時間與空間的另類喘息：家庭照顧者使用支持性方案之經驗

Abstract

家庭照顧者的照顧負荷沉重，其多表達有支持性服務的需要，故針對家庭照顧者使用支持性方案之經驗，頗值得研究加以探討。本研究目的為瞭解家庭照顧者使用支持性方案的情形為何，進而探索使用服務期間從事活動的經驗，剖析家庭照顧者在使用支持性服務期間重新回復能量之過程。\n本文採質性研究法，以深度訪談法蒐集資料，訪談樣本來自台灣失智症協會，共有4位失智症照顧者接受訪談。主要研究結果如下﹕\n1.家屬使用「各項家庭照顧者支持性方案」的情形，以瑞智學堂、瑞智互助家庭、家屬聯誼會為例，進而比較上述三項服務方案之異同：(1)學堂到互助家庭，家屬「聚在一起」和「舒緩的時間」更多；家屬更懂得「釋放關心」。(2)從學堂到家屬聯誼會：「家屬未經組織的團體聚會」到「成為團體成員後的聚會」。(3)服務對象與受惠對象方面，學堂服務對象以「失智長者為主，長者受惠較多」；互助家庭以「長者和家屬為主，家屬受惠較多」；家屬聯誼會以「家屬為主，家屬受惠較多」；但其實「長者與家屬之間具有相互性」，家屬獲益之後，更能以健康的身心靈來提供長者的照顧，相對的，長者的功能得以維持或減緩退化，亦有益於家屬提供照顧。\n2.家屬的需求與動力是推動支持性方案重要的推展，從學堂到互助家庭的歷程，家屬與長者有三個階段的活動經驗，包含麻將班、烹飪班以及樂樂班，其顯示家屬有時間、空間以及活動參與的需求。\n3.家屬使用服務期間從事活動獲得「心理喘息」的要素，可就休閒與休息、自我效能感、團體的歸屬感、採取行動的層面進行分析，分別為(1)休閒與休息：「才能展現」、「享受說話」以及提升生活「滿意感」；(2)自我效能感：「學習」、「突破」、「成就感」的過程，增進自我效能感；(3)團體的「歸屬感」，以及(4)社會貢獻的使命和生命的「意義感」，可見家屬由照顧者蛻變成助人者的軌跡。

The caregivers in families carry a heavy responsibility, and many of them express the need for supportive services. As such, their experience in using supportive programs warrants further study and examination. In this study, we aim to first understand how such programs are being used. Next, we examine the restorative process in which caregivers use such services to gain respite.\nThis study used the qualitative research approach, and collected data from Taiwan Alzheimer`s Disease Association and included semi-structured in-depth interviews with four caregivers of the elderly with dementia. The research findings were listed below:\n1.We studied the following three supportive programs and analyzed their similarities and differences: the School of Wisdom, the Family of Wisdom, and the Family Club. (1) As the group progresses from the School of Wisdom to the Family of Wisdom, family members have more and more time to spend together and respite time; they also tend to show more care for others. (2) As the group progresses from the School of Wisdom to the Family Club, unorganized group gatherings evolve into organized gatherings for members of the group. (3) The target participants for the School, the Family and the Club are, respectively, senile seniors, seniors and their families, and families; the beneficiaries of the programs are seniors, families, and families. However, there is also an interrelation between seniors and their families: families who benefit from improved mental, physical and spiritual health are better able to care for their seniors. Vice versa, it is easier for families to care for seniors who are able to maintain or mitigate the degeneration of their daily functions.\n2.The needs and motivations of families are pivotal drivers for supportive programs. Throughout the evolution from the "School" to the "Family", families and seniors go through three stages of participation in activities, namely, mahjong classes, cooking classes and hobby classes. The progress reveals the families` need for respite time and space and their levels of participation. \n3.Families enjoy a restorative mental break by participating in activities. We analyzed the key elements of this mental break: leisure and rest, self-efficacy, belongingness, and level of participation. (1) Leisure and rest: display of talent, enjoyment of talking, and enhanced satisfaction toward life. (2) Self-efficacy: enhanced self-efficacy through the process of learning, breakthrough and sense of achievement. (3) Belongingness: the sense of belonging to a group. (4) Level of participation: the sense of mission to contribute to the society and meaning of life demonstrated by the families show an evolution from being the caregiver to the one who helps others.