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題名 哀傷的時間性：癌末病患照顧者與過世病人之關係流變與倫理連結
Grieving temporality: the “becoming” relationship and ethical bond between caregivers and deceased patients
作者 李宛霖
Lee, Wan-Lin
貢獻者 林耀盛<br>姜忠信
李宛霖
Lee, Wan-Lin
關鍵詞 喪親悲傷
照顧者
持續性連結
縱貫式研究
Bereavement
Caregiver
Continuing bonds
Longitudinal study
日期 2019
上傳時間 7-Aug-2019 16:33:59 (UTC+8)
摘要 陪伴至親的臨終過程會帶來巨大的痛苦，在癌末臨終處境，不僅末期病患深受折磨，照顧者亦陷落受苦深淵。在受苦時刻，喪親經驗也帶出重新認識「關係」（relationship）的可能性。過去的悲傷研究多將重點放在悲傷適應的結果，而忽略探究喪親者與逝者間的關係本質與悲傷的歷程性。本研究擬融合不同的知識論典範，以質化與量化研究並進的方式釐清研究問題。研究目的在嘗試與西方持續性連結理論進行對話，懸置悲傷適應論的框架，進而從關係取向理解悲傷現象，故在知識論上，將以量化實徵論與詮釋現象學兩種取向進行問題探究。在研究一中，研究者擬修訂西方的悲傷量表與持續性連結量表，以增加工具本身的文化適切度。研究二以研究一所發展之量表工具，對臺灣癌末病患家屬從病人過世前，至病人過世後半年至一年的期間進行縱貫式追蹤研究。研究三將同時以量表與質性訪談持續追蹤數位家屬，整合量化資料與質性訪談的研究結果，分析末期病患家屬如何在悲傷歷程當中安置逝者，藉此對持續性連結理論做出修正，並提出一套適合解釋臺灣喪親悲傷現象的理論模式。透過三個子研究的整合，研究發現臨終照顧到喪親悲傷的過程，是空間、時間、關係和倫理的軌跡：（1）量化的悲傷軌跡給出的是均值的線性悲傷時間，但喪親者的悲傷敘事帶出深度安靜的存有時間，量表分數回答的是「什麼」（what），但無法捕捉敘事時間綿延皺褶的「如何」（how）。（2）關係默化是地下莖（塊莖）式的流變，斷而未斷的關係存有連結，內化與外化不再是二分的關係類型，而是可以並置、超越、或是交錯的意義。（3）家庭倫理連結的流動是臺灣本土喪親現象的重要意涵，這也使得喪親研究需轉向「關係」，西方的心理韌性、照顧負荷論與持續性連結理論，都可嘗試以關係先於主體的認識論重新探究之。最後，本研究提出哀傷的時間性是朝向生命缺口的倫理學，並討論應用於悲傷陪伴的可能性與未來研究方向。
Caring for terminally ill people causes great suffering for caregivers. At the same time, for the bereaved caregiver, the experience from caring to grieving also brings out the possibility to review the relationship with the patient. The aim of the study was to understand the bereavement process with a vision of relationship. Using mixed-method design, the present study suspended the grief adaptation framework in mainstream psychology, exploring the grieving process and the nature of relationship with patient in Taiwanese bereaved caregivers. In study 1, the authors developed Chinese version of HGRC and R-CBS. In study 2, using the instruments developed in study 1, we investigated grief and CB reactions in caregivers of cancer patients at the time points of pre-loss and post-loss within 1 year. In study 3, we conducted a convergent mixed method design, using both quantitative instruments data and qualitative narrative texts to understand the way that the caregivers make sense of relationship with the deceased patients. By integrating results of three studies, we’ve found that the process from caring to grieving is crisscross of time, space, relation and ethics. First, the quantitative grief trajectories are the average scores derived from the population norm. The quantitative scores represented chronological time and certainly answered the question of ’what’ outcome. But grief narratives were deep folds of duration, which escape from the measure of chronological time. Second, relationship with the deceased was the process of ‘becoming’. The silent transformation of relationship went beyond the binary classification of internalized and externalized CB. Third, the re-cathexis of ethical bond had significant meaning in Taiwanese bereaved caregivers. We suggest to reinvestigate the western concept of resilience, caring burden and continuing bonds theory using the relational approach. Finally, our study proposed a theory of grieving temporality, emphasizing the infinite ethic toward the Other. Findings have both theoretical and clinical implications.
