安寧護理人員自我照顧模式的探討

Two Modalities of Self-Care of Hospice Nurses

蔡淑玲(Shu-Ling Tsai) ； 蔡昌雄(Chang-Hsiung Tsai) ； 周傳姜(Chuan-Chiang Chou)

《安寧療護雜誌》 14卷2期 (2009/07) Pp. 115-126

https://doi.org/10.6537/TJHPC.2009.14(2).1

摘要

本研究旨在探索身爲照顧者的安寧護理人員之自我照顧的具體經驗。選擇詮釋現象學爲研究方法，實徵資料係透過在某安寧病房的參與觀察，以及對該病房12位護理人員的深度訪談蒐集而得。分析文本聚焦於以下主題：(1)開顯理解的前結構，(2)反思現象本質的基本主題，(3)在研究文本的部份與全體之間平衡考量，(4)發現行爲的基本模式。本研究者發現，在回應死亡焦慮引發的工作壓力時，安寧護理人員發展出兩種基本的自我照顧模式：亦即「做」的自我照顧模式與「在」的自我照顧模式。前者包括五種主要方式：(1)築起「防禦」的堡壘，(2)讓「遺憾」少一點，(3)創造「喘息」的空間，(4)與重要他人分享，(5)尋求宗教與成長團體的支持。在此，自我照顧的工作被視爲是除去各種外在威脅的手段。後者則與任何特定的作爲方式無關，它所指的是，個人在死亡照顧工作上面對死亡焦慮的思維與態度之調整。所涉及的主題有：(1)從反思中超越，(2)與挫折和焦慮共處，(3)愛與意志的凝煉，(4)留心語言背後的沈默底景，(5)情人口角的反思。綜合而言，安寧護理人員會採取第一種模式中的某種因應機轉，然而成效有其限制。隨著死亡照顧經驗的深化，她們會發現自己更爲涉入第二種模式中的存在挑戰。一旦態度改變，照顧的品質將大幅提升。雖然兩種照顧模式在實務上不可分割，但是概念上的區分有助於了解安寧護理人員自我照顧本質與形式之間的關係。

關鍵字

安寧護理人員 ； 自我照顧 ； 臨終照顧 ； 死亡焦慮 ； 詮釋現象學

並列摘要

The objective of this study is to explore the embodied experience of self-care of hospice nurses as caregivers. The researchers chose interpretive phenomenology as the method. The empirical data were collected through field participation in a hospice ward in Taiwan and depth-interviews on 11 hospice nurses therein. The researchers analyzed the text by focusing on the following issues: (1) disclosing the fore-structure of understanding, (2) reflecting on the essential themes, which characterize the phenomenon, (3) balancing the research context by considering parts and whole, (4) discovering the essential modes of involvement.
The researchers found that in response to the work pressure derived from death anxiety, hospice nurses developed two basic modalities of self-care, i.e., the modality of ”doing” and that of ”being.” The former consisted of five major means, including ”developing defensive mechanism,” ”lessening regrets,” ”creating respite room,” ”resorting to meaningful others,” ”depending upon group support.” The self-care work was thus viewed as doing away all sorts of threat outside. The latter had little to do with any specific way of doing. It rather referred to the adjustment of one's existential attitude toward death anxiety from the death caring work. The major themes involved were: (1) to come to terms with frustrations and anxieties, (2) to attain transcendence by way of self-reflective process, the circling of awareness, reflection, and action.
In conclusion, all nurses resorted to some of the coping mechanisms in the 1st modality. However, the effects were limited. As death caring went deeper, they found themselves become more involved in the existential challenges contained in the 2nd modality. Once attitude change occurred, it shall enhance the quality of care considerably. The two modalities discussed were practically inseparable, but the conceptual distinction helped understanding the relationship between the essence and forms of hospice nurses' self-care.

並列關鍵字

hospice nurse ； self-care ； terminal care ； death anxiety ； hermeneutic phenomenology