The Self-Empowerment Process of Primary Caregivers: A Study of Caring for Elderly with Dementia

主要照顧者之自我充能歷程－以失智症為例

車慧蓮(Hui-Lian Che)；葉明理(Ming-Lee Yeh)；吳淑美(Shu-Mei Wu)

主要照顧者 ； 自我充能 ； 失智症 ； 老人 ； primary caregiver ； self-empowerment ； dementia ； elderly

The Journal of Nursing Research

14卷3期（2006 / 09 / 01）

209 - 218

英文

本研究目的為建立失智症老人的主要照顧者自我充能過程的概念性理論。採茁根理論(grounded theory)研究法，理論性取樣九位居住於北部的主要照顧者參與研究。深入訪談後之錄音紀錄逐字轉譯為文字稿，並以持續比較分析原則，進行資料的編碼程序直至理論呈現。研究結果得到自我充能過程的六個要素分別是「孝道義務感」、「無助失控感」、「內在意識」、「照顧能力」、「心靈重整」和「生活的經營」。其中「孝道義務感」和「無助失控感」為前趨類組，用以激發照顧者的「內在意識」。內在意識啓動充能過程，並在不同階段幫助主要照顧者，促使其「照顧能力」、「心靈重整」和「生活的經營」三部分獲致成長。此三部分經時間催化，各發展出由淺到深的三階段，三階段間彼此又平行並互為助力或阻力。此外，充能過程也受到阻力和助力的影響，差別端賴主要照顧者如何運用，當助力大於阻力時，充能過程便能持續下去。整個架構蘊含著「力量」的流動。研究結果提供一個新的觀點看待失智老人主要照顧者的照顧過程，除對照顧者各階段心理更有感知外，更能導引其對照顧歷程產生正向感受。

The purpose of this qualitative research was to explore and develop the process of self-empowerment for primary caregivers responsible for caring for elderly with dementia. Nine primary caregivers who lived in northern Taiwan were interviewed through a theoretical sampling procedure. In-depth, face-to-face interviews were tape-recorded and transcribed verbatim. The grounded theory method was applied for analyzing data. The six main components that emerged in this model: ”filial piety”, ”feeling of out of control”, ”inner awareness”, ”care ability”, ”emotion reconstruction”, and ”life management”. This model starts from ”filial piety” and ”feeling of out of control,” then evokes caregivers' ”inner awareness”. The inner awareness powerfully influences caregivers' ”care ability”, ”emotion reconstruction” and ”life management,” which account for the three inner mechanism parts in their caregiving experience. Each part comprises three stages that are influenced by ”inner awareness”. The lower stage of each part supports the next higher stage. The same stages in all parts parallel one another, and influence each other by providing support or creating barriers. On the other side, competition between support and barriers from the outside environment determines the completion of this self-empowerment process. Results of this research extend the knowledge in understanding the psychological processes related to caring for elderly with dementia. The findings also provide readers a positive viewpoint on the caring experiences of primary caregivers of elderly with dementia.

