居家輕、中度失智老人靈性需求之初探

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Title:	居家輕、中度失智老人靈性需求之初探 A Preliminary Study to Explore The Meaning of Spiritual Need for the Elderly with Mild to Moderate Dementia at the Residential Home
Authors:	陳幸佳;Hsing Chia Chen
Contributors:	護理學系碩士班
Keywords:	居家;輕中度失智老人;靈性需求;Home care;mild and moderate dementia;spiritual need
Date:	2015-08-11
Issue Date:	2015-11-04 17:09:13 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	國內目前失智患者仍以居住在家庭中為最多，失智症屬於慢性、不可逆之疾病，病人因疾病所致造成精神行為障礙，帶給病人本身與其家庭照顧者莫大衝擊。人們終其一生都會不斷地探索生命的意義，失智症患者會因疾病出現的焦慮、憂鬱與失落造成靈性的困擾與需求，往往更容易因此失去希望與生存意志而弱化身體功能，致使家屬的照顧壓力倍增。失智症照顧歷程中若僅早探究心靈層面的問題，讓病人與照顧者更加適應疾病所造帶來的衝擊，才能降低家庭衝突的狀況發生。本文將完整如實地呈現輕、中度失智老人之靈性需求，藉由了解失智老人靈性需求的變化與現況，使得照顧者及臨床醫護照護相關人員能更了解及重視，研究結果亦能做為失智照護重要參考依據。本研究主要目的乃在於探討輕、中度失智老人之靈性需求。研究設計採用質性研究法，以立意取樣選取台灣中部某精神專科醫院門診個案，共收案輕、中度10位失智症老人，資料收集採半結構訪談作為指引，進行一對一的深度錄音訪談，將所收集之資料採質性內容分析法逐步進行分析。研究結果，居家輕、中度失智老人共參與10位對於靈性需求之描述與經歷，將所有訪談資料逐字轉為文字檔，進行資料分析後，歸納出居家輕度失智老人靈性需求具有四個主軸十六個次主軸，包含「倒轉時間沙漏的需求?（扭轉自主能力喪失、拼湊心靈的缺憾）；「具有重整過去經驗的需求?（自我認同的詮釋、人生統整的脈絡、民俗規條重新檢視與信念重新檢視）；「信仰提供力量的需求?（信仰認知的需求、被了解、被疼惜、被保護、具有主宰的能力以及真實存在）；「掌控剩餘生命火花的需求?（擁有安排自在生活的能力、擁有給予的能力、控制有意義的他人以及社交需求）。至於，居家中度失智老人靈性需求具有三個主軸九個次主軸，包含「腦海中熟識圖騰再現的需求?（逐漸崩壞的認知能力、崩壞的認知能力影響心情）；「回顧來時路重整人生的需求?（自主能力逐漸喪失、自我認同的詮釋、人生統整的脈絡、民俗規條重新檢視與信仰提供力量）；「擁有掌控此岸到彼岸擺渡人的需求?（擁有安排自在生活的能力、需疼愛的人照顧）。本研究結果能讓輕、中度失智老人靈性需求被照顧者及臨床醫護照護相關人員了解及重視，且能做為日後失智照護重要參考依據。 In our country, most dementia patients live with their family. Dementia is a chronic, irreversible disease. The psychological behavioral obstacle caused by the disease results in great impact on both patients and their families. People always look for the essence of life. The anxiety, depression and lost will lead to patients’confusion and demand of spirituality. They often lose hope and surviving will, which weaken patients’ physical function and increase the burden of caregivers. Discussing problems of spirtuality aspect in early caring process can help patients and cargivers get used to the impacts as soon as possible. This research truly presents the spiritual demands of mild and moderate dementia patients. Cargivers and clinical researchers can focus more on the dementias’ demands through understanding changes and recent situation of their spirituality. Besides, the result can be reference material for clinical caring research. The topic of this research discussed the spiritual demands of elders with mild and moderate dementia. Qualitative reasearch method was used for this study and participants of this study werecollected from a psychological hospital in Taichung. Tenelders were recruited including 5 elders with mild and 5 elders with moderate dementia. The data were clollected by using semi-struction interview as a guide to process one to one interview. Collected information was analyzed by qualitative analysis. The result presents the interview description and process of 10 cases’ spiritual demands. All the interview information were presented in the text. After analyzing the data, for elders with mild dementia, there were four main themes and sixteen subthemes, including “the demand of reverse time comprehesion” (within 2 subthemes: to compensate the lost of independent ability and the regret of spirtuality), “the demand of reforming past experince” (within 4 subthemes: the explanation of self identification, life streming, recheck folk rulers and refined folk faith), “the demand of faith power” (within 6 subthemes: the faith comprehension, the need of being understanding, the need to be care, the need to be protected, truly power and real existence) and “the demand of controling life” (within 4 subthemes: possessing the ability of independent living, being capable of giving, be with significant others and doing social activity) . As for the spiritual demand of elders with moderate dementia, there were three main themes and nine subthemes, including “the demand of representation of mind pictures” (within 2 subthemes: collapsing cognitive ability and the influence of collapsing cognitive ability on emotion), “the demand of life memory” (within 5 subthemes: losing the ability of self identification, the needs of explanation of self identification, life streming, recheck folk rulers and refined folk faith), “the demand of possessing the ability to control living,” (within 2 subthemes: being capable of arranging living and taking care by beloved person). The result of this research may highlight the spiritual demand of elders with mild and moderate dementia for arising the attention by cargivers and health clinical providers. Besides, it can be important reference material for caring elders with dementiag.
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