2021年5月15日，中央流行疫情指揮中心發布雙北疫情警戒提升至第三級。因應社區COVID-19傳播有擴大趨勢，針對民眾確診出院後照顧、居家隔離、自主健康管理，及因疫情問題停止服務之居家服務個案之急迫性醫療與長期照顧需求，新北市政府發展微光守護計畫，以提供上述個案居家遠距照護(含照顧)。
本研究採取行動研究，研究者親自參與微光守護之規劃，推動與執行居家照護，並藉由多元資料，包括參與觀察、訪談、個案服務29位成效記錄以及錄影、服務日誌等文件分析，針對參與微光守護專案的不同對象（計畫規劃者3名、服務提供者5名、主要照顧者3名）進行質性深度訪談、研習及座談等方式來蒐集資料，探討疫情期間在宅提供居家遠距照護模式在規劃與實際服務過程，所遭遇的困境、主觀感受，以及未來推廣所需之配套措施等，做為未來建構更完善的社區式連續性的居家遠距照護服務模式之參考。
研究結果發現微光守護在2021年6月28日至10月31日間共提供29個個案居家遠距照護。結果摘要如下：
1.透過行動研究已發展創新之居家遠距照護模式，成為2022年全臺發展居家遠距照護之重要基礎。
2.針對計畫的推動，各利害關係人遭遇之困境與感受如下：(1)規畫者：在計畫初期因公部門回應不及造成推動進度緩慢；透過密集會議，加強溝通與相互學習，逐步改善問題。啟動服務後發現：受既有政策限制，地方政府容易保守因應；在推動創新服務模式時，無論提供者或政府皆需有當責態度。(2)服務提供者：遭遇之困境包括：收案流程不同於長照2.0，政策宣導不足；服務單位量能不足；擔心入家服務若確診，其處理流程不明確；使用視訊科技之障礙；擔心觸犯視訊診療的規定，推廣不易；缺乏居家整合的在宅醫師；(3)個案或主要照顧者：怕因接受居家服務洩露確診身分，而被歧視；居家遠距照護科技產品學習困難，常遇到機器問題(故障、通訊不穩定)；少數個案病況難以改善、反覆住院等。
3.針對29位個案服務成效之分析發現：(1)結案原因以在家自主照顧為主，恢復自立生活者高達86.2%。(2)有管路者結案移除率高達66.7%。(3)遠距科技運用之優點為呈現護理的即時性及效率，受到認同與滿意並了解服務使用者的特性與需求，可提升與改善照顧者的照護技巧。(4)提供之心理支持有助復能。(5)經由醫療團隊溝通，即時了解醫療與生活需求。(6)個案病況有實質的改善。
4.行動研究的學習歷程對個人的專業發展：行動研究過程中，其焦點不是終結於問題的解決，而是回到認識問題本身，針對當時情境中的問題採取行動，透過計畫的參與規劃、實施、完成行動研究。
針對未來若擬推廣微光守護遠距居家照護，有如下建議：
1.政策面：微光守護遠距照護模式已具初步成效，值得推廣；後續推廣時應建立正式標準作業流程(SOP)及配套措施，建構更完善社區式連續性照護服務模式。
2.法規面：政府應檢討視訊診療相關法規，以利結合居家醫療與長照的居家遠距照護服務系統之推動。
3.財務面：(1)政府應結合健保與長照2.0之給付，提供足以支撐居家遠距照護模式的補助。(2)民間可整合公私資源，在政府的補助外，發展自費居家遠距照護服務方案，讓市場能靈活提供家庭需要的居家整合照護。(3)試辦居家遠距照護之包裹式支付(Bundled payment)，以簡化行政流程，藉單一窗口提升團隊效率。
4.管理面：(1)發展專業人員居家遠距照護培訓計畫。(2)倡導居家遠距照護，讓民眾能了解並願意使用。
5.醫療資訊科技面：(1)發展「以人為中心」便捷的視訊遠距科技照護系統，方便提供者與受照顧者使用，促進新的照護方式之推廣。(2)建立居家遠距照護推廣平台：串聯醫療科技監測系統，並普遍推廣，以促進資通科技之應用。
6.服務面：(1)建立居家遠距照護分級服務：根據個案醫療與長期照顧服務需求分級，並依個案需求，提供居家式、社區式、住宿型長照機構之精準服務。(2)以個案需求為中心，居家護理團隊扮演跨專業整合角色，提供一站式、多元、整合、連續與即時的服務模式。

On May 15, 2021, the Central Epidemic Command Center (CECC) announced that the epidemic alert was raised to level 3 in both Taipei and New Taipei city. In re-sponse to the expanding trend of COVID-19 outbreak in the community, New Taipei City has developed the Shimmering (Wei-Guang) Telecare Program (STP) to pro-vide home telecare for people with urgent medical and long-term care needs for post-discharge care, home isolation, independent health management, and home ser-vice cases that have been discontinued due to the epidemic.

In this study, the researcher participated in the planning, promotion, and home care of the STP, with collected data through multiple methods, including participant ob-servation, interviews, analysis of case outcome records, and documentary analysis such as video recordings and diaries also do in-depth interviews, studies, and discus-sions with different participants (3 program planners, 5 service providers, and 3 primary caregivers) in the STP. The purpose of this study was to examine the diffi-culties encountered in the planning and actual service delivery process of the home care model during the epidemic, the subjective feelings, and the supporting measures needed for future promotion, and to serve as a reference for the future construction of a better community-based continuous home care service model.

