本研究主要聚焦於安寧護理人員在照顧末期病人與家庭的過程中，當病人面對家人的照顧而自覺負擔時，安寧護理人員涉入這個現象裡的內在經驗與因應。

研究採立意取樣，分別於北、中、南區醫療院所，邀請4位具合作與訪談意願、能清楚描述與討論、且實際從事安寧照顧三年以上的安寧護理人員，共同參與研究。研究以詮釋學為研究法基礎，透過半結構訪談的形式，個別訪談4位護理年資5～13年的安寧護理人員，每位2～3次，每次1～1.5小時，以匯集安寧護理人員面對自覺負擔現象的照護經驗及內在感受。訪談文本資料參照沈清松、Ricoeur的策略，進行詮釋分析。

研究結論呈現出安寧護理人員所觀察的自覺負擔現象是：（一）自覺負擔是護理照顧的文化背景；（二）自覺負擔涉及關係議題，是病人對照顧依賴的主觀壓力感受；（三）自覺負擔是生理崩解而來的關係焦慮。而安寧護理人員面對自覺負擔現象的內在與因應經驗是：（一）自覺負擔的接觸，牽動安寧護理人員的自身經驗而情緒糾結；（二）奠基安寧護理人員的個人經驗而衍生獨特的因應模式；（三）情感牽動安寧護理人員的自身經驗而啟動學習動能。而從安寧護理人員與自覺負擔現象之間的關聯性來看，則是：（一）角色與自我的斷裂；（二）專業角色與內在自我的拉扯與平衡；（三）融合角色與自我的深度護理陪伴。

最後，依據研究結論提出研究限制與建議。

Purpose. In Chinese culture, the caring is the task of family members. When the patients felt self-perceived burden (SPB), it may influence the family’s emotion. And also, it may influence the nurses’ caring task. The aim of this research is to investigate the caring experience of hospice nurse while the terminally ill patients suffered the SPB.

Method. Based on the hermeneutics perspective, semi-structure interview was used to gather the experiences of 4 hospice nurses (worked in hospice around 5-13 years). These interviews (2-3 times each subject, about 60-90 min each interview) were transcribed and analyzed by Ricoeur’s hermeneutics strategies.

Results. For hospice nurses’ experiences, the themes about SPB include “SPB is the background of Chinese culture”, “SPB is a subjective feeling of pressure about being cared”, “SPB comes from the anxiety of the clasped of relationship, not just the physical pain or death anxiety”. The themes about the hospice nurses’ inner and coping experiences of caring SPB are “the caring of SPB triggers nurses’ personal experiences and emotional arousal”, “the coping strategies which based on the nurses’ personal experiences are varied and unique”, “nurses are active in learning by the personal experiences and emotion aroused”. And the themes of the relation between the hospice nurses and SPB are “the broken and struggle of the professional roles and the self”, “the conflict and balance of professional roles and the self”, and “the deeply nursing companion based the infusion of professional roles and the self”.

Conclusion. The findings from this research suggest (1) the nursing training may bridge the professional knowledge and the personal experience, (2) clinical or counseling psychologists and social workers may more involve in hospice teamwork, (3) when patients diagnosed cancer may be the time to concern the SPB, (4) the psychological treatment about SPB may be the emotional contact between the patients and their caregivers, and the meaning reconstruction about their relationship and the caring experience. There are also limitations and suggestions for further research.

