臨終照護中的實踐智慧

The Practical Wisdom Gained in the Provision of End-of-Life Care

劉盈君(Ying-Chun Liu) ； 蔣欣欣(Hsien-Hsien Chiang)

《護理雜誌》 61卷5期 (2014/10) Pp. 33-42

https://doi.org/10.6224/JN.61.5.33

摘要

背景　臨終照護觸及死亡的受苦經驗，影響護理人員的生活世界。從事臨終照護的護理人員，由其護理實踐所萃鍊出來的照護智慧歷程是值得探討的議題。目的　本研究目的以「實踐智慧」和列維納斯「為他者」的觀點探討從事臨終照護護理人員的照顧經驗。方法　本研究為質性研究，採詮釋現象學的質性研究法。以深度訪談七位有臨終照護經驗的護理人員。訪談資料轉錄為文本，以詮釋現象學方法分析（interpretative phenomenology analysis）。結果　研究結果發現臨終場域，護理人員的投身與實踐是心靈轉化與獲得照護智慧的機會與歷程，照護過程中智慧的表現在（一）照護的難為，（二）承認自己的有限，（三）貼近病人的腳步。結論／實務應用　臨終照護提供護理人員成長與轉化的契機，能夠啟發護理人員在照護中承擔他者的倫理性。從覺察照護難為的處境，承認自我的有限，以至於可以轉向病人，最終以進入他者的智慧與倫理行動提供臨終病人照護。

關鍵字

臨終照護 ； 實踐智 ； 面對他者 ； 質性研究

並列摘要

Background: The suffering experienced by nurses while providing end-of-life care to patients influences the lived experience of these nurses. The perspectives of ＂for the other＂ and ＂practical wisdom＂ may be used to elicit the experience of nurses in caring for dying patients and to help illustrate the ethical contents and meanings of end-of-life care. Purpose: This study describes the experiences of nurses who have provided end-of life care in hospital settings. Methods: In-depth interviews were used to explore the respective experiences of 7 nurses. Data were analyzed using interpretative phenomenological analysis (IPA). Results: The findings show that practicing and engaging in end-of-life care provide nurses the opportunity to acquire practical care wisdom in three categories, including (1) the emotional difficulties of patient care; (2) the limitations of the self; and (3) learning to adjust to the needs and pace of the patient. Conclusions / Implications for Practice: End-of-life care is an opportunity for both dying patients and nurses to transform and grow spiritually. Dealing with the emotional difficulties of end-of-life care, recognizing their self-limitations in care, and adjusting their care provision to meet the needs and pace of their patients help increase the awareness of nurses to the ethical responsibility they have toward patients. These findings give nurses new perspectives on caring for others.

並列關鍵字

end-of-life care ； practical wisdom ； face the other ； qualitative study

參考文獻

王心運（2008）．他者的倫理學．護理雜誌，55（1），9－13。[Wang, S. Y. (2008). The ethics of the other. The Journal of Nursing, 55(1), 9－13.] doi:10.6224/JN.55.1.9

江蘭貞（2004）．臨終處境下護病之靈性遭逢．安寧療護雜誌，9（1），91－98。[Chiang, L. T. (2004). On nurse-patient spiritual encounter at terminal stage. Taiwan Journal of Hospice Palliative Care, 9(1) , 91－98.]

吳澤玫（2004）．高達美論文本意義與詮釋者的關係．哲學與文化，31（7），163－181。[Wu, T. M. (2004). On Gadamer's theory of the relationship between the interpreter and the meaning of text. Monthly Review of Philosophy and Culture, 31(7), 163－181.]

連雋偉（2003）．高達美的哲學詮釋學．哲學與文化，30(11），63－92。[Lian, J. W. (2003). Hans-Georg Gadamer’s philosophical hermeneutics. Monthly Review of Philosophy and Culture, 30(11), 63－92.]

楊婉儀（2012）．以「在同一當中的大寫他者」論萊維納斯的責任與倫理意涵．東吳哲學學報，26，109－135。[Yang, W. I. (2012). On the responsibility and the ethical signification in Levinas's “other-in-the-same. Soochow Journal of Philosophical Studies, 26, 109－135.]