Data from June 28 to October 31, 2021.The 29 STP care recipients was collected with the following findings:
1. Through action research on our innovative home telecare models, it has become an important foundation for telecare in Taiwan in 2022.
2. Focus on the promotion of the program, the stakeholder encountered the following difficulties and feelings: (1) Planners: This plan made slow progress due to the lack of response from the public sector at the beginning of the project. Through intensive meetings and enhancing communication, the problems can be improved. After start-ing the program, we found that the governments tend to be conservative due to the limit of policy. Governments or providers need to maintain a responsible attitude in promoting innovative service models. (2) Service providers: They encountered the plight, for example, the process of receiving cases, which is different from long-term care 2.0, insufficient policy advocacy, insufficient capacity of service, the process that service providers are diagnosed as COVID-19 is not clear, the barrier of using the video call, promoting telecare is not easy because people are afraid of vio-lating the rules of telemedicine, the lack of a home doctor who can integrate the telemedicine team. (3) Cases and primary caregivers: They concerned of discrimina-tion because receiving homecare services will reveal the identity of being diagnosed as COVID-19. Other dilemmas include difficulties of learning telecare technology products, machine problems such as malfunction, and unstable communication, and few cases have difficulties improving the disease or repeat hospitalization.
3. The results of the analysis of 29 cases indicate: (1) The reason for closing the case is that the patients are mainly taken care at home, and the percentage of those who have resumed independent living is 86.2%. (2) For the cases with the tubes, the per-centage of removing tubes is 66.7%. (3) Through the advantages and disadvantages of the use of remote technology, the immediacy and efficiency of nursing with rec-ognized and satisfied. It is important to understand the characteristics and needs of cases to improve the caregiver’s caring skills. (4) The provided mental support helps rehabilitation. (5) It is able to understand the medical and living needs immediately through the medical team's communication. (6) Substantial improvement in cases’ conditions.
4. The learning process of action research for individual professional development:
The focus of action research is not to end with problem-solving, but to return to the problem itself. Complete action research by taking action on the problem in the cur-rent situation, participating, planning, and implementing the plan.

For promoting the STP in the future, here are the following suggestions:
1.Policy:
This model has had initial success, and it is worth promoting. Nevertheless, Standard Operating Procedures (SOPs) and supporting measures should be established to build a better community-based continuous home care service model.
2.Regulation:
The government should review the laws and regulations on video diagnosis and treatments to integrate home healthcare and long-term care to help the promotion of home telecare system.
3.Financial:
(1) The government should provide adequate subsidy for telecare model by combin-ing benefits of health insurance and long-term care 2.0. (2) In addition to the subsidy, the private sector can integrate public and private resources to develop a self-funded home telecare scheme so that the resources can be flexibly applied to those who need home integrated care. (3) Conduct telecare bundled payment to simplify ad-ministrative processes to enhance team efficiency
4.Administration:
(1) Develop home telecare programs for professionals. (2) Promote telemedicine care to make the public understand and willing to use it.
5.Medical Information Technology:
(1) Develop a "person-centered" and convenient video system for telecare in order to assist the promotion of a new caring pattern (2) Establish a platform for home tel-ecare to link and promote medical monitoring technology to facilitate the applica-tion of information and communication technology.
6.Services:
(1) Establish the classification services of home telecare: According to the case’s needs for medical and long-term care services and provide precise services, such as home, community, or residential long-term care facilities (2) By focusing on the needs of the case, the home nursing team can play a multi-disciplinary role for inte-gration, and provide a one-stop service combined with continuous and immediate service pattern.

摘　要 i
Abstract iii
目　錄 v
圖目錄 vii
表目錄 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 名詞釋義 4
第二章 文獻探討 6
第一節 疫情下臺灣的相關防疫策略 6
第二節 居家遠距照護及遠距醫療 15
第三節 行動研究的相關理論 18
第三章 研究方法 21
第一節 研究設計 21
第二節 研究對象與樣本 24
第三節 研究工具 26
第四節 資料收集 31
第五節 資料處理與分析 32
第六節 研究倫理 35
第四章 研究結果 36
第一節 三級疫情間湧現之照護問題 36
第二節 研擬居家遠距照護模式之行動策略 40
第三節 擴大推廣徵求合作夥伴 52
第四節 正式推動行動計畫 53
第五節 居家遠距照護行動研究評估與回饋 57
第五章 討論 72
第一節 建立COVID-19三級警戒期間之居家遠距照護模式 72
第二節 行動方案遭遇之困境與感受 75
第三節 微光守護專案服務成效之討論 78
第四節 行動研究的學習歷程對個人的專業發展 79
第五節 研究限制 81
第六章 結論與建議 82
第一節 結論 82
第二節 建議 84
第七章 參考文獻 86
附錄一：同意人體研究證明書 89
附錄二：參與者同意書 90
附錄三：微光守護計畫書 93
附錄四：工作分配與內容 105
附錄五：收案與結案流程 106
附錄六：居家醫療視訊收案與送藥流程 107
附錄七：防疫車隊派案流程 108
附錄八：遠距科技系統操作流程 109
附錄九：防護裝備評估與指引 110
附錄十：研究者全家確診經驗 111

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