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    题名: 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
    贡献者: 林耀盛
    Lin, Yaw Sheng
    王雅婷
    Wang, Ya Ting
    关键词: 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
    上传时间: 2017-02-08 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. 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.
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