朝向疾病的療癒：血液透析者心理經驗之詮釋

Toward the Healing Process of Chronic Illness: Exploring the Psychological Experiences of Hemodialysis Patients

本研究探討罹患末期腎臟病，定期進行血液透析者的存在經驗，回到病人置身所在的生活脈絡考察其心理歷程與存在經驗。研究採用詮釋現象學分析方法，以立意取樣方式招募參與者，共10位（女性7位，男性3位）完成訪談，每位參與者每次訪談約60分鐘。研究發現洗腎者置身結構包含：「物質性裝置的它者性融入自我經驗」、「從洗腎覺察時間感到自我存在經驗」、「置身所在的位移與照顧行動的連動」和「洗腎者的生活軌跡與生命療癒」四大主題。如此四重置身結構，呈現血液透析者正負情愫交融的身體處境與回返日常性的生命治理策略。最後，本研究提出兩個論點：一、洗腎者置身結構包含：它物自身化、時間意義化、處境日常化、療癒互補化。二、洗腎體驗的表述包含：是一種既逆向呈現，亦過度呈現的正負情愫交融身體。如此觀點的踐行歷程，可深化對病患照顧行動的倫理反思。

This article explores the existential experiences of the patients who suffer from end-stage renal disease with regular hemodialysis. We applied a phenomenological method with purposive sampling. Ten (7 female and 3 male) chronic hemodialysis patients who gave informed consent were interviewed once for one hour. Interviews were recorded, transcribed, and analyzed. The results revealed four themes, namely, ＂the device merging into life experience,＂ ＂existential awareness of time spent in dialysis,＂ ＂displacement to medical regimen as caring,＂ and ＂trajectory of dialysis and life healing＂. The illness experience went beyond the medical regimen. Hemodialysis patients' situations are embedded with ambivalent feelings about their corporeality when in treatment towards the daily life. We reached the following conclusions: (1) The situated structure of the renal dialysis experience: The machine as part of the self, the temporality as meaning disclosure, the situation as daily life, and healing process as 'hi' (虛) and 'bǔ' (補) complementarity. (2) Body awareness of dialysis: Ambivalence about the body combined with absent body that bodily experiences place in a background disappearances and hyper-appearing body that situates in the mode of sensitive awareness of the bodily vicarious experiences. The outcome deepens the reflections on the caring ethics to patients to appreciate the unique 'order of meaning' lying at the heart of their suffering experiences. Ethical healing is the cornerstone of relational understanding towards the human subjectivity rather than the medical positivism which targets to control and prediction human chaotic state of mind in an over-simplistic objectification way.