從「我們」到「我」- 失智症高齡伴侶照顧者於心理調適歷程之自我照顧

本研究旨在探討失智症高齡伴侶照顧者於自我照顧時心理狀態的轉變、以及了解照顧者本身所具有的內在資源對此調適歷程之影響。研究者以質性研究取向，邀請一位男性及兩位女性研究參與者，以半結構訪談大綱之方式進行訪談。研究者先以敘事分析中之「整體-內容」方法對參與者在照顧歷程進行分析，再以「類別-內容」之分析觀點整理照顧者在自我照顧過程中出現的主題內涵，研究結果發現：一、使用自我照顧角度來審視照顧過程時，能夠將照顧者放於較主動之位置，來探討照顧者照顧自己之狀態。當關注於自我照顧，照顧者將更可能發覺自身之力量，進而維持較佳身心狀態。此外，這樣的關注角度亦可加強照顧過程中之希望感，而非僅接受照顧工作之被動角色。二、而照顧者內在資源的應用對於自我照顧有十分重要之影響，除了直接影響其自我照顧的效果以外，也會間接影響照顧者如何善用社會資源提供之協助。因此，內在資源之應用是照顧者自我照顧時一關鍵的要素；另外失智症高齡伴侶照顧者於自我照顧歷程中會呈現循環歷程，其進程分別為「因應期」、「調適期」與「平衡期」。進入照顧歷程後，若照顧者之自我照顧方向合適且有效能，則可幫助自己朝向「平衡期」發展，但若自我照顧之方向並不合適，則可能發生停滯或是往回循環的現象。三、在伴侶照顧工作中顯現之情義與法律約束於照顧關係中的角色，皆是高齡伴侶照顧者有別於一般照護工作之獨特面向。從本研究分析中可了解到，無論是情義或是法律，兩者皆為照顧者願意繼續維持照顧關係中重要之因素，並且，兩者於不同時期所擔任之角色與平衡尤為重要。最後，本研究對於未來實務工作者也提出相關建議，包括協助發掘照顧者內在資源進而達成自我照顧、多元文化的敏感度的重視、心理諮商工作介入的必要性、以及社會資源介入之相關建議等。

關鍵字

失智症；高齡照顧者；自我照顧

並列摘要

This research aimed to investigate psychological adjustment in eldery caregivers' self-care process during caring for their partners with dementia, and attempted to understand the influence of internal resources on their adjustment processes. The research method was qualitative research with one male and two females who were invited to this research as participants through open recruitment, and semi-structured interview was used in this study.‘Holistic-content’ and ‘categorical-content’ approaches of narrative research were applied to understand the stories of these elderly caregivers to, and to analyze and compare their self-care process while caring for elderly partners with dementia. Several conclusions were made as follows: 1. Addressing the issue of self-care could give scope to caregivers’ initiative in taking care of themselves. While focusing on self-care process, caregivers could discover their inner strength to maintain better mental condition as well as increase hope in caring process. 2. Utilizing internal resources was crucial in caregivers' self-care processes. In addition to its direct effect on the self-care process, the use of internal resources also increased the caregiver’s ability to apply social resources. 3. A cyclical course was found in caregivers' self-care processes during caring for elderly partners with dementia. Three stages of self-care processes were discovered: “reaction stage,” “adjustment stage,” and “balance stage.” If the caregiver’s self-care method was effective, then he/she could help himself/herself moving forward to “balance stage,” otherwise the phenomenon of moving backward to previous stage or remaining stagnant might occur. 4. The affect and binding force of law in marriage ties played important roles in the caring process, and these were special dimensions deserved to be mentioned while addressing issues in caregivers who were caring for elderly partner with dementia. The researcher found that the affect and binding force of law in marriage could help maintaining caring relationship, and these two elements also had different influences in different stages. Finally, the researcher provided several suggestions for practical works, including the importance of helping elderly caregivers discover internal resources, the emphasis of multicultural sensitivity, the necessity of counseling intervention, and some advices regarding the assistance from social resources,etc.