曲等非預期的結果(三)醫療體系內部的不一致性、分工不均以及共病因子的分配問題。上述的結構性因素，讓一線護理人員在面對既定的篩檢目標數與相關規範下備感壓力，內部體系的不一致性也衍生許多衝突與緊張的關係，而順應篩檢計分相應而生的策略，除了導致非預期的結果，也讓護理人員對自我專業產生不認同感，進而降低對工作的熱忱。本文建議：藉由專業健康講座以及在地權威人士、大眾傳播媒體，來提升民眾健康知識與形塑正確的健康信念，建置協助資源機制或平台，以改善偏鄉交通等社會面問題。醫護人員應以健康服務的核心信念出發，回歸健康服務精神，並建置溝通管道，以改善內體制的衝突。　　The Health Promotion Administration of Ministry of Health and Welfare announced the top ten causes of death of Taiwanese of 2019. Cancer has been ranked first for 38 consecutive years. For entire society, it costs greatly in finance and other resources for a country to deal with the problems caused by cancer treatment. In view of this, The Health Promotion Administration has been promoting comprehensively the four major cancer screening services since 2010. The well-intended cancer screening policy has facing resistance while promotion process and not been widely accepted at both the implementation level. Factors of cultural background and conditions of social and economic status both affect the promotion of cancer screening. In addition, there are also issues worthy of reflection such as screening achievement oriented attitude. This article takes colorectal cancer as example, from the perspective of first-line nurses, explores the factors that cause people's unwillingness to be screened and the unexpected effects caused by related policies. This article uses qualitative research method, using semi-structured and in-depth interviews to present the true feelings of the first-line nursing staffs and their corresponding countermeasures and attitudes derived therefrom. The results of this study found that the colorectal cancer screening policy has caused the following problems in the field of implementation: (a) the willingness of the public is affected by the limitations and frameworks of aspects of knowledge, culture, and society, (b) the governance policy of colorectal cancer has caused effects such as distortion of professional images of nursing staffs, health inequality due to unequal screening target oriented, unexpected results of gift-giving motivated screening taking, (c) the inconsistent consensus of internal medical system, uneven division of labor, and comorbidity factors related issues. The above structural factors make front-line nursing staffs feel over pressured when they face the set number of screening achievement and related policy standards. The inconsistent consensus of internal medical system also raises conflicts and tensions. The adapted working method to unequal scoring of screening policy, not only leads unintended results also makes nursing staffs feel disagreement with their profession, thereby reducing their enthusiasm for work. Therefore, this study proposes: through professional health lectures, local authority figures, and mass media to promote and enhance the public's health literacy and shape correct health beliefs and through establishing assistant resource mechanisms or platforms to improve social problems such as rural transportation. Medical staffs should start afresh back to the original intention of the spirit of health services and should establish communication channels to improve internal system conflicts.
顯示於類別:	[應用社會學系(社會工作與社會設計碩士班,教育社會學碩士班)] 博碩士論文-社會學碩士班(停招)

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