失智老人機構安置之家庭決策過程探討

黃秀梨

doi:10.6342/NTU.2009.01140

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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

黃秀梨 , Ph.D　　Advisor：張媚　　

繁體中文 DOI： 10.6342/NTU.2009.01140

失智症；家庭；機構安置；決策過程；認可；和諧； Dementia ； family ； institution placement ； decision making ； approval ； synchronization

Abstract │ Reference (189) │ Times Cited (2) │ Altmetrics

Abstract 〈TOP〉

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【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.

Reference ( 189 ) 〈TOP〉

王文芳、陳玉敏 (2004)•家屬安置老人於長期照護機構之經驗•長期照護雜誌，8(3)，327-344。
連結：
毛治國 (2003)•決策•台北：天下雜誌。
連結：
長期照護專業協會(2006，2月28日)•台閩地區機構式長期照護家數與床數分佈表---依機構類別分(至95.2.28)•2008年12月26日取自http://www.ltcpa.org.tw
連結：
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。
連結：
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．
連結：

Times Cited (2) 〈TOP〉

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