中文文獻
丁凡（譯）（2011）。以畫為鏡：存在藝術治療（原作者：B. Moon）。台北：張老師出版。
方格正（2014）。年輕人罹癌康復後生命經驗之詮釋（未出版之博士論文）。國立台灣師範大學：台北市。
王應棠（2010）。研究訪談的特性：哲學詮釋學的觀點。教育與多元文化研究期刊，2，1-20。
任延豔、劉化俠、田秀麗（2013）。癌症患者自我感受負擔量表條目的篩選及測試版的形成。護理學雜誌，28(5)，25-27。
何英奇（2004）。批判研究方法的架構及其在教育與心理研究上的應用。教育研究方法論：觀點與方法。229-259頁。台北：心理出版。
李佩怡（2003）。助人者與癌症末期病人關係歷程之質性研究（未出版之博士論文）。國立台灣師範大學，台北市。
李佩怡（2006）。臨終諮商倫理初探－照護癌末病人個我經驗之反思與建構。哲學與文化，33(4)，33-56。
沈清松（1993）。詮釋學方法評介。政治大學研究通訊，1，5-17。
李榕峻（2004）。安寧療護醫療團隊工作壓力與壓力調適之研究（未出版之碩士論文）。慈濟大學：花蓮市。
武燕燕、姜亞芳（2010）。癌症患者自我感受負擔的調查與分析。護理管理雜誌；10(6)：405-407。
林遠澤（2008）。療癒性的談話：論交互主體性的護病互動關係。護理雜誌，55(1)，14-19。
唐欣元（2010）。支持性心理治療對改善癌症患者自我感受負擔的效果研究。泰安：泰山醫學院，2010：15-16。
高淑清（2001）。在美華人留學生太太的生活世界：詮釋與反思。本土心理學研究，16，225-285。doi:10.6254/2001.16.225
張慶娜、李惠萍、王德斌（2013）。中文版自我感受負擔量表在癌症患者中應用的信效度評價。中國實用護理雜誌，29(2)，1-4。
陳小英（2006）。媳婦角色規範與婆媳諧和關係之探究。中華家政學刊，40，149-164。
陳向明（2002）。社會科學質的研究。台北：五南。
畢恆達（1995）。生活經驗研究的反省：詮釋學的觀點。本土心理學研究，4，224-259。
陳美碧、蔣欣欣（2008）。安寧緩和療護的困頓與成長－護理人員的經驗。實證護理，4(3)，191-199。
陳盛文（2004）。安寧護理人員的專業角色調適。（未出版之碩士論文）。南華大學。
許雅惠（2009）。醫院病房護理人員慈悲疲倦、慈悲滿足與靈性健康間的關係探討（未出版之碩士論文）。輔仁大學：新北市。
陳榮華（2011）。高達美詮釋學：真理與方法導讀。台北：三民
陳慧女（2003）。詮釋學在諮商歷程研究中的應用：以胡賽爾的超驗現象學方法為例。諮商輔導學報，9，1-16。
黃光國（2000）。社會科學的理路。台北：心理出版。
程建萍、李連君（2010）。家屬參與護理模式對乳腺癌手術患者自我感受負擔(SPB)的影響。國際護理學雜誌，29(5)，672-674。
程巍（譯）（2012）。疾病的隱喻（原作者：S.Sontag）。台北：麥田文化。
單德興（譯）（1995）。知識分子論（原作者：E.Said）。台北：麥田。
葉光輝（2005）。華人孝道的心理與行為。楊國樞、黃光國、楊中芳主編，華人本土心理學。臺北：遠流出版。
葉光輝（2009）。台灣民眾的代間交換行為：孝道觀點的探討。本土心理學研究，31，97-141。
楊明磊（2001）。資深諮商工作者的專業發展—詮釋學觀點（未出版之博士論文）。國立彰化師範大學：彰化市。
楊姬娟、李惠萍、蘇丹、張慶娜（2014）。癌症患者自我感受負擔與社會支持及生命質量的相關性研究。中國全科醫學，17(1)，94-97。doi: 10.3969/j.issn.1007-9572.2014.01.029
楊歡、吳慶文（2012）。癌症患者自我感受負擔影響因素及干預策略研究進展。中國護理管理，12(3)，94-96。
管貴貞、連秀鸞（2005）。詮釋學方法在質性研究中之探究。輔導季刊，41(3)，1-10。
鄧文章，李佩怡（2014）。從護理人員觀點看末期病人接受家人照顧之心理負擔現象。安寧療護雜誌，19(3)，229-257。
蔣欣欣（2008）。情緒與護病關係，護理雜誌，55(1)，20-23。
蔡錚雲（2013）。照護知識的藝術性格。護理雜誌，60(4)，5-8，doi:10. 224/JN. 0.4.5。
謝美慧，王秀紅。護病互為主體的陪伴概念與意涵。2011。志為護理：慈濟護理雜誌，10(4)，56-63。
嚴平（譯）（1992）。詮釋學（原作者：R. E. Palmer）。台北：桂冠。
蕭仁釗（1998）。安寧療護專業人員之壓力問題。安寧療護雜誌，10，21-26。
蕭瑞麟（2007）。不用數字的研究：鍛鍊深度思考力的質性研究。台北：培生出版。
 
英文文獻
Abendroth, M. & Flannery, J. (2006). Predicting the risk of compassion fatigue: A study of hospice nurse. Journal of Hospice & Palliative Nursing, 8(6), 346-356.
