本研究之目的在探討住院失能老人之家庭照顧者，在出院回到家這段過渡期間的需求層面及內容。採用質性研究設計，在住院期間、出院後1-2星期及出院後3-4星期三個時間點，對11位失能老人的家庭照顧者，進行面對面訪談及參與式觀察，並以Miles及Huberman( 1994 )之分析法進行資料分析。結果發現:家庭照顧者在出院回家的過渡期間的需求，包括:人力支持、情感及靈性支持、社會經濟福利、醫療相關服務以及醫療照護訊息。其中醫療相關服務及醫療照護訊息的需求，最常被照顧者提到需要專業人員的協助。本研究的發現可做為出院計畫服務及居家護理訪視評估處置的依據，讓專業人員瞭解家庭照顧者在過渡階段的需求內容，以發展出有效的護理措施。

This qualitative study was designed to assess the discharge needs of family caregivers of hospitalized disabled elders. Face-to-face interviews with participant observations were used to investigate the subjective experiences and transitional needs of the caregivers. Fourteen family caregivers of 11 disabled elders were interviewed at three different points in the transition from hospital to home: prior to leaving the hospital, one to two weeks after leaving the hospital, and three to four weeks after leaving the hospital. The analytical method described by Miles and Huberman (1994) was used to analyze the data. The results indicate that family caregivers have various needs in the transition from hospital to home, including needs for manpower resources; emotional and spiritual supports; social and welfare supports; medical related services; and health care related information. Among these needs, medical related services and health care related information were mentioned most often. The findings of this study may provide a basis for discharge planning and home nursing Services by sensitizing nurses to the needs of family caregivers, and facilitating the development of effective InterventIOns.