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題名 鄉村型態安寧照顧者之照顧處境探究：以「居家」為視域
Exploring the caring situatedness of family members as caregivers of terminal patients in home-based palliative care model : From the perspective of “Homelikeness”作者 王雅婷
Wang, Ya Ting貢獻者 林耀盛
Lin, Yaw Sheng
王雅婷
Wang, Ya Ting關鍵詞 社區醫療
現象學心理學
棲居
居家照顧處境
家屬照顧者
community medicine
phenomenological psychology
dwelling
home-based caring situatedness
family caregivers日期 2017 上傳時間 8-二月-2017 16:50:50 (UTC+8) 摘要 社區安寧療護的推展以「居家存有」為中心，以身心整體照顧為導向的醫療，與全然「醫療權力」視角不同。本研究嘗試探討家屬照顧者於居家安寧照顧處境下的經驗，嘗試以「倫理關係」思考居家型的照顧內涵。 本研究透過田野參與觀察及深度訪談法，以北部某醫療院所提供之社區安寧療護服務區域為田野，訪談接受社區安寧照護之五位家屬主要照顧者。資料分析依現象學心理學分析方法（李維倫、賴憶嫺，2009）。而後，邀請兩名受訪者，對資料的組織脈絡描述及其所驅動的主題置身結構，予以交叉討論與分享，提昇質性研究可靠度的品質。 研究結果發現，鄉村型態安寧照顧者的置身經驗中，呈現出一種「鄉村型態的寓居」混合狀態，既安居又陌生的處境。一方面，參與者經驗到的棲居地域，並不侷限於家屋建築或特定地域，更是對地方的認同與情感的依附，從而開展自我「寓居於世」的「照顧者棲居」樣態；另一方面，照顧事件的衝擊，為照顧者帶來一種既熟悉又陌生的詭譎「無居家感」（uncanny）狀態。然而，如此看似矛盾處境，反使其於居家照顧處境之倫理凝視中，啟動反身窺探自我生命，以及於居家照顧處境中與他者間關係的梳理，進一步帶出「居家照顧作為一倫理行動」，進而深刻化「照顧自己/關切他人」的倫理意涵。 由此發現，鄉村型態居家照顧經驗之置身結構，可為與其相似處境之居家照顧者提供置身經驗之參考，並據以推動社區安寧方案的規劃。
The goal of the home-based palliative care model is to facilitate the patients and their family to feel “being at home.” Differ from the perspective of the “power domination in medical regime,” the home-based palliative care model focuses on the ethical relationship besides the bio-psycho-social care aspects. This study aims to understand the caring situatedness of family members as caregivers in home-based palliative care model, and try to disclose the sense of homelikeness through the caring relationship. We applied the participatory observation and depth interview to collect data. Five family caregivers who agreed the informed consent were recruited from home-based palliative care service in northern Taiwan and were interviewed twice. Interviews were recorded, transcribed, and analyzed by a phenomenological psychology method. The results revealed that there is ambivalent caring experience towards “dwelling in the community-home”. The experiences they felt seemed both strange and familiar. On the one hand, the caregivers’ dwelling pattern of being-in-the-world was constructed from the perspective of human-environment comfortable relationship (sense of feeling at home); on the other hand, they are bothered and struck by the caring problem, they faced the new challenges and thrown into the situation of “uncanny.” It is an unhomelike being-in-the-world in which Da-sein takes on alien and uncanny qualities. However, the two caring modes manifested the meaning of existentiality. Immersed in this situation, caring is not only the labor work, it is also the ethical act to respond the worrisome emotion and regain the relationships with others during the caring experiences. Ethical caring is the cornerstone of relational understanding towards the human subjectivity rather than the medical positivism. 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國立政治大學
輔導與諮商碩士學位學程(MPCG)
