不可承受之重：癌末主要照顧者的心思經驗探究   免費試閱

Unbearable Burden: Understanding the Psychological Reactive Experiences of Primary Caregivers for the Terminal Cancer Patients

本研究主要探討癌末照顧者的心思經驗，以南部某癌症醫療單位為研究田野。透過深度訪談蒐集資料，共訪談七位主要照顧者，每一位至少接受兩次訪談，並以詮釋現象心理學方法分析資料。結果發現，交織倫理、此有與關鍵時刻存有樣態下的四種主要照顧結構：一、在世性的存有：宛如約拿斯面孔的芻思機制；二、既存性的存有：夙緣結構下的照顧負荷；三、前導性的存有：做為流變的未來希望觀；四、生活世界的關係：回向自身的超越認同。就學術實踐與臨床應用而言，本研究指出：一、照顧模式：從證據導向實踐到能力導向表現；二、寓居於世的牽掛結構：希望時間感的存在性徵開展。照顧者當照顧親人過世，開啟了Heidegger的重要哲學理念 ..生命的艱困，生命究竟必須面對的是意義問題的「無底深淵」。癌末照顧者置身「終極的限制」處境，也嘗試打開未來無限可能性，而不僅是受限於夙緣牽絆或哀悼死亡，其經歷足以反思存在感。

This article probed into psychological reactive experiences of the primary caregivers who looked after the terminal phase of cancer patients at a certain medical unit of cancer center in southern Taiwan. Narrative collecting process through numerous depth interview and clinical observation were conducted, seven participants were interviewed, each person accepted the interview two times at least, and data analysis was adopted by phenomenological psychology methodology. Four main structures are found within the narrative from the interactive existential relationships among Dasein, Ethos, and Kairos, namely, (1) Temporality of being-alongside: Caring experiences as Janus face of rumination here and now. (2) Temporality of being-already-in-the-world: Caring burden under the structure of predestination from the past. (3) Temporality of being-ahead-of-itself: Caring horizon for the hope of the becoming in future. (4) Gestalt life world: Caring going back to self identity beyond the current situation. Regarding academic implication and clinical practice, this paper was pointed out that (1) the necessary element of the caring model from the evidence-based practice to competency-based performance. (2) The significance of phenomenology of hope and understanding Dasein's sources of Care/Sorge. Human life-worlds are structured by Care/Sorge. To explore and promote caring relationship as existential dimension merged with hermeneutics of facticity in Heidegger's meaning to fit into the patients' need and situation context is an important agenda in a further study.