双重责任与意义重构:家属照顾者的临终关怀研究
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摘要
居家养老服务已经成为我国一项基本国策,作为我国居家养老服务一支重要力量的社会工作者也因此需要面对临终关怀服务的挑战。家属照顾者在整个临终阶段经历了初知噩耗、照顾陪伴、维持平衡和离世告别等四个不同阶段,其中承担着两种角色的照顾责任,即患者的照顾责任和其他家庭成员的照顾责任。这两种照顾责任的转换成为家属照顾者生命意义重构的关键,使他们能够一方面释怀与患者的情感和责任关联,另一方面又能够重建与其他家庭成员的新的情感和责任关系。这一发现为从事临终关怀服务的社会工作者提供了清晰的服务依据和参考指引。
Home-based care services have been included in the basic state policy in China. Therefore, as the major force of the home-based care services, social workers are faced with challenges brought about by hospice care services. It has been found by this study that the family caregivers experienced four stages during the whole deathwatch period, including understanding grievous news, keeping the company, maintaining the balance and bidding farewell to the patients. Caregivers play two roles. Namely, they should both take care of the patients and other family members. The transition of these two responsibilities is the key to the reconstruction of the meaning of caregivers. On the one hand, they will be able to dismiss from the emotional bonds of the patients. On the other hand, they are capable of re-establishing new emotional and responsible relationships with other family members. This finding provides clear and distinct guidance for social workers engaged in hospice services.
Home-based care services have been included in the basic state policy in China. Therefore, as the major force of the home-based care services, social workers are faced with challenges brought about by hospice care services. It has been found by this study that the family caregivers experienced four stages during the whole deathwatch period, including understanding grievous news, keeping the company, maintaining the balance and bidding farewell to the patients. Caregivers play two roles. Namely, they should both take care of the patients and other family members. The transition of these two responsibilities is the key to the reconstruction of the meaning of caregivers. On the one hand, they will be able to dismiss from the emotional bonds of the patients. On the other hand, they are capable of re-establishing new emotional and responsible relationships with other family members. This finding provides clear and distinct guidance for social workers engaged in hospice services.
引文
(1)张文范:《中国人口老龄化与战略性的选择》,《人口与经济》,1998(1)。
(2)国务院:《关于印发“十三五”国家老龄事业发展和养老体系建设规划的通知》,http://www.gov.cn/zhengce/content/2017-03/06/content_5173930.htm,2017年3月6日。
(3)陈雷、江海霞、张秀贤:《城乡统筹下新农保与相关养老保障制度整合衔接战略研究》,《管理现代化》,2011(6)。
(4)章越松:《老年关怀的概念界定及其内涵解读》,《医学与社会》,2003(1)。
(1)秦燕:《安寧療護與悲傷輔導》,高雄:巨流圖書股份有限公司,2015,第39页。
(2)(3) Kübler-Ross E,Kessler D.On grief and grieving:Finding the meaning of grief through the five stages of loss.Simon and Schuster,2005,p.130-131.
(4) Corr C.A.,Corr D.M.,Doka K.J.:《死亡课:关于死亡、临终和丧亲之痛》,北京:中国人民大学出版社,2011,第52页。
(5) Singh,K.D.:《陪伴生命:我从临终病人眼中看到的幸福》,北京:中信出版社,2012,第186-187页。
(6)余德慧等:《臨終心理與陪伴研究》,台北:心靈工坊文化事業股份有限公司,2006,第181-227页。
(7) Krill D.F.Existential social work.Advances in Social Work,2014,15(1):117-128.
(8)梁潇云:《关注存在意义:临终者的死亡焦虑与社会工作的介入》,华东理工大学硕士学位论文,2013年。
(9) Rubin,G.K.Helping a clinic patient modify self destructive thinking.Social Work,1962,7(1):76-80.
(10) Krill,D.F.Existential social work.In Francis J.Turner(5th ed.),Social work treatment:Interlocking theoretical approaches(pp.179-204).New York:Oxford University Press,2011,p.197.
(11) Krill,D.F.Existential social work.In Francis J.Turner(4 ed.).Social work treatment:Interlocking theoretical approaches(pp.251-281).New York:The Free Press,1996,p.268-269
(12) Nilsson,I.,Jansson,L.,&Norberg,A.Crisis phenomenon after stroke reflected in an existential perspective.International Journal of Aging and Human Development,1999,49(4):259-277.