102172003資料來源 http://thesis.lib.nccu.edu.tw/record/#G0102172003 資料類型 thesis dc.contributor.advisor 林耀盛 zh_TW dc.contributor.advisor Lin, Yaw Sheng en_US dc.contributor.author (作者) 王雅婷 zh_TW dc.contributor.author (作者) Wang, Ya Ting en_US dc.creator (作者) 王雅婷 zh_TW dc.creator (作者) Wang, Ya Ting en_US dc.date (日期) 2017 en_US dc.date.accessioned 8-二月-2017 16:50:50 (UTC+8) - dc.date.available 8-二月-2017 16:50:50 (UTC+8) - dc.date.issued (上傳時間) 8-二月-2017 16:50:50 (UTC+8) - dc.identifier (其他 識別碼) G0102172003 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/106476 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 輔導與諮商碩士學位學程(MPCG) zh_TW dc.description (描述) 102172003 zh_TW dc.description.abstract (摘要) 社區安寧療護的推展以「居家存有」為中心，以身心整體照顧為導向的醫療，與全然「醫療權力」視角不同。本研究嘗試探討家屬照顧者於居家安寧照顧處境下的經驗，嘗試以「倫理關係」思考居家型的照顧內涵。 本研究透過田野參與觀察及深度訪談法，以北部某醫療院所提供之社區安寧療護服務區域為田野，訪談接受社區安寧照護之五位家屬主要照顧者。資料分析依現象學心理學分析方法（李維倫、賴憶嫺，2009）。而後，邀請兩名受訪者，對資料的組織脈絡描述及其所驅動的主題置身結構，予以交叉討論與分享，提昇質性研究可靠度的品質。 研究結果發現，鄉村型態安寧照顧者的置身經驗中，呈現出一種「鄉村型態的寓居」混合狀態，既安居又陌生的處境。一方面，參與者經驗到的棲居地域，並不侷限於家屋建築或特定地域，更是對地方的認同與情感的依附，從而開展自我「寓居於世」的「照顧者棲居」樣態；另一方面，照顧事件的衝擊，為照顧者帶來一種既熟悉又陌生的詭譎「無居家感」（uncanny）狀態。然而，如此看似矛盾處境，反使其於居家照顧處境之倫理凝視中，啟動反身窺探自我生命，以及於居家照顧處境中與他者間關係的梳理，進一步帶出「居家照顧作為一倫理行動」，進而深刻化「照顧自己/關切他人」的倫理意涵。 由此發現，鄉村型態居家照顧經驗之置身結構，可為與其相似處境之居家照顧者提供置身經驗之參考，並據以推動社區安寧方案的規劃。 zh_TW dc.description.abstract (摘要) The goal of the home-based palliative care model is to facilitate the patients and their family to feel “being at home.” Differ from the perspective of the “power domination in medical regime,” the home-based palliative care model focuses on the ethical relationship besides the bio-psycho-social care aspects. This study aims to understand the caring situatedness of family members as caregivers in home-based palliative care model, and try to disclose the sense of homelikeness through the caring relationship. We applied the participatory observation and depth interview to collect data. Five family caregivers who agreed the informed consent were recruited from home-based palliative care service in northern Taiwan and were interviewed twice. Interviews were recorded, transcribed, and analyzed by a phenomenological psychology method. The results revealed that there is ambivalent caring experience towards “dwelling in the community-home”. The experiences they felt seemed both strange and familiar. On the one hand, the caregivers’ dwelling pattern of being-in-the-world was constructed from the perspective of human-environment comfortable relationship (sense of feeling at home); on the other hand, they are bothered and struck by the caring problem, they faced the new challenges and thrown into the situation of “uncanny.” It is an unhomelike being-in-the-world in which Da-sein takes on alien and uncanny qualities. However, the two caring modes manifested the meaning of existentiality. Immersed in this situation, caring is not only the labor work, it is also the ethical act to respond the worrisome emotion and regain the relationships with others during the caring experiences. Ethical caring is the cornerstone of relational understanding towards the human subjectivity rather than the medical positivism. By elaborating the situatedness of home-based palliative care model, further planning of the community-based palliative care model in similar situation may base on this study outcome implication. en_US