Ablett, J. R. & Jones, R. S. (2007). Resilience and well-being in palliative care staff: A qualitative study of hospice nurses’ experience of work. Psychooncology, 16(8), 733-740.
Akazawa, T., Akechi, T., Morita, T., Miyashita, M., Sato, K., Tsuneto, S., Shima, Y., & Furukawa, T.A. (2010). Self-Perceived Burden in Terminally Ill Cancer Patients: A Categorization of Care Strategies Based on Bereaved Family Members Perspectives.Journal of Pain and Symptom Management, 40(2), 224-234.
Akechi, T., Okuyama, T., Sugawara, Y., Nakano, T., Shima, Y., &Uchitomi, Y. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients. Journal Clinical Oncology, 22, 1957-1965.
Arbour,R.B., Wiegand, D.L. (2014). Self-described nursing roles experienced during care of dying patients and their families: A phenomenological study. Intensive and critical care nursing 30, 211-218.
Arnold, B. L. (2011). Mapping hospice patients’ perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry. BMC Palliative Care, 10. doi:10.1186/1472-684X-10-1
Bausewein, C., Calanzani, N., Daveson, B. A., Simon, S. T., Ferreira, P. L., Jigginson, I. J., … Gomes, B. (2013). 'Burden to others' as a public concern in advanced cancer: A comparative survey in seven European countries. BMC Cancer, 13, 105-115.
Beckett, A., Gilbertson, S., Greenwood, S. (2007). Doing the right thing: nursing students, relational practice, and moral agency. Journal Nurse Education, 46, 28-33.
Bodnar-Deren, S. (2008). End of life planning, the Impact of self perceived burden of care, The Gerontologist, 48, 506.
Botti, M., Endacott, R.,Watts, R., Cairns, J., Leiws, K., & Kenny, A. (2006). Barriers in providing psychosocial support for patients with cancer. Cancer Nursing, 29(4), 309-316.
Bowman, K.W., Singer, P.A. (2001). Chinese seniors’ perspectives on end-of-life decisions. Social Science Medicine, 5, 455-464.
Cahill, E., Lewis, L. M., Barg, F. K., & Bogner, H. R. (2009). ‘‘You don’t want to burden them’’: Older adults’ views on family involvement in care. Journal of Family Nursing, 15, 295-317. doi: 10.1177/1074840709337247
Chio, A., Gauthier, A., Calvo, A., Ghiglione, P., & Mutani, R. (2005). Caregiver burden and patients’ perception of being a burden in ALS. Neurology, 6, 1780-1792.
Chochinov, HM. (2002). Dignity-conserving care: A new model for palliative care: helping the patient feel valued. JAMA, 287(17), 2253-2260.
Chochinov, HM, Krisjanson, LJ, Hack, TE, Hassard, T, McClement, S, & Harlos, M. (2007). Burden to others and the terminally ill. Journal of Pain and Symptom management, 34(5), 463-471.
Cohen S. R., Leis, A. (2002). What determines the quality of life of terminally ill cancer patients from their own perspective? Journal Palliative Care, 18, 48-58.
