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  • 學位論文

嚴重慢性精神障礙者其手足照顧經驗之探究

The studying of sibling care experience in people with severe mental illness

指導教授 : 童伊廸

摘要


本研究之目的在了解影響嚴重慢性精障者其手足照顧態度之相關因素,亦同探索手足在面對精障者照顧工作時,在經驗上與角色上的處境,並進一步理解在照顧歷程當中的照顧者需求與照顧分工模式的形塑。最後根據研究發現與結果,提出具體之建議,提升家屬服務方案的品質,改善在精障者在雙重老化下,於代間照顧責任轉移時產生的困境,使精障者之照顧歷程得以延續與維持照顧品質,並期望引起大眾對於精障者手足照顧者以及其家庭之關注。 依據研究之目的,本研究運用質性研究之深度訪談法,訪問了一共九位嚴重慢性精神障礙者手足,將受訪者的經驗整理與分析後,歸納以下結果: 一、四種精障者手足承擔照顧工作的態度:分別為「欣然接受」、「勉強接受」、抗拒接受」、「迷惘」的照顧態度,愈正向的手足照顧態度,愈能夠積極的參與照顧工作,在代間移轉照顧責任的過程當中,亦有更高的意願承接照顧責任。 二、「一人為主,他人為輔」的照顧分工模式:在該分工模式當中,精障者的家庭將調整內部之照顧分工,除核心之主要照顧者承擔大部分的照顧責任與工作外,其於手足次系統往往扮演輔助性的照顧者角色。 三、兩種精障者手足照顧循環經驗:分別為「苦盡甘來的正向照顧經驗」與「心力交瘁的負向照顧經驗」,這些照顧經驗將在照顧歷程當中產生不同的正、負向的循環性影響,左右手足照顧品質與意願。 四、四種精障者手足對照顧責任的觀點:分別為「對照顧責任責無旁貸」、「對照顧責任感到抗拒與掙扎」、「僅願扮演輔助性照顧者角色」、「完全拒絕承擔照顧責任」四種對照顧責任的觀點。 五、心照不宣的精障者家庭代間照顧責任移轉:研究發現在女性手足比男性手足有更高的意願出面提供精障者照顧,並且代間照顧責任移轉的議題在親代間與子代間是鮮少討論的。 六、被忽視的精障者手足照顧者需求:精障者手足在「情感性需求」、「訊息性需求」、「實質服務性需求」三個層面有著不同程度的需求,並且手足在參與精障者照顧與治療的過程當中,是很少被重視與滿足的。 七、精障者手足照顧者期待社會關懷與國家支持:手足期盼能夠在照顧精障者的歷程當中獲得更多的社會層面支持,落實精障者個案管理的服務,許精障者一個更穩定的復健環境。 本研究之福利政策與實務工作層面建議如下: 一、關注雙重老化家庭衍生的照顧移轉議題。 二、強化家庭、國家、社會三角關係。 三、代間責任轉移的規劃。 四、落實個案管理之實務工作服務。 五、整合醫療與社區在精障者就業服務之資源。 六、精障手足照顧者資源的建構與符合其需求之方案設計。

並列摘要


Abstract Objectives:The objectives of this study is to understand influencing factors of sibling care attitude in people with severe mental illness (PSMI) and explore the sibling care experience and caregiver’s role, further understand the sibling care needs and care division pattern among the course of taking care of the people with severe mental illness (PSMI) . Lastly, according to the research, to suggest the specific proposal and to enhance the quality of the family services program in order to solve the dilemma of intergenerational care duty transfer in double-aging family. Methods: Depending on the purpose of research, this study uses qualitative research depth interviews, accessing 9 siblings in people with severe mental illness. The following results explored and summarized the experiences of the participants. Results: (1)Four types of sibling care attitude in PSMI: Namely "gladly accepted", "reluctantly accepted", "Resist accepted", "confusion". The more positive care attitude of sibling, the more actively involved in care work, and get greater willingness to undertake the duty of care. (2)Care division mode of "One person-based, supplemented by others.": In addition to the core of the primary caregivers bear most of the care responsibility and work, and other siblings often plays a supporting care role. (3)Two types of sibling care cycle experience: Are "positive care experience" and "negative care experience", these care experiences will generate positive and negative effects of the cycle, and impact the sibling care willingness and quality of care. (4)Four types of sibling care duty perspectives: these are "unshakable responsibility for care duty ", " Feel resistance and struggle for duty ", "Only willing to play a supporting care role " and "Totally rejected responsibility for care duty " . (5)The issues of intergenerational care duty transfer in PMSI families: This study found higher will in women sibling than men sibling have the willingness to come forward to provide PSMI care. The issues of intergenerational care duty transfer that is rarely discussed between parents and offspring. (6)The sibling caregiver’s needs in PSMI: Sibling caregiver in three levels of "emotional needs", "informational needs" and " Substantive servicing needs" with varying degrees of demand. Moreover sibling involved in the process of the treatment and service , which is rarely valued and satisfied. (7)The sibling caregivers in PSMI expect social care and States’ support: Sibling caregiver expect access to social support, Implementation of PSMI case management services, and PSMI have a more stable rehabilitation environment. Conclusion: according to present study results, we proposed the suggestions: (1)Suggestions for policy: Concerning about the issues of intergenerational care duty transfer dilemma in double-aging family, and strengthening the family, the state, society trilateral relations. (2)Suggestions for policy: Strengthening the intergenerational care duty transfer for planning, implementation of case management services, integration of employment services in the health and community resources, and construction to conform the needs of sibling caregivers’ service programs and resources.

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被引用紀錄


徐開慧(2015)。手足罹患思覺失調症之壓力因應模式〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-2101201509512500
張育瑛(2016)。思覺失調症患者手足的生命經驗初探〔碩士論文,國立臺北大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0023-1303201714245652

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