哀傷理論於喪親家屬之護理應用

The Application of Grief Theories to Bereaved Family Members

哀傷是人類面臨各種失落而無可避免的生命經驗，病人家屬遭遇到失去摯愛的親人所引起的哀傷，需要護理人員的支持。護理人員需有足夠的知識去看到喪親家屬在失去所愛親人後之哀傷， 並適時提供合宜的照護支持或轉介。本文介紹佛洛伊德的哀傷理論、Bowlby依附理論、Stroebe 和 Schut雙軌過程模式和Neiyemer意義再建構理論。佛洛伊德的哀傷理論認為哀傷調適是運用另一種方式與逝者維持連結，進而重建自我的過程。依附理論觀點為個體面臨分離焦慮所引起的哀傷反應是心理適應的過渡期，若抗拒改變則適應困難。雙軌過程模式強調哀傷調適是個人面對失落引起之哀傷時，同時亦須重建現實生活的角色任務。意義再建構理論則主張哀傷調適的重要力量來自於個人對於事件之意義重新構建。本文期能提供護理人員多種哀傷觀點，於執行護理過程中反思及看到自己對於哀傷情境的反應，並以哀傷理論為基礎，提供符合家屬個別性且及時性之護理。渡過哀傷需要時間，護理人員對於哀傷若能有更深的認識，將能及時撫慰喪親家屬於當時的哀傷歷程，投注希望於未來生活並回歸生活常規。

Loss is an inevitable experience for humans for which grief is a natural response. Nurses must have an adequate understanding of grief and bereavement in order to be more sensitive to these painful emotions and to provide appropriate care to families who have lost someone they love deeply. This article introduces four important grief theories: Freud’s grief theory, Bowlby’s attachment theory, Stroebe and Schuts’ dual process model, and Neiyemer’s meaning reconstruction model. Freud’s grief theory holds that the process of grief adaptation involves a bereaved family adopting alternative ways to connect with the death of a loved one and to restore their self-ego. Attachment theory holds that individuals who undergo grieving that is caused by separation from significant others and that triggers the process of grief adaptation will fail to adapt if they resist change. The dual process model holds that bereaved families undergo grief adaptation not only as a way to face their loss but also to restore normality in their lives. Finally, the meaning reconstruction model holds that the grief-adaptation strength of bereaved families comes from their meaning reconstruction in response to encountered events. It is hoped that these theories offer nurses different perspectives on the grieving process and provide a practical framework for grief assessment and interventions. Additionally, specific interventions that are based on these four grief theories are recommended. Furthermore, theories of grief may help nurses gain insight into their own practice-related reactions and healing processes, which is an important part of caring for the grieving. Although the grieving process is time consuming, nurses who better understand grief will be better able to help family members prepare in advance for the death of a loved one and, in doing so, help facilitate their healing, with a view to the future and to finally returning to normal daily life.