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描述 博士
國立政治大學
心理學系
101752501
資料來源 http://thesis.lib.nccu.edu.tw/record/#G1017525011
資料類型 thesis
dc.contributor.advisor 林耀盛<br>姜忠信zh_TW
dc.contributor.author (Authors) 李宛霖zh_TW
dc.contributor.author (Authors) Lee, Wan-Linen_US
dc.creator (作者) 李宛霖zh_TW
dc.creator (作者) Lee, Wan-Linen_US
dc.date (日期) 2019en_US
dc.date.accessioned 7-Aug-2019 16:33:59 (UTC+8)-
dc.date.available 7-Aug-2019 16:33:59 (UTC+8)-
dc.date.issued (上傳時間) 7-Aug-2019 16:33:59 (UTC+8)-
dc.identifier (Other Identifiers) G1017525011en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/124862-
dc.description (描述) 博士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 心理學系zh_TW
dc.description (描述) 101752501zh_TW
dc.description.abstract (摘要) 陪伴至親的臨終過程會帶來巨大的痛苦，在癌末臨終處境，不僅末期病患深受折磨，照顧者亦陷落受苦深淵。在受苦時刻，喪親經驗也帶出重新認識「關係」（relationship）的可能性。過去的悲傷研究多將重點放在悲傷適應的結果，而忽略探究喪親者與逝者間的關係本質與悲傷的歷程性。本研究擬融合不同的知識論典範，以質化與量化研究並進的方式釐清研究問題。研究目的在嘗試與西方持續性連結理論進行對話，懸置悲傷適應論的框架，進而從關係取向理解悲傷現象，故在知識論上，將以量化實徵論與詮釋現象學兩種取向進行問題探究。在研究一中，研究者擬修訂西方的悲傷量表與持續性連結量表，以增加工具本身的文化適切度。研究二以研究一所發展之量表工具，對臺灣癌末病患家屬從病人過世前，至病人過世後半年至一年的期間進行縱貫式追蹤研究。研究三將同時以量表與質性訪談持續追蹤數位家屬，整合量化資料與質性訪談的研究結果，分析末期病患家屬如何在悲傷歷程當中安置逝者，藉此對持續性連結理論做出修正，並提出一套適合解釋臺灣喪親悲傷現象的理論模式。透過三個子研究的整合，研究發現臨終照顧到喪親悲傷的過程，是空間、時間、關係和倫理的軌跡：（1）量化的悲傷軌跡給出的是均值的線性悲傷時間，但喪親者的悲傷敘事帶出深度安靜的存有時間，量表分數回答的是「什麼」（what），但無法捕捉敘事時間綿延皺褶的「如何」（how）。（2）關係默化是地下莖（塊莖）式的流變，斷而未斷的關係存有連結，內化與外化不再是二分的關係類型，而是可以並置、超越、或是交錯的意義。（3）家庭倫理連結的流動是臺灣本土喪親現象的重要意涵，這也使得喪親研究需轉向「關係」，西方的心理韌性、照顧負荷論與持續性連結理論，都可嘗試以關係先於主體的認識論重新探究之。最後，本研究提出哀傷的時間性是朝向生命缺口的倫理學，並討論應用於悲傷陪伴的可能性與未來研究方向。zh_TW
dc.description.abstract (摘要) Caring for terminally ill people causes great suffering for caregivers. At the same time, for the bereaved caregiver, the experience from caring to grieving also brings out the possibility to review the relationship with the patient. The aim of the study was to understand the bereavement process with a vision of relationship. Using mixed-method design, the present study suspended the grief adaptation framework in mainstream psychology, exploring the grieving process and the nature of relationship with patient in Taiwanese bereaved caregivers. In study 1, the authors developed Chinese version of HGRC and R-CBS. In study 2, using the instruments developed in study 1, we investigated grief and CB reactions in caregivers of cancer patients at the time points of pre-loss and post-loss within 1 year. In study 3, we conducted a convergent mixed method design, using both quantitative instruments data and qualitative narrative