護理之家住民生活經驗之探討

醫學的進步大大的延長國人的壽命，兩性平均壽命也增加，使得老年人口也相對提升。他們的身體功能隨著老化提高了失能狀況，又在少子化的衝擊下，家屬無力照顧，長期照顧機構則是一種選擇。老人在機構內生活，已是社會的趨勢之一。團體式的生活步調，顯然與家中生活不同，生活型態的改變對老人而言是一項很大的挑戰。國內以長照機構為研究對象者，皆以養護機構或安養中心居多，以護理之家作為研究對象，也僅著重於初期生活適應遷移症候群的研究居多；而對於護理之家長期入住之住民，只針對探討對象的生活經驗則較少。因此，本研究目的是想了解護理之家住民的生活經驗。本研究採立意取樣，參與者為護理之家之住民。以質性訪談方式收集資料，直到資料飽和共收集九位住民，並利用內容分析法將資料做歸納與整理。研究結果共有三個主題十二個次主題，分別為(一)「生活樣態」：接受日常生活層面照顧、接受人際互動層面照顧、接受環境層面的服務、接受醫療層面的照顧(二)「生活反影生命」：生活層面的衝擊、環境層面的衝擊、身體層面的衝擊、社會層面的衝擊、心理層面的衝擊 (三)「自我轉化」：採用直接行動、採用心理調適、及尋求支持系統。本研究依結果提出以下建議包括 (一)機構宜增聘足夠的照顧人員滿足住民的需求；(二)改善住民人際互動關係與團體活動的策略； (三)研擬住民日常生活服務改善措施； (四)增加住民之自主性與受尊重感； (五)改善住民易跌倒與異味環境的問題； (六)改善住民身體困擾問題； (七)提供心理或諮商輔導，協助改善住民心理問題； (八)強調增進新入住住民溝通之重要性。期望本研究能協助了解機構中住民的生活經驗，提供引導長期照顧機構照護人員作為照護問題之參考。因而達到老年人生活於機構中，擁有「去機構化」及人性化的照顧。

關鍵字

住民；生活經驗；護理之家

並列摘要

Advancements in the field of medicine have greatly prolonged the life of Taiwanese people. And the average life expectancy of both sexes has also increased. These have resulted in a corresponding rise in the aged population. Along with aging, the extent of disabilities of their physical functions increases. And under the impact of a low birth rate, their family members are unable to take care of them, with long-term caring facilities being an option. The elderly living in facilities has already become one of the social trends. The tempo of group life is obviously different from that of life at home. This change in the way of life is indeed a very great challenge to the elderly. In Taiwan, studies with long-term care facilities as the research subject focus more on care facilities or retirement centers. Those taking nursing home as the research subject mostly center on the relocation syndrome in the elderly’s life adaptation in the early stage, with relatively few studies only concentrating the investigation on the life experiences of long-term nursing home residents for their own sake. Therefore, the purpose of this study is to understand the life experiences of nursing home residents. This study employed the method of purposive sampling, with participants living in nursing home. Data were collected by qualitative interviews with nine residents until data saturation were reached; which was followed by a content analysis to sum up and sort out the data. The research findings contain a total of three themes subdivided into twelve subthemes , they are as follows: (1) “forms of life” : accepting care in the dimension of daily life, accepting care in the dimension of interpersonal interaction, accepting care in the environmental dimension, and accepting care in the medical dimension; (2) “life impacting life” : impacts on the life dimension, impacts on the environmental dimension, impacts on the body dimension, impacts on the social dimension, and impacts on the psychological dimension; (3) “self-transformation” : adopting direct actions, adopting psychological adjustment, and seeking support system. Based on the findings of the research, some recommendations were made: (1) to hire sufficient care providers to meet the needs of residents; (2) to improve the relationship of interpersonal interaction for residents and the strategies of group activities; (3) to make strategies to improve the daily life services for residents; (4) to increase residents’ autonomy and sense of being respected; (5) to ameliorate the problems of residents’ proneness to fall and smelly environment; (6) to ameliorate the problem of residents’ physical distress; (7) to offer psychological or consultative counseling to help ameliorate residents’ psychological problems; and (8) to emphasize the importance of increasing communication with new residents. It is hoped that this study can be of help in understanding the life experiences of residents in long-term care facilities, and that it can serve as a reference for the care providers in such facilities in respect of care problems. So that, the elderly living in these facilities receive “deinstitutionalized” and humanized care.