Cousineau, (2000). Development and preliminary validation of a self-perceived burden scale for individuals with chronic illness.(Unpublished doctoral dissertation). University of Ottawa, Canada.
Cousineau, N., McDowell, I., Hotz, S., & Hebert, P. (2003). Measuring chronic patients’feelings of being a burden to their caregivers: development and preliminary validation of a scale. Medical Care, 41(1), 110-118.
Coyle, N., Sculco, L. (2004). Expressed desire for hastened death in seven patients living with advanced cancer: a phenomenological inquiry. Oncological Nursing Forum, 31, 699-709.
Crawford, G. B., & Price, S. D. (2003). Team working: palliative care as a model of interdisciplinary practice.MJA, 179, 32-34.
Cukrowicz, K. C., Cheavens, J. S., Van Orden, K. A., Ragain, R. M., & Cook, R. L. (2011). Perceived burdensomeness is critical and may explain gender and suicide ideation in older adults. Psychology and Aging, 26, 331-338. doi: 10.1037/a0021836
Dempsey, L. E., Karver, M. S., Labouliere, C., Zesiewicz, T. A., & Nadai, A. S. (2012). Self-Perceived Burden as a mediator of depression symptoms amongst individuals living with a movement disorder. Journal of Clinical Psychology, 68(10), 1149-1160.
Dowling, M. (2008). The meaning of nurse-patient intimacy in oncology care settings: From the nurse and patient perspective. European Journal of Oncology Nursing, 12, 319-328.
Dunne, K. (2005). Effective communication in palliative care. Nursing Stand, 20: 16370506. doi:10.7748/ns2005.12.20.13.57.c4024
Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stressdisorder in those who treat the traumatized. Bristol, PA: Brunner/Mazel
Flick, U. (2007). Designing qualitative research. London: Sage
Freudenberger, H. J. (1974). Staff burnout. Journal of Social Issues, 30, 159-165.
Ganzini, L., Johnston, W. S., & Hoffman W. F. (1999). Correlates of suffering in amyotrophic lateral sclerosis. Neurology, 52, 1434-1440.
Halldorsdottir, S. (2007). The dynamics of the nurse-patient relationship: introduction of a synthesized theory from the patient's perspective.Scand Journal Caring Science, 22, 643–652. doi: 10.1111/j.1471-6712.2007.00568.x
Hamon, R. R., Blieszner, R. (1990). Filial responsibility expectations among adult child-older parent pairs. Journal of Gerontology: Psychological Sciences, 45, 110-112. Retrieved from http://psychsocgerontology.oxfordjournals.org
Hickman, SE, Tilden, VP, & Tolle, SW. (2004). Family perceptions of worry, symptoms, and suffering in the dying. Journal Palliative Care, 20, 20-27.
Horne, G., Payne, G. (2004). Removing the boundaries: Palliative care for patients with heart failure. Palliative Medicine, 18, 291-296.
Jahn, D. R., Crkrowicz, K. C. (2011). The impact of the nature of relationships on perceived burdensomeness and suicide ideation in a community sample of older adults.Suicide and Life-Threatening Behavior, 41(6), 635-649. doi: 10.1111/j.1943-278X.2011.00060.x
Jahn, D. R., Cukrowicz, K. C., Linton, K., & Prabhu, F. (2011). The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging & Mental Health, 15, 214-220. doi: 10.1080/13607863.2010.501064
Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22, 116-122.
Kirby, E., Broom, A., & Good, P. (2014). The role and significance of nurses in managing transitions to palliative care.BMJ Open, 4, e006026. doi:10.1136/bmjopen-2014-006026
Kuijer, R. G., Buunk, B. P., Jong, M. D., Ybema, J. F., & Sanderman, R. (2004). Effects of a brief intervention program for patients with cancer and their partners on feelings of inequity, relationship quality and psychological distress, Psycho-Oncology, 13, 321-334. doi: 10.1002/pon.749
Kwon, Y. C., Shin, D. W., Lee, J. H., Heo, D. S., Hong, Y. S., Kim S. Y., & Yun, Y. H. (2009). Impact of perception of socioeconomic burden on advocacy for patient autonomy in end-of-life decision making: A study of societal attitudes.Palliat Med, 23, 87-94. doi: 10.1177/0269216308099244.
