安寧病房護理人員的照護困境與轉化學習

從事安寧療護是一項辛苦的工作，在過程中有許多的困難、挑戰、壓力、與悲傷，如何因應與轉化是一大挑戰。研究目的：本研究旨在瞭解護理人員在安寧病房遇到的困境、因應資源、轉化學習的過程。方法：採質性研究設計，透過立意及滾雪球取樣方法，共訪十位安寧病房護理人員為研究參與者，透過半結構式訪談蒐集資料後進行分析。結果：安寧療護護理人員照護的困境為理念認知、病人照顧、護病關係與團隊合作。面對照護困境時因應的內在資源有宗教信仰、專業信念、自我宣誓與跳脫轉移，外在資源則包括專業團隊的支持、重要他人的支持、課程研習與自主閱讀等。而面對困境時轉化學習的經驗有開放心智、瞭解同理、聆聽內在、回歸核心、付諸行動與體認安寧工作意義與價值。結論：研究發現安寧病房護理人員面臨困境時，可觸發其個體轉化的過程，從而有所學習和改變。本研究並針對學校及職場提出相關建議。

關鍵字

安寧病房護理人員；困境；轉化學習

並列摘要

Hospice care is a hard work. There are many difficulties, challenges, stresses, and sorrows. How to transform and cope with it is quite a challenge. Purpose: The aim of this study was to explore the transformative learning phenomenon of hospice nurses in the workplace, in order to understand the difficulties they face and the transformative learning approaches they adopt, and the changes in their attitudes attributable to their learning experience. Method: A qualitative study design was employed, and the research subjects were 10 full-time nurses working in the palliative care ward in Taiwan. In-depth interviews and document analysis were adopted to collect data. Result: The difficulties faced by hospice nurses are outlined as follows: hospice and palliative care knowledge, patient care, nurse-patient relationship, and teamwork. Religious beliefs, professional faith, self-vow and emotional detachment are the internal resources that support hospice nurses when they resolve their difficulties, whereas team support, support from others, educational training and initiative reading are external resources that help nurses respond to difficulties. Being open-minded, understanding empathy, listening to the inner voice, returning to the core value, putting into action, and recognizing the significance and value of hospice work are the experience of transformative learning of hospice nurses when they confront their difficulties. Conclusion: The difficulties that hospice nurses face could trigger the process of their individual transformation which would lead to individual learning and changing. This study also provides suggestions applicable for school and workplace settings.

並列關鍵字

hospice nurse ； difficulties ； transformative learning

參考文獻

Kear, T. M. (2013). Transformative learning during nursing education: A model of interconnectiv-ity. Nurse Education Today, 33(9), 1083-1087. doi:10.1016/j.nedt.2012.03.016

施勝烽、龍紀萱、何建德（2010）。臺灣安寧療護團隊成員的工作壓力與其調適歷程。人文及社會科學集刊，22（3），303-352。