「照顧存在性」研究的準備工作與實務理論之建構

The Existentiality of Caring': The Research Preparation and Theoretical Construction Work

本篇將分兩大部分來述說企求對精神病患家庭照顧存在性的研究做更深入的了解及剖析：壹、研究「照顧存在性」的準備工作；貳、「照顧存在性」實務理論的建構。傳統的研究者多半跳過知識論的自我察覺而直接去看課題，研究者常常看不到自己的知識論，難以說出知識論所在；因此，有關照顧存在性研究的準備工作研究者將以「學科與基本概念的反思質疑」、「選擇及進入照顧存在世界」、「照顧存在性的揭露與界說」等三大界域分別述說研究者對此主題研究相關之思維與理路。至於第二部分照顧存在實務理論之建構是本篇文章的重點，因為不論實務上或純理論的理論架構建立後，勢必要進一步和經驗觀察結合，使理論和經驗相互輝映，其乃針對原本研究結果初步發現之「照顧的當然存在」、「照顧的不存在」、「照顧的有限性」、「照顧的轉化與超越」、及「照顧的交託與流轉」五種照顧存在意識型態，研究者再進一步探究比較相關現象學理論與各主題意識型態內所隱含之重要概念，對所歸結出微妙的關係以內圓陰陽及外方做一圖示呈現及文字述說。陽代表照顧的存在性；陰代表照顧的不存在性，外方表達著家庭照顧的交託及轉移的外在照顧現象。最後討論以「家人關懷的共同感與專業的同感心」及「寂寞的惟我感與孤寂中的超越」為議題，來探討本文之發現和台灣精神病患家庭照顧之現象與社會上普遍意識之間的牽連。

This article has been divided into two parts to facilitate a better understanding of psychiatric family caring experiences. Particular attention of the first part of this article briefly presents the researcher's underpinning motivation and ways of exploring the phenomenon of psychiatric family caring experiences. The epistemological and methodological individualism is implicit within most research articles. The inspiration of why I was interested in conducting this research, what would be the relationship between the researcher and disciplines, and how I conducted this research are introduced. Three major themes within this part are: 1) Questioning and reflection on the crisis of basic concept of care within the nursing discipline; 2) Selecting the topic and how to start the field work of getting into the family caring life worlds; 3) Uncovering the meaning of the family care existential phenomenon. In the second part, the researcher constructs a theory about the existentiality of caring within the psychiatric family caring phenomenon. A concept map of the inner-round, both Ying -Yang (陰，陽), and outside-square is drawn to explain the three major domains within this phenomenon, which are: 1) Yang's caring existential domain-- the existential care; 2) Ying's caring existential domain-- the non-existential care; 3) External caring existential domain-- Displacemental and exchangeable care. The important concepts within each domain and related descriptive data and mutual relationships are represented. Finally, the family communal feeling and the health professional empathic feeling are compared. The loneliness of psychiatric patients and their families as well as how to achieve the transcendence from this dilemma are also addressed and discussed in this article.