“照”“护”之间:失能老人长期照护的实践困境

Interprofessional Relationships and Implicit Strategies:Practical Characteristics of Long-Term Care for the Disabled Elderly

对失能老人的长期照护实践的过往研究多从人口数据出发,以定量方法探索长期照护的宏观路径,但是对照护实践中至为关键的职业群体及其潜在风险关注不足。文章采用质性研究的方法,选取G老年医院作为案例场域,通过五年的追踪随访,对以护工为主的职业群体进行深入访谈,考察疫情前后照护群体的工作情境,从失能老人的照护过程、照护形式、照护对象等维度,探析了长期照护的实践特征及其内在困境。研究发现,失能老人的长期照护实践,蕴藏着多元化的职业关系和隐性策略:照护过程突出了双重体系下,照与护间的职业博弈;照护者在不同职业关系内部,展开应对性的行动策略;失能老人作为对象,在照护依赖的情境中,难免面临职业关系带来的风险。隐性策略的结构性作用,使原本一体的照护过程出现张力,加剧了职业关系的冲突表象。最后文章从制度及理念层面入手,对老年照护的职业角色及其发展进行了探讨。

Most of the previous studies explored the macroscopic path of long-term care using quantitative methods based on population data,but paid little attention to the occupational groups and their potential risks which is pivotal in the practice of care.This paper adopts the method of qualitative research and selects the most typical G geriatric hospital as the case field.Through in-depth interviews mainly with the professional group of care workers,this paper investigates the working situation of the care group before and after the epidemic,and probes into the practical characteristics and internal difficulties of long-term care from the perspective of the process,form and object of the care for disabled elderly through in-depth investigation of the working situation of the care workers after five years of follow-up.It is found that the long-term care practice of the disabled elderly contains diversified interprofessional relationships and implicit strategies:the care process highlights the occupational game between the caring and nursing under the dual system;caregivers develop reactive action strategies in different interprofessional relationships;the disabled elderly in the situation of dependence as the object of care,inevitably faces the risks brought by the interprofessional relationship.The structural effect of the implicit strategies makes the original integrated care process appear tension and intensifies the conflict appearance of the interprofessional relationship.Finally,the role development of the elderly care profession is discussed from the institutional and conceptual aspects.