融滲照護、關懷及悲憫於護理問題分析及解決法

關懷照護是護理的核心，目前醫療品質的核心價值是以病人為中心，重視安全、有效、適時、效率、公正優質的服務（陳、徐、邱，2004）。本研究主要目的是運用照護、關懷、悲憫(3C)理念於護理行政專案中，具體目標在探討融滲3C於護理問題分析及解決法的學習成效。研究方法運用行動研究法，於某護理學系二技「護理領導與管理」臨床實習中，一組11位同學為研究對象，學生每週與老師討論在「行政專案」的學習，每週進度作業作為分析資料，比較初次與末次「問題分析」以及「問題解決」作業，將與3C有關的敘述作為行為單元，以質性內容分析法分析。結果呈現學生對護理問題的分析由行為表面、責備而增進為可深入到重視以人為核心的特質。在問題分析方面呈現四大層面「病患及家屬的個別特質與身心靈的壓力調適」、「以人本為中心的規範流程及設備」「醫護人員職場情境的困頓」、「護理人員全人化的成長需求」，在問題解決法方面呈現「提供尊重病患及家屬的個別特質及重視心靈壓力調適的照顧」、「制定與規劃人本為中心的規範流程及設備」「體諒與扶持的管理文化」及「建構護理自我與專業的知情意成長」。本研究顯示3C雖有其個別獨立的定義，但在護理問題分析及解決法中，3C是在一起的整體概念，不能劃分出是獨立屬於關懷、照護或悲憫，而是融合三個層面所獲得出的結果，發展出以人為中心，重視有關病患、護理人員及工作職場的觀點，更能接近關懷照顧與醫療品質的特質。

關鍵字

3C的學習；行政專案；問題分析；問題解決法

並列摘要

Caring concern is the core of nursing. Quality medical care is patient-centered and based on safety, effectiveness, adequacy, efficiency, and equality. This study explored the phenomenon about the incorporation of care, concern and compassion (3c) into nursing administration. Specially, this study assessed the effectiveness of 3c on problem analyzing and resolving in nursing. This study applied an action research design. The research subjects included one teacher and 11 students in a course of ”Leadership and Management”, which was offered as part of a 2-year on-job continuous education division of a university nursing department. The subjects participated in weekly discussions of the learning experience associated with the clinical practicum. Weekly progress reports regarding administration projects were obtained for data analysis. The first and final reports regarding problem analysis and resolution were analyzed. Within the reports, each statement expressing the concept of 3c was treated as a ”behavioral unit”. Through the content analysis, the results revealed four main aspects on problem analysis: ”Individual characteristics of patients and families and their stress adaptation on bio-psycho-spirits”, ”Humanity-centered procedures and equipment”, ”Suffering related to nursing working context”, and ”Nurse growth to be a whole person”; and displayed the following aspects on problem resolution: ”Offering care in respecting the individual characteristics of patients and their families, and stressing care in stress adaptation of bio-psycho-spirits”, ”Formulating and planning humanity-centered nursing procedures and equipment”, ”Cultivating an understanding and supportive nursing administration culture”, and ”Construct the developing program of knowledge, attitude and behavior for self and professional development”. This investigation demonstrated that despite separate definitions for each item of 3c, they comprise an integrated whole in nursing problem analyzing and resolving. The 3c are not necessary to be treated separately and independently. The result of incorporation of 3c will develop a humanitarian perspective, focused on patients, nurses, and working environment perspective, which will more closely meet the core value of caring concern and medical quality.