texts to understand the way that the caregivers make sense of relationship with the deceased patients. By integrating results of three studies, we’ve found that the process from caring to grieving is crisscross of time, space, relation and ethics. First, the quantitative grief trajectories are the average scores derived from the population norm. The quantitative scores represented chronological time and certainly answered the question of ’what’ outcome. But grief narratives were deep folds of duration, which escape from the measure of chronological time. Second, relationship with the deceased was the process of ‘becoming’. The silent transformation of relationship went beyond the binary classification of internalized and externalized CB. Third, the re-cathexis of ethical bond had significant meaning in Taiwanese bereaved caregivers. We suggest to reinvestigate the western concept of resilience, caring burden and continuing bonds theory using the relational approach. Finally, our study proposed a theory of grieving temporality, emphasizing the infinite ethic toward the Other. Findings have both theoretical and clinical implications.en_US
dc.description.tableofcontents 摘要 i
Abstract ii
表目錄 vi
圖目錄 vii
前言 1
文獻回顧 3
1. 古典悲傷理論 3
2. 悲傷理論的演進 5
3. 持續性連結理論（continuing bonds theory）概述 7
4. 悲傷者與逝者的持續性連結：量化研究的不一致 9
5. 悲傷者與逝者的持續性連結：質性研究與量化研究結果不一致 11
6. 末期心理陪伴議題 19
現有研究限制與待解決議題 22
1. 悲傷適應論的限制 22
2. 西方悲傷理論解釋臺灣本土文化現象的限制 25
3. 末期病患照顧者的心理陪伴議題：悲傷是否有清楚的起始點？ 26
研究目的與架構 29
研究一 31
研究目的與方法論 31
研究方法 32
研究一 分析結果 43
研究一 討論 58
研究二 61
研究目的 61
研究方法 61
研究二 分析結果 66
研究三 74
研究目的 74
研究方法論 75
受訪者 78
研究工具 81
研究三 分析結果 85
綜合討論 130
喪親悲傷的倫理面向：方法論之間的相互補充與對話 130
追憶時刻啟動的悲傷：悲悼的時間皺褶、記憶與敘事 132
喪親後成長與希望的雙重面孔 136
關係的流變：與持續性連結理論的對話 137
未竟之事：回返喪親悲悼的原初倫理之地 140
研究貢獻、限制與未來研究方向 143
研究貢獻與臨床應用 143
研究限制與未來方向 144
參考文獻 145
附錄一：研究三受訪者的悲傷/成長變化與持續性連結變化圖 156
附錄二：HGRC中文版與R-CBS量表 164		zh_TW
dc.format.extent 2241356 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G1017525011en_US
dc.subject (關鍵詞) 喪親悲傷zh_TW
dc.subject (關鍵詞) 照顧者zh_TW
dc.subject (關鍵詞) 持續性連結zh_TW
dc.subject (關鍵詞) 縱貫式研究zh_TW
dc.subject (關鍵詞) Bereavementen_US
dc.subject (關鍵詞) Caregiveren_US
dc.subject (關鍵詞) Continuing bondsen_US
dc.subject (關鍵詞) Longitudinal studyen_US
dc.title (題名) 哀傷的時間性：癌末病患照顧者與過世病人之關係流變與倫理連結zh_TW
dc.title (題名) Grieving temporality: the “becoming” relationship and ethical bond between caregivers and deceased patientsen_US
dc.type (資料類型) thesisen_US
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dc.identifier.doi (DOI) 10.6814/NCCU201900642en_US