Lambie, G. W. (2006). Burnout prevention: A humanistic perspective and structured group supervision activity.Journal of Humanistic Counseling, Education and Development, 45(1), 32-48.
Lawson, G. (2007). Counselor wellness and impairment: A national survey. Journal of Humanistic Counseling, Education and Development, 46, 20-34.
Lincoln, Y. S., Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
Lofaso, C. R., Weigand, D. A. (2014). Individual Characteristics and Self-Perceived Burden in Cancer Patients, Current Psychology,33,174–184. DOI 10.1007/s12144-014-9204-y
Lowey, S. E. (2008). Communication between the nurse and family caregiver in end-of-life care: a review of the literature. Journal of Hospice and Palliative Nursing, 10(1), 35-48.
Lui, Y. M. (2014). Self-perceived burden in cancer patients: A multi-method approach.(Unpublished doctoral dissertation). The University of Hong Kong, Hong Kong.
Maslach, C. (1982). Burnout: The Cost of Caring. Englewood Cliffs, NJ. Prentice Hall.
Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12, 189-192.
Marco L., Bermejillo I., Garayalde N., Sarrate I., Margalle A. & Asiain C. (2006) Intensive care nurses’ belief and attitudes towards the effect of open visiting on patients, family and nurses. Nursingin Critical Care 11(1), 33–41.
May C. (1995). ‘To call it work somehow demeans it’: the social construction of talk in the care of terminally ill patients. Journal of Advanced Nursing, 22(3), 556–561.
McPherson, C. J., Wilson, K. G., & Murray, M. A. (2007). Feeling like a burden: Exploring the perspectives of patients at the end of life. Social Science & Medicine, 64, 417-427.
McPherson, C. J., Wilson, K. G., Chyurlia, L., & Leclerc, C. (2010). The balance of give and take in caregiver-partner relationships, Rehabilitation Psychology, 55(2), 194–203.
Mok, E., Chiu, P. C. (2004). Nurse-patient relationships in palliative care. Journal of Advanced Nursing, 48(5), 475-483.
Oeki, M., Mogami, T., & Hagino, H. (2012). Self-perceived burden in patients with cancer: Scale development and descriptive study. European Journal of Oncology Nursing, 16, 145-152.
Patrick, D.L., Pearlman, R.A., Starks, H.E., Cain, K.C., Cole, W.G., Uhlman, R.F. (1997). Validation of preferences for life-sustaining treatment: implications for advance care planning. Annual International Medicine, 127, 509-517.
Perroud S., Delaney K.R., Carlson-Sabelli L., & Johnson M.E. (2006). Advanced practice psychiatric mental health nursing, finding our core: the therapeutic relationship in 21st century. Perspective Psychiatry Care, 42, 215-226.
Qian, H., Zhou, Y. Q., Liu, Y., Xiao, J. Q., Shen, X., & Jiao, Y. H. (2013). Investigation of self-perceived burden and its influencing factors among cancer patients. Chinese Nursing Mangaement, 13, 42-45.
Remen. R. N. (1996). Professionals don’t cry. Kitchen Table Wisdom. Penguin Putnam Inc. http://www.thewitness.org/archive/9912/currentarticle2.html
Ricoeur P. (1988). Hermeneutics and the Human Sciences (JB Thompson ed. and translated). Cambridge University Press, New York.
Risser, J. (1997). Hermeneutics and the Voice of the Other: Re-reading Gadamer’s Philosophical Hermeneutics.
Russell, C. K., Bunting, S. M., & Gregory, D. M. (1997). Protective care-receiving: the active role of care-recipients. Journal of Advanced Nursing, 25, 532-540.
