남성노인의 케어경험에 관한 근거이론 연구

Abstract

The purpose of this study is to examine the experiences of rural elderly men who take care of their spouses with cerebral in the context of structure and time and to have an in-depth understanding of their caregiving experiences through grasping the meaning and essence of their experiences. The study also intended to arouse society's interest and understanding about elderly men in rural areas in terms of social welfare and provide fundamental materials based on their experiences and desires for the development of effective and unique social welfare plans for them. The researcher believed exploration process needed to be carried out before examining feelings, thoughts, and real life experiences of rural elderly men who take care of their spouses suffering from cerebral. Therefore, using a qualitative research method involving Strauss and Corbin’s grounded theory, the researcher tried to understand the essence of caregiving by rural elderly men who lived with only their sick spouses. The subjects of this study were 17elderly men in Jangseong-gun, Jeollanam-do who had no problem in communicating with interviews and who were looking after their spouses over two years who had experiences in treating cerebral and became disabled due to encephalopathy. The data was collected for five months from May 2006 to December 2006 through in-depth interviews and participant observations. Following the procedures of Strauss and Corbin’s grounded theory method, comparative analysis was performed continuously to analyze data immediately after data collection. According to paradigm of grounded theory, conceptualization and categorization were performed during open coding. And in axial coding, category analysis and process analysis were made. During selective coding, a core category and a story line was described. Then, type categorization was made through the establishment of relations between the core category and other categories and then a contingency Model was set. Through open coding, 113concepts, 51sub-categories and 16categories were generated. According to the results of category analysis in axial coding, the casual condition of caregiving process of elderly men taking care of their spouses with cerebral was 'fainting spouse'. And the casual condition caused the core phenomenon, 'lonely fight as a male caregiver'. The contextual conditions of the core phenomenon were 'negative self-perception as a male caregiver' and 'responsibility as a husband'. The strategy of action/interaction to control the phenomenon included 'enhancing willingness to look after wife', 'discovering duties as a husband', and 'cultivating happiness eagerly'. The intervention conditions for that were 'understanding of the illness', 'perception of care though system', 'the rural environment difficult to care patients', and 'support system'. The results were 'giving up caring', 'stability of living, 'self-confidence', 'remaining crisis' and 'recurring frustration'. Caregiving processes elderly men experience over time can be categorized into four stages: ‘initiation stage’, ‘training stage’, ‘concentration stage’, and ‘sacrifice stage’. Elderly men who looked after their spouses with cerebral apoplexy displayed different behaviors at each stage. In ‘initiation stage’, after rural elderly women, suddenly fall into collapse due to cerebral, rural elderly men who live with only their spouses assume all the responsibilities such as livelihood, housework and caring for their spouse. In this stage, elderly men regret their past misdeeds, feel sorry for their wives and have fear and concern for future living. In ‘training stage’, elderly men accept situation in which they have to look after their spouses. With the support of family, friends, neighbors and community, they become determined to willingly care for their wives rather than considering their condition negatively. In ‘concentration stage’, with the support and encouragement with others, elderly men accept the situation which has been considered negatively. In this stage, they enhanced their willingness to care for their wives through mediation and rehabilitation training. In ‘sacrifice stage’, elderly men understand their spouses' illness and make specific preparations to take good care of their wives. In selective coding, the core category was ‘seeking happiness with the memory of marring their wives under the support system’. The results of analysis of the core category generated four types: ‘frustration type’, ‘abandonment type’, ‘optimistic type’, and ‘apprehension type’. Elderly men in frustration type have an in-depth understanding of their spouse' illness and make effort to offer systematic and planned care. However, in spite of their utmost care, there spouses do not get any better. This lead them to think they may have to spend rest of their lives caring for their wives, which makes them frustrated. Elderly men in ‘abandonment type’ have lack of understanding of their wives' illness and perceive rural environment very negatively. They utilize family-based personal system. They expect the conditions of their wives and their health to get deteriorated without any hope of getting better. Therefore they accept everything as their destiny and give up hope. Elderly men in ‘optimistic type’ have an accurate understanding of their wives' cerebral apoplexy. With the help of aggressive and continuous support system, they manage their health and care for their wives. Therefore, they still have hope, though they feel difficulty looking after their wives with the illness. Elderly men in ‘appreciation type’ try to do their duties as a husband and care for their spouses, though they are still confused with situation in which their spouses suffer from cerebral. However, they fail to adjust to their new situation and lose enthusiasm for life. They begin to feel apprehension about caring for their wives for a long time. So far, the study examined the processes of 'seeking happiness of the memory of marrying their wives under the support system' of elderly men who look after their wives with cerebral. Such processes can be considered as behaviors which elderly men display while they are being adjusted to their changed economical, physical, psychological and social conditions. These essences of experiences were discussed in connection with social welfare. Based on the research results, following suggestions were offered in term of social welfare. In theoretical aspects, the study provided an opportunity to comprehensively understand caregiving experiences of rural elderly men and offered fundamental materials for the establishment of clinical intervention strategy after the instruction of public long-term care system. In addition, in practical aspects, it provided an empathic understanding of caregiving which elderly men experience as a man, husband, elderly and parent under the social and cultural conditions of modern society and presented a basis for taking different approach to them. Thus, the study will be a meaningful material for the development of welfare service in various situations. Especially at a time when the instruction of public long-term care system is just around the corner, the study suggested the development of service and political measures that reflect various demands of users and their families form the perspective of users. Lastly, on the basis of elderly men caregivers' unique care motive and beliefs, research need to be carried out on care practice suitable for Korean sentiments and values.