1. Archbold, P. G.,Stewart, B. J.,Greenlick, M. R.,Harvath, T.(1990).Mutuality and preparedness as predictors of caregiver role strain.Research in Nursing & Health,13,375-384.
2. Chadiha, L. A.,Adams, P.,Biegel, D. E.,Auslander, W.,Gutiérrez, L.(2004).Empowering African American women informal caregivers: A literature synthesis and practice strategies.Social Work,49(1),97-109.
3. Chen, H. T.,Lee, M. F.(2000).Dementia in Taiwan.Research in Applied Psychology,7,191-199.
4. Gibson, C. H.(1991).A concept analysis of empowerment.Journal of Advanced Nursing,16,354-361.
5. Gutiérrez, L.,GlenMaye, L.,DeLois, K.(1995).The organizational context of empowerment practice: Implications for social work administration.Social Worker,40(2),249-258.
6. Holloway, I.,Wheeler, S.(1996).Qualitative research for nurses.Oxford, UK:Blackwell Science.
7. Kuhn, D.,Fulton, B. R.,Edelman, P.(2003).Powerful tools for caregivers: Improving self-care and selfefficacy of family caregivers.Alzheimer's Care Quarterly,4(3),189-200.
8. Lai, F. M.,Lu, Z. Y.(1998).Female caregiver's experience with homebound disabled patients.The Journal of Nursing Research,6(5),372-382.
9. Langner, S. R.(1993).Ways of managing the experience of caregiving to elderly relatives.Western Journal of Nursing Research,15(5),582-594.
10. Lee, C. S.,Chang, S. F.,Su, C. L.,Chen, Z. Y.,Chen, R. C.(1997).An epidemiological survey of dementia in a rural area.Acta Neurological Taiwanica,6(1),27-35.
11. Lee, S. S.(2000).Continuing study subjects following special issue of dementia.Research in Applied Psychology,8,11-19.
12. Leininger, M. M.,M. M. Leininger(Ed.)(1991).Culture care diversity and university: A theory of nursing.New York:National League for Nursing Press.
13. Lincoln, Y. S.,Guba, E. G.,Y. S. Lincoln(Eds.),E. G. Guba(Eds.)(1985).Naturalistic inquiry.London:Sage.
14. Liu, C. K.,Lai, C. L.,Tai, C. T.,Lin, R. T.,Yen, Y. Y.,Howng, S. L.(1998).Prevalence and subtypes of dementia in southern Taiwan: Impact of age, sex, education and urbanization.Journal of the Neurological Sciences,160,67-75.
15. Man, D. W. K.(2002).Hong Kong family caregivers' stress and coping for people with brain injury. International.Journal of Rehabilitation Research,25(4),287-295.
16. Patton, M. Q.(2002).Qualitative research & evaluation methods.Thousand Oaks, CA:Sage.
17. Persson, L.,Rasmusson, M.,Hallberg, I. R.(1998).Spouses' view during their partners' illness and treatment.Cancer Nursing,21(2),97-105.
18. Rodwell, C. M.(1996).An analysis of the concept of empowerment.Journal of Advanced Nursing,23,305-313.
19. Shyu, Y-I. L.,Archbold, P. G.,Imle, M.(1998).Finding a balance point: A process central to understanding family caregiving in Taiwanese families.Research in Nursing and Health,21,261-270.
20. Shyu, Y-I. L,Yang, C. T.,Yih, P. K.(1996).Communitybased integrated home care model for the demented patients and their families.Kaohsiung Journal Medicine Science,12,359-369.
21. Strauss, A. L.,Corbin, J.(1990).Basics of qualitative research: Grounded theory procedures and techniques.Thousand Oaks, CA:Sage.
22. Suwa-Kobayashi, S.,Yuasa, M.,Noguchi, M.(1995).Nursing in Japan: Caregiver of elderly family members with dementia.Journal of Gerontological Nursing,21(1),23-30.
23. Tang, L. Y.,Mao, C. L.,Chou, C. F.,Chen, R. C.,Liu, H. C.(1992).Caregiver burden of demented elderly and related factor-An exploratory study.The Journal of Nursing,39(3),89-98.
24. Wang, Y. U.,Shyu, Y. I.,Yao, K. P.,Wu, S. C.(1998).Finding a balance point: A process central to understanding family caregiving in Taiwanese families.The Journal of Nursing Research,6(6),489-500.
25. Wilson, H. S.(1989).Family caregiver for a relative with Alzheimer's dementia: Coping with negative choices.Nursing Research,38(2),94-98.
26. Wu, S. C.,Lin, H. S.(1999).A national profile of family caregivers of the disabled elderly people in Taiwan.Chinese Journal Public Health,18(1),44-53.

1. Sayori SAKANASHI,Rie KONNO,Kimie FUJITA(2021).Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study.The Journal of Nursing Research,29(3),1-8.
2. Wang, Jing-Jy,Lin, Jong-Ni(2008).Psychometric Evaluation of the Chinese Version of the Cornell Scale for Depression in Dementia.The Journalof Nursing Research,16(3),202-210.
3. 蔡榮順、蔡佳容、李佩怡(2016)。失智症家庭照顧者之受苦與因應經驗研究。中華輔導與諮商學報，47，59-90。
4. 連雅棻(2015)。失能老人家庭之孫子女照顧者的經驗初探。美和學報，34(1)，53-70。