Seymour, J., Payne, S., Chapman, A., & Holloway, M. (2007). Hospice or home:Expectations of end-of-life care among white and Chinese older people in the UK.Sociology of Health & Illness, 29(6), 872–890. doi: 10.1111/j.1467-9566.2007.01045.x
Simmons, L. A. (2007). Self-perceived burden in cancer patients: Validation of the Self-perceived Burden Scale. Cancer Nursing, 30(5), 405-411.
Stayt L.C. (2007) Nurses’ experiences of caring for families with relatives in intensive care units. Journal of Advanced Nursing 57(6), 623–630. doi: 10.1111/j.1365-2648.2006.04143.x
Steinhauser, K. E., Christakis, N. A., Clipp, E. C., McNeilly, M., McIntyre, L., & Tulsky, J.A. (2000). Factors considered important at the end of life by patients, family, physicians, and other care providers.JAMA, 284(19), 2476-2482.
Skovholt, T.M. (2005). The cycle of caring: A model of expertise in the helping professions. Journal of Mental Health Counseling. 27(1), 82-94.
Strandberg, G., Jansson, L. (2003). Meaning of dependency on care as narrated by nurses.Scand Journal Caring Science, 17, 84–91.
Tang, S.Z., Chang, W.C., Chen, J.S., Su, P.J., Hsieh, C.H., & Chou, W.C. (2014). Trajectory and predictors of quality of life during the dying process: roles of perceived sense of burden to others and posttraumatic growth.Support Care Cancer, 22, 2957–2964. DOI 10.1007/s00520-014-2288-y
Tang S. T., Liu T. W., Lai, M. S., & McCorkle R. (2005). Discrepancy in the preferences for place of death between terminally ill patients and their primary family caregivers in Taiwan. Soc Sci Med, 61, 1560-1566.
Turner, H. J. (1998). The Structure of Sociological Theory. Belmont, Calif: Wadsworth Pub. Co.
Twigg, J. (2000). Bathing:The Body and Community Care. pp.71-74. London: Routledge.
Van Orden, K. A., Bamonti, P. M., King, D. A., & Duberstein, P. R. (2012). Does perceived burdensomeness erode meaning in life among older adults.Aging Ment Health, 16(7), 855–860. doi:10.1080/13607863.2012.657156
Vig, E.K., Pearlman, R.A. (2003). Quality of life while dying: a qualitative study of terminally ill older men. Journal America Geriatr Soc, 51, 1595-1601.
Wilson, K. G., Chochinov, H. M., & McPherson, C. J. (2007). Desire for euthanasia or physician-assisted suicide in palliative cancer care. Health Psychology, 26(3), 314-323.
Wilson, K. G., Curran, D., & McPherson, C. J. (2005). A burden to others: A common source of distress for the terminally ill. Cognitive Behaviour Therapy, 34(2), 115-123.
Winter, L., Parks, S. M. (2012). The Reluctance to Burden Others as a Value in End-of-life Decision Making. Journal of Health Psychology, 17(2), 179-188. doi: 10.1177/1359105311414956
Wilstrand, C., Lindgren, B.M., Gilje, F., Olofsson, B. (2007). Being burdened and balancing boundaries: a qualitative study of nurses' experiences caring for patients who self-harm.Journal of Psychiatric and Mental Health Nursing, 14, 72–78.
Wu, H.L., Volker, D.L. (2009). Living with death and dying: The experience of Taiwanese hospice nurses. Oncology Nursing Forum, 36(5), 578-584.
Young, A. J., Ofori-Boateng, T., Rodriguez, K. L., & Plowman, J. L. (2003). Meaning and agency in discussing end-of-life care: a study of elderly veterans’ values and interpretations. Quarter Health Research, 13(8), 1039-1062.
Zheng,R.S., Guo, Q.H., Dong, F.Q., Owens, R.G. (2014) Chinese oncology nurses’ experience on caring for dying patients who are on their final days: A qualitative study. International Journal of Nursing Studies, 52, 288–296.