精神病患家庭關照時間流之現象探討

Exploring the Temporal Flow Phenomenon in the Family Care of Psychiatric Patients

背景：關懷意識和照顧行動為護理專業的核心價值，而內在時間流的概念有潛能開展生命和照顧方面更豐富和特殊的意義，精神病患家庭照顧現象具再探索的價值。目的：透過精神病者家庭照顧的現象描述和分析來理解和展現關懷意識、照顧行動、和生命時間流之間的關係和議題。本研究企圖以受照顧者為主體，提出共存共在之關照時間流取向供家庭和臨床照顧者之應用參考。方法：研究針對精神病患者及其家屬為對象，以參與式觀察、個別深入性、及焦點團體訪談等多重方法所收集有關家庭照顧的感受、看法和經驗的文本資料，再度運用詮釋現象研究方法學進行二度質性資料分析。結果：以兩大面向及十個子題呈現：一、照顧者與被（受）照顧者時間流的交會：（一）生病是兩照的聚焦點、（二）感應帶動彼此的時間流、（三）質疑照顧者時間流的籠罩、（四）捲入受照顧者時間流的漩渦、（五）雙方形成時間流的平行線；二、病者自我照顧時間流的形構：（一）期待保有內在關照時間流的掌控權、（二）啟動產生照顧時間流的內在動能、（三）探索找到自己關照時間流的脈動、（四）回歸每日常態生活的時間流、（五）牽引匯集共存共在的關照時間流。當照顧者與被照顧者在不同時間和不同照顧型態介入和索求時，彼此會產生多重關照時間流的樣貌和變化。結論：病者與照顧者對彼此生命時間性的掌控與讓渡權之消長和競爭，經常受雙方的成熟度和本身對關懷心思與照顧行動的需求與付出所影響，照顧者須尊重與適度保育和帶動個體生命時間流，當主體能再度回歸和掌握其生命時間性的主流才是關照的核心宗旨和要素。

Background: Caring consciousness and care action are core nursing values. The concept of internal temporal flow offers the potential to provide patients a richer and more meaningful life and better care. The family care phenomenon of psychiatric patients merits re-exploration.Purpose: This study identifies and describes relationships and issues within and between caring consciousness, care actions, and internal temporal flow by describing and interpreting the family care phenomenon of psychiatric patients. This study targets the care-recipient as a primary subject and highlights the orientation of co-existing and co-presenting caring-temporal flow for family and professional care applications and references.Methods: This study conducts secondary data analysis using hermeneutic phenomenology inquiry. Research work was completed using multi-perspectives and multi-methods of data collection, including participant observation, individual in-depth and focus group interviews with psychiatric patients and their family members regarding their feelings, and thoughts and experiences of psychiatric family care.Results: Data analysis results are divided into two parts: (1) the intersection of caregiver's and care receiver's caring-temporal flow and (2) The trajectory and construction of psychiatric patients' self-care temporal flow. Multiple appearances of the caring-temporal flow were formed when caregivers and care receivers engaged in different time and diverse care patterns.Conclusion: Fluctuation and competition among psychiatric patients' and their family members' control and transfer in terms of their lived temporality were influenced by mutual maturity as well as the demand and offering of caring consciousness and care action. The psychiatric patient as a primary subject should return and take control over his or her own mainstream lived temporality, which is the core essence of care.