以公共衛生觀點探討護理人員經驗SARS的復原歷程

The Resilience of Nurses Who Experienced SARS from Public Health Perspective

紀滋兒(Tzu-Ern Chi)

指導教授 ： 張玨

國立臺灣大學/公共衛生學院/衛生政策與管理研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01968

摘要

研究目的在於經由瞭解護理人員在SARS疫情爆發與蔓延那段時間，可能經驗到的一些心理變化，和適應與調適的過程，以及外界對受訪者的影響。以公共衛生觀點瞭解面對新興傳染病照護者的需求，提出合宜的支持系統。
本研究採質性研究（Qualitative Research）方式進行，透過滾雪球的方式尋求適合的受訪對象，共選取10個護理人員，利用深入訪談的方式來進行資料的收集，最後採用7個護理人員的訪談資料。
研究結果可以發現：個人的情緒是多元性，並非單一的，因此我們應該重視所有正面與負面的情緒，而不只是單就某一種情緒來處理。經由此研究，也可以看到不同情緒之間的變化情形，這是與其他研究較不同的地方。
此外，對受訪護理人員在經歷這次SARS事件將近一年之後的情緒變化，發現害怕（恐怖、恐懼、排斥）、擔心（不放心）這兩類的情緒大致已經復原，但是對於生氣（氣憤、抱不平、背叛、怨恨、忿恨不平、不平衡、煩躁、不齒、不屑）這類的情緒普遍都尚未復原，而感動（感謝、窩心、滿足、高興）這類正向的情緒，也不容易消失。
本研究也發現受訪者的個人特質與生命事件，不但會對復原歷程有影響，亦會影響受訪護理人員對情緒的感受和程度。
受訪者在出現情緒後會開始尋求出口，個人會去尋求一些因應的方法，其中以宗教、寫東西和增加知識對情緒的復原最有幫助，其次為放鬆、紓發情緒、正向信念、轉念、跳脫情境與轉移注意力，而尋求醫療的幫助較少。至於外界給予受訪對象的幫助，則以醫院提供足夠的防護設備與訓練課程，和朋友/同事的支持對受訪護理人員的幫助最大，家人的支持次之，而主管的鼓舞（階層不同有所隔閡）、民眾的支持與鼓舞（抵不過民眾的排擠與歧視）、政府政策介入（SARS津貼、封院政策不當和應變速度過慢）與心理輔導介入（疾病化與不主動），對她們的幫助似乎不大。
以公共衛生三段五級觀點，可以發現目前我國缺少政策與規劃，多半是靠個人力量在因應或尋求支持，但是透過政府或工會等有組織的協助則較缺。我國的公共心理衛生工作需要加強。

關鍵字

心理健康 ； 公共衛生 ； 復原力 ； 護理人員 ； SARS

並列摘要

The purpose of this study is to understand the psychological changes, coping strategy, adaptation and the effects of external assistance experienced by nurses during the outbreak and spread of SARS. The study also aims to provide policy implications, from a public health perspective, for the needs of nursing staff in face of new infectious diseases.
This study is a qualitative research and potential interviewees were reached by snowballing. In-depth interviews were initially conducted with ten nurses and final analysis was based on data collected with seven among all.
The findings reveal that emotion is of multiple dimensions, and therefore, attention must be paid to both positive and negative emotions, rather than one single dimension. The study is also unique in addressing changes in different types of emotion.
After one year of the SARS outbreak, nurses interviewed have almost resiled from fear (frightened, scared, and repelled) and worry (concerned about), but not anger (fury, unfairness done to someone else, betrayal, hate, anxiety, and contempt) and positive sensation (gratitude, thoughtfulness, satisfaction, and happiness).
In addition, this study finds that personality and life event not only affect the process of emotional resilience, but also the perception of emotion and its strength.
When having an emotional experience, nurses would try to cope with it in a variety of ways. Among all, resorting to a religion, being involved in writing and acquiring knowledge are considered to be most helpful, followed by relaxing oneself, expressing emotions, having positive beliefs, keeping away from the occasion and shifting attention. Seeking medical treatment is relatively rare. With regard to assistance provided, protective equipment and training offered by the hospital and support from friends and colleagues are most helpful, followed by familial support. However, the encouragement from supervisors (due to differential organizational class) and the public (unable to balance public’s repellence and stigmatization), government intervention (SARS supplement, improper policy of closing the hospital, and inefficient crisis management) and counseling (disease labeling and lack of motivation) are of little use.
According to the public health approach of three stages and five levels, it is concluded that policy planning has been absent from dealing with the issue of interest. While individual efforts and coping strategy have been relied on the most, the government and professional association have failed to coordinate assistance in a systematic manner. Our government needs to strengthen the Public Mental Health system.

並列關鍵字

nurses ； resilience ； public health ； mental health ； SARS

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