dc.description.tableofcontents 第一章 緒論 1第二章 文獻探討 5 第一節、社區安寧療護狀態與發展 5 第二節、居家安寧家屬照顧者處境 8 第三節、研究問題與目的 18第三章 研究方法 19 第一節、研究取徑 19 第二節、研究田野與對象 20 第三節、研究流程 21 第四節、資料分析方法 22第四章 結果分析 24 第一節、受訪者的背景資料描述 24 第二節、鄉村型態居家照顧者的置身處境 25第五章 綜合討論 41 第一節、照顧者的棲居 41 第二節、居家照顧作為一倫理行動 43 第三節、文化母體樣態的殘存牽引 46第六章、小結 49 第一節、研究貢獻與反思 50 第二節、研究限制與建議 52參考文獻 54 zh_TW dc.format.extent 2114003 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0102172003 en_US dc.subject (關鍵詞) 社區醫療 zh_TW dc.subject (關鍵詞) 現象學心理學 zh_TW dc.subject (關鍵詞) 棲居 zh_TW dc.subject (關鍵詞) 居家照顧處境 zh_TW dc.subject (關鍵詞) 家屬照顧者 zh_TW dc.subject (關鍵詞) community medicine en_US dc.subject (關鍵詞) phenomenological psychology en_US dc.subject (關鍵詞) dwelling en_US dc.subject (關鍵詞) home-based caring situatedness en_US dc.subject (關鍵詞) family caregivers en_US dc.title (題名) 鄉村型態安寧照顧者之照顧處境探究：以「居家」為視域 zh_TW dc.title (題名) Exploring the caring situatedness of family members as caregivers of terminal patients in home-based palliative care model : From the perspective of “Homelikeness” en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 中文文獻王應棠（2009）。棲居與空間：海德格空間思維的轉折。地理學報，（55），25-42。doi:10.6161/jgs.2009.55.02。石世明（譯）（2012）。什麼讓治療產生治療性？（原作者：Kunz, G.）。中華團體心理治療，18（2），3-17。汪文聖（2003）。本土精神病患照顧倫理的現象學探討。本土心理學研究，（19），65-108。doi:10.6254/2003.19.65。汪文聖（2007）。一葉一如來：精神病院研究個案所反映的醫護現象學意義。應用心理研究（34），113-144。何雪綾（2015）。社區醫療照護模式中末期患者家屬參與患者之「預立醫療計劃討論」的心理歷程特徵（博士論文）。取自華藝線上圖書館系統。（系統編號U0001-0408201500370800）。利翠珊（2002）。婆媳與母女：不同世代女性家庭經驗的觀點差異。女學學誌：婦女與性別研究，（13），179-218。doi:10.6255/JWGS.2002.13.179。李維倫（2016）。從實證心理學到實踐心理學學：現象學心理學的本土化知識之道。台灣心理諮商季刊，8（2），1-15。李維倫、賴憶嫺（2009）。現象學方法論：存在行動的投入。中華輔導與諮商學報（25），275-321。余德慧（2000）。臨終病人的事實處境：臨終的開顯。安寧療護雜誌，5（2），29-32。余德慧（2006）。臨終心理與陪伴研究。台北：心靈工坊文化。余德慧、林耀盛（2012）。生死學在台灣的文化沉思。見廖欽彬（編輯校正）「朝往東亞的生死學：台日國際硏討會特集」，頁47-63。東京：東京大學大學院人文社會系研究科。胡文郁（2004）。台灣文化脈絡下癌末患者之生活品質。台灣醫學，8（5），688-697。林秀純、徐亞瑛、姚開屏、吳淑瓊（1999）。台灣北部地區失能老人家庭照顧品質及相關因素之探討。護理研究，7，15-28。林維君、黃文聰、廖純真、謝玉娟、邱智鈴、夏德瑛、曹朝榮（2003）。安寧病房中家屬照顧者的資訊需求。安寧療護雜誌，8（2），161-174。林德祐（2016）。從沙粒到珍珠：西呂尼克與心理韌性的跨領域編織。載於謝幸芬、林德祐（譯），心理韌性的力量：從創傷中自我超越。台北：心靈工坊文化。林耀盛（2006）。聆聽受苦之聲：從“咱們”關係析究慢性病照顧。應用心理研究（29），183-212。 林耀盛（2009）。逆向呈現與過度呈現之間：慢性病患者的身心受苦經驗。生死學研究，（9），1-43。林耀盛（2011）。精神分析取向心理病理學講稿。未發表之手稿。林耀盛（2012）。因應多樣性與效用性：慢性病門診病人的疾病因應方式。生死學研究，（13），83-119。林耀盛（2015）。放與不放間，身心千萬難？堅持與放手，一念之間。張老師月刊，455，10-14。林耀盛（2016a）。字化成宇：從象徵到真實。中央大學人文學報，（61），27+29-53。林耀盛（2016b）。實證論陰影及其超越：迂迴或直面。台灣心理諮商季刊，8（2），36-43。林耀盛（2016c）。坦塔洛斯的困題：思「反」心理學，批判社群革「心」。論文發表於第五十五屆臺灣心理學年會。台南：成功大學。林耀盛、邱子芸（2015）。臨終處境的陪伴轉化：癌末病患及其照顧者心理經驗與存在現象探究。中華心理衛生學刊，28（2），189-219。林耀盛、李弘毅（2016）。朝向疾病的療癒：血液透析者心理經驗之詮釋。本土心理學研究，（45），129-174。doi:10.6254/2016.45.129。林耀盛、吳英璋（2004）。雙重變奏曲：探究「九二一」地震「失親家毀」受創者之心理經驗現象。中華心理衛生學刊，17（2），1-41。林耀盛、陳玫蓉（2009）。「和而不同」的生病事件建構：以對偶關係探究腸造口癌症患者及其照顧者的心理生活經驗。本土心理學研究，（32），251-325。doi:10.6254/2009.32.251。林耀盛、蔡逸鈴（2012）。不可承受之重：癌末主要照顧者的心思經驗探究。教育與心理研究，35，37-66。林耀盛、龔卓軍（2009）。我的傷口先於我存在？從創傷的精神分析術到倫理現象學作為本土心理治療的轉化。應用心理研究，(41)，185-234。張維真、林耀盛（2012）。天然災害倖存者的心理現象：以八八風災災民為例。高雄行為科學學刊，（3），95-124。張榮哲、林耀盛（2012）。家庭醫學中的醫病關係與人性關懷。台灣醫學，16，660-666。doi:10.6320/FJM.2012.16(6).11。費孝通（1948）。鄉土中國。上海：觀察社。彭富春（譯）（1991）。詩・語言・思（原作者：Heidegger, M.）。北京：文化藝術出版社。（原著出版年：1971）。彭榮邦、廖婉如（譯）（2012）。好走（原作者：Singh, K. 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