(13) Klugman,D.Existentialism and constructivism:A Bi-polar Model of subjectivity.Clinical Social Work Journal,1997,25(3),297-313.
(14) Brown,J.Child abuse:An existential process.Clinical Social Work Journal,1980,8(2),108-115.
(1) Hacker,D.An existential view of adolescents.The Journal of Early Adolescence,1994,14(3),300-327.
(2) Brown,J.,&Romanchuk,B.Existential social work practice with the aged:Theory and practice.Journal of Gerontological Social Work,1994,23(1/2):49-65.
(3) Walsh,J.Incorporating existential themes into the supervision of social work practitioners.The Clinical Supervisor,1999,18(1):1-16.
(4) Dean,R.,&Fenby,B.Exploring epistemologies:Social work action as a reflection of philosophical assumptions.Journal of Social Work Education,1989,25(1):46-54.
(5)(6) Krill,D.F.Existential social work.In Francis J.Turner(5th ed.),Social work treatment:Interlocking theoretical approaches(pp.179-204).New York:Oxford University Press,2011,p.185;p.194.
(7)这个案例是应社区的要求由社区转介过来的,算作该社区居家养老的项目购买任务。
(2)国务院:《关于印发“十三五”国家老龄事业发展和养老体系建设规划的通知》,http://www.gov.cn/zhengce/content/2017-03/06/content_5173930.htm,2017年3月6日。
(3)陈雷、江海霞、张秀贤:《城乡统筹下新农保与相关养老保障制度整合衔接战略研究》,《管理现代化》,2011(6)。
(4)章越松:《老年关怀的概念界定及其内涵解读》,《医学与社会》,2003(1)。
(1)秦燕:《安寧療護與悲傷輔導》,高雄:巨流圖書股份有限公司,2015,第39页。
(2)(3) Kübler-Ross E,Kessler D.On grief and grieving:Finding the meaning of grief through the five stages of loss.Simon and Schuster,2005,p.130-131.
(4) Corr C.A.,Corr D.M.,Doka K.J.:《死亡课:关于死亡、临终和丧亲之痛》,北京:中国人民大学出版社,2011,第52页。
(5) Singh,K.D.:《陪伴生命:我从临终病人眼中看到的幸福》,北京:中信出版社,2012,第186-187页。
(6)余德慧等:《臨終心理與陪伴研究》,台北:心靈工坊文化事業股份有限公司,2006,第181-227页。
(7) Krill D.F.Existential social work.Advances in Social Work,2014,15(1):117-128.
(8)梁潇云:《关注存在意义:临终者的死亡焦虑与社会工作的介入》,华东理工大学硕士学位论文,2013年。
(9) Rubin,G.K.Helping a clinic patient modify self destructive thinking.Social Work,1962,7(1):76-80.
(10) Krill,D.F.Existential social work.In Francis J.Turner(5th ed.),Social work treatment:Interlocking theoretical approaches(pp.179-204).New York:Oxford University Press,2011,p.197.
(11) Krill,D.F.Existential social work.In Francis J.Turner(4 ed.).Social work treatment:Interlocking theoretical approaches(pp.251-281).New York:The Free Press,1996,p.268-269
(12) Nilsson,I.,Jansson,L.,&Norberg,A.Crisis phenomenon after stroke reflected in an existential perspective.International Journal of Aging and Human Development,1999,49(4):259-277.
(13) Klugman,D.Existentialism and constructivism:A Bi-polar Model of subjectivity.Clinical Social Work Journal,1997,25(3),297-313.
(14) Brown,J.Child abuse:An existential process.Clinical Social Work Journal,1980,8(2),108-115.
(1) Hacker,D.An existential view of adolescents.The Journal of Early Adolescence,1994,14(3),300-327.
(2) Brown,J.,&Romanchuk,B.Existential social work practice with the aged:Theory and practice.Journal of Gerontological Social Work,1994,23(1/2):49-65.
(3) Walsh,J.Incorporating existential themes into the supervision of social work practitioners.The Clinical Supervisor,1999,18(1):1-16.
(4) Dean,R.,&Fenby,B.Exploring epistemologies:Social work action as a reflection of philosophical assumptions.Journal of Social Work Education,1989,25(1):46-54.
(5)(6) Krill,D.F.Existential social work.In Francis J.Turner(5th ed.),Social work treatment:Interlocking theoretical approaches(pp.179-204).New York:Oxford University Press,2011,p.185;p.194.
(7)这个案例是应社区的要求由社区转介过来的,算作该社区居家养老的项目购买任务。