呼吸器依賴老人之中老年女性照顧家屬的生活世界

本研究目的主要藉由詮釋現象學研究方法，瞭解呼吸器依賴老人之中老年女性照顧家屬的生活經驗，及詮釋生活經驗所帶來的意義，進而了解她們的生活世界。應用質性研究方式，以半結構開放式大綱對呼吸器依賴老人之中老年女性照顧家屬做深度訪談，共收取17個家庭之19名女性照顧家屬。訪談內容均在受訪者同意下進行與錄音，事後並謄成文字稿分析，歸納出17個受訪家庭女性照顧家屬的生活世界。 17個家庭之呼吸器依賴老人平均年齡79.47±9.24歲（範圍65-96），其中男性9人，女性8人；受訪女性家屬平均年齡60.63±7.92歲（範圍50-82），其中受訪女性和老人的關係有7位是配偶（37%）、8位是女兒（42%）、4位是媳婦（21%）；17個家庭中有11個家庭雇請外籍看護工協助照顧（65%）；使用侵襲型呼吸器的老人有6位（35%），非侵襲型的有11位（65%）；受訪女性照顧呼吸器依賴老人的時間為4個月到10年。　　從受訪女性的故事文本裡，綜合分析及詮釋，共分析出呼吸器依賴老人的中老年女性照顧者生活世界的三個故事軸（一）呼吸器的意涵、（二）生活詮釋、（三）生活歷程。生活詮釋包括四個主題（一）維生/責任：做最好的選擇、（二）綁住：生活的變化無形枷鎖、（三）調適：尋找平衡點、（四）鏡照：從病人的現在看到自己的未來。而她們的生活歷程包含三階段（一）磨合探索階段、（二）適應調和階段、（三）接受昇華階段。研究發現每位受訪女性家屬其生活世界的背後蘊藏著不同的故事，不管當初她如何成為照顧者，在多重角色下她們會去尋求她自己的平衡點，隨著個人自己的生活經驗及心態做調整，且藉由照顧而轉化看到自己的未來。研究也發現其目前生活經歷會影響她們自己未來的人生規劃及老後生活，也發現影響她們生活的共生模式，它影響著照顧者與被照顧者的生活。研究最後在臨床照護、教育、政策、照顧家屬方面提出幾點看法，尤其在居家照護上應以〝病人—家屬〞為中心的照護，且希望在長照新政策實施同時也能多關注這群夾心世代的女性，幫助她們揮灑更美好的人生。

關鍵字

老人；呼吸器依賴病人；女性；照顧家屬；生活世界

並列摘要

Objective: This study focused on middle-aged and elderly female family caregiver. The purpose was to understand the life experience and mentality of middle-aged and elderly female family caregiver of the elder with ventilator-dependent, to interpret the meaning of life experience, and further to understand their living world. Methods: A qualitative research design was based on hermeneutic phenomenological methodology. Interviews used semi-structured with open-ended outline doing in-depth interviews to middle-aged and elderly female family caregiver of the elder with ventilator-dependent. The total number of participants was 19 (17 families). Interviews were carried out with the consent of the participants and recording, afterwards and transcripts into text-by-word line by line analysis. Each interview recording was transcribed verbatim and coding. The analysis via inductive, integration, hermeneutic circle became the integration of certain categories or themes. Results: The average age of the ventilator-dependent patients was 79.47±9.24 years (Range 65-96); the average age of female caregivers was 60.63±7.92 years (Range 50-82). Relationship with the patient, there were 7 wives, 8 daughters, and 4 daughters-in-law. There were 11 out of 17 families had foreign workers (65%) . In addition, the life stories of the 17 families were presented, and a comprehensive analysis of their living world were divided into four axial: (1) Life support / responsibility: Making the best, (2) Tie: Life changes like invisible manacles, (3) Adjustment: Finding the new balance, (4) Mirror: A reflection of one’s future from the present status of a patient. Their living world consisted three stages: run – in / exploration phase, adapt / adjustment phase, accept / sublimation phase. Conclusions: Middle-aged and elderly female family caregiver often had multiple roles. No matter how the reason becoming caregiver, she needed to seek her own balance, with the individual's own life experience and attitude to do the adjustment. And by care and transform, they saw their own future. The study found that the current life and future life images were related, and would affect the caregiver's future life planning and the old life. Further this study found a co-life theory (model) that affected the caregiver's life. In the future, clinical care to provide home care should be "patient - family" as the center of care, could not ignore the main family caregiver. Finally, some suggestions on the government, medical professionals, and family caregiver, hope we could more attention to these sandwich generation of female, to help them sway a better life.