透過您的圖書館登入
IP:3.233.221.42
  • 學位論文

失智老人機構安置之家庭決策過程探討

An exploration of the decision making of institution placement among families with dementia elderly person

指導教授 : 張媚

摘要


【背景與目的】 由於失智是不可逆的疾病,會隨病情惡化加重照顧者的負擔,往往促使失智症群體成為機構式照顧的高危險群體。機構安置決策是一個動態且複雜的過程,雖然西方國家已有部份研究探討機構安置過程,但大多是針對失能老人或以照顧者為主要研究對象,以家庭為單位的決策過程研究還十分稀少,目前尚缺乏完整的理論可指引實務人員瞭解失智症老人家庭在台灣文化下之機構安置決策過程,因此,本研究旨在建構失智老人機構安置之家庭決策過程的理論架構。 【方法】 本研究使用採用茁根理論質性方法。主要的訪談對象是曾經考慮過機構安置或有機構安置經驗的失智老人家庭成員。資料收集以家庭為單位,每個家庭主要訪談對象至少包括主要照顧者及/或決策者。資料收集採面對面訪談,受訪家庭可以多位成員一起接受訪談,也可分別接受訪談,所有訪談均採錄音及逐字轉譯。資料分析主要應用ATLAS.ti資料分析軟體及持續比較策略。深度訪談22個家庭, 33位家庭成員接受訪談,總訪談次數為32次。受訪者中有19位女性,14位男性,年齡最小為37歲,最長為84歲,平均年齡為55.3歲。 【結果】 研究經分析後,發現家庭決定將失智老人安置到機構歷程之重要概念,形成「尋求認可與和諧的過程」。家庭採用「尋求認可與和諧過程」,是為了要維持機構安置決策過程中個人、家庭及社會價值關係的平衡與和諧。「尋求認可與和諧過程」包括四個過程要素分別為「覺察改變照顧的需求」、「照顧資源評價」、「家庭協商」、「發展鞏固認可策略」,這四個要素通常是需要一一達成,家庭方可完成機構安置決策的過程。這四個要素彼此互相影響及互動,呈現家庭決策過程一連串的評估及評價,是一個循環、且動態的過程。 【結論】 此模式可以供作解釋台灣社會脈絡中的決策過程及相關變項,研究結果可以豐富老人護理專業領域的理論基礎,提供給社區照護人員及個案管理人員家庭機構安置決策過程可能遭遇的問題、壓力及需求等相關知識,提升家庭照護品質,研究結果亦可作為未來發展失智老人照護政策之參考。

關鍵字

失智症 家庭 機構安置 決策過程 認可 和諧

並列摘要


【Background and specific aim】 The combination of the irreversible disease process of dementia and the progressively heavy caregiving load on families often makes dementia persons a high risk group for institutionalization. The decision making process to place a person in an institution is a complex and dynamic one. Some researches have been conducted in western countries exploring the decision-making process of institutionalizing a family member. However, in most of the studies on frail elders or on their primary caregivers, the research conducted specifically on the family unit was minimal or non-existing. To date, there is a lack of a sound theory to provide a guide for clinical practice to understand the family decision-making process of institutionalizing a family member in the Taiwanese culture, especially for families living with a dementia person. Thus, the purpose of this study was to develop a conceptual framework related to the decision making process by a family to institutionalize an elderly family member with dementia. 【Methods】 The grounded theory method was used in this study. The main participants were families that had experienced institutionalizing a relative with dementia, and families that were intending to do so. The data collection unit was the family. Each family participating in this study was interviewed which included at least the primary caregiver and/or the primary decision maker. Twenty-two families, including 32 family caregivers participated in the present study, and 32 face-to-face interviews were used to collect the data. The representative of each family could choose if they wanted the interviewer to interview only the representative of the family or several members of the family. All interviews were audio-recorded and then transcribed verbatim. ATLAS.ti soft ware and a comparative strategy were employed to analyze the data. The participants included 19 female and 14 male family caregivers, their ages ranged from 37 to 84 years, and their mean age was 55.3 years. 【Results】 The findings of our study revealed that “seeking for approval and synchronization” emerged as the core category from the family decision-making process of institutionalizing their relative with dementia. The “seeking for approval and synchronization” by the family caregivers was as a result of their desire to maintain a harmonious and balanced relationship between the individual, the entire family and society when going through the decision-making process to institutionalize their elderly family member with dementia. This “seeking for approval and synchronization” included four components: “recognizing the need of a change in the caregiving mode”, an appraisal of the institution care”, “family negotiation”, and “developing strategies to consolidate an agreement”. If a family completed these four components then they had finished their process of making their decision to institutionalize their elderly relative with dementia. These four components are interrelated and showed that there is continuity in the family decision making process. The process turns out to be circular and dynamic. 【Conclusion】 The findings of this study provide a conceptual model to explain the decision making process and its related variables to institutionalize an elderly relative with dementia, in the context of the Taiwanese society. The findings of this study enrich the theoretical base of the field of gerontological nursing by providing additional knowledge regarding the problems, stresses and needs of a family when going through the decision making process to institutionalize an elderly family member with dementia. This information will be useful to community health nurses and care managers, and promote the quality of family caregiving. Our findings also provide guidelines for the making of policies regarding this subject in Taiwan in the future.

參考文獻


胡幼慧、郭淑珍、王孝仙 (1996) 老人長期病患照顧者對取代方案之考量潛在需求與困境之分析•中華公共衛生雜誌,15(4),275-288。
林信男、蔡茂堂、林憲 (1984)•農村老年人之精神疾病:恆春研究•中華民國神經醫學會會刊,10(2),65-79。
吳淑瓊 (2003)•建構長期照護體系先導計畫(第三年計畫)•內政部委託研究。
林麗嬋、歐美、吳肖琪 (1997).長期照護中主要照顧者之家庭功能社會支持與情緒•護理研究,5(1),77-87.
徐亞瑛 (1996)•茁根理論介紹—「以台灣地區殘病老人家庭照護品質研究為例」•護理研究,4(3),263-271。

被引用紀錄


曾珮玲(2014)。失智症家庭照顧者之照顧負荷研究〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834%2fCSMU.2014.00143
吳勁儫(2013)。失智老人家庭雇用外籍看護工之經驗〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2013.10385

延伸閱讀