護理人員對愛滋病病患之初次照護經驗探討

根據2017年聯合國愛滋病規劃署資料統計顯示，全球有3690萬名愛滋病毒感染者，當年即新增180萬名感染者，面臨愛滋感染人數日益增加，凸顯愛滋感染的照護需求增加。護理人員在照護階段所面臨的調適壓力，以及在面對具傳染性風險的愛滋病環境中，護理人員的態度、經驗及感受，目前缺乏相關研究，但需要被重視與深入探討之部分，才能了解工作所面臨的挑戰及因應方式。本研究主要目的在於，深入探討護理人員初次照護愛滋病病人過程之經驗感受，及了解照護需求為何。本研究設計採質性研究方式進行，個案來源為中市某醫學中心護理人員，以立意取樣法，選取10位初次照護愛滋病病人六個月內之護理人員為研究對象，並使用半結構式一對一深度訪談進行資料搜集，運用主題內容分析法進行資料分析。其研究結果歸納出三個主題及五個次主題，主題分別為(一)自我衝擊：害怕面對病人及家屬、擔憂工作安全、刻板印象；(二)轉念化為正向：正向鼓勵自己、支持的力量；(三)照護需求。本研究依據研究結果提出以下建議：(一)提供臨床醫護人員規劃倫理議題時，增加愛滋倫理議題討論，讓護理人員更清楚愛滋的倫理思辨；(二)定期安排臨床個案小組討論，以瞭解護理人員照護感受，透過角色模範帶領，以降低初次照護之護理人員對疾病的恐懼及減少汙名的錯誤觀念；(三)透過病友會的活動增進病人、家屬與醫護人員之護病溝通，並藉由跨領域團隊合作，提供病人多元的醫療諮詢服務，亦能提升病友自我照護能力，改善社會大眾對疾病的歧視；(四)規劃初階與進階課程，並規範照護之相關病房所有護理人員必需參與此課程，以增加照護技能，降低恐懼及害怕心理。期盼藉由本研究結果，在臨床、政策、教育及研究給予建議，提供護理人員對愛滋病病患之初次照護經驗參考依據，以提升照護品質。

關鍵字

質性研究；初次照護經驗；愛滋病

並列摘要

According to the data of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2017, about 36.9 million people worldwide were infected with the HIV virus and there were 1.8 million newly diagnosed individuals in 2017. With the increasing number of HIV-infected patients, the demands for nursing care are also growing. The adjustment stress of nursing staff during the nursing period, and their attitudes, experiences, and feelings when facing the risk of being infected with the HIV virus, are subjects that are rarely seen in existing related studies, but these subjects require attention and in-depth exploration. Only by studying these subjects, we can understand the challenges faced by the staffs well as their coping methods. The main purpose of this study is to carry out an in-depth exploration of the first-time experiences of nursing staff when caring for patients with AIDS and to learn the nursing requirements. A qualitative research method was employed in this study, and the cases involved nursing staff in a medical center in Taichung City, Taiwan. Purposive sampling was utilized to select ten nursing staff who had taken care of AIDS patients for the first-time within the last six months as study participants. At the same time, semi-structured in-depth one-to-one interviews were conducted to collect data. Afterward, Thematic Content Analysis (TCA) was used to analyze the data. Three themes and five sub-themes were concluded from the results and the themes included： (1) Self-impact： fear of patients and their families, worrying about safety at work and stereotypes; (2) Creation of an optimistic mindset： encourage yourself and find support; (3) Nursing requirements. The following suggestions are proposed based on the study results. (1) When planning programming regarding ethical issues for nursing staff, ethical issues about AIDS should be added and discussed so that nursing staff will have clearer ethical thoughts about AIDS; (2) Case study group discussions should be regularly arranged to gain a better understand of the feelings of nursing staff and the nursing staff’s fears of the disease and their misconceptions such as stigma should be reduced through role modeling; (3) Communication between patients and their families and the nursing staff should be enhanced through patient association activities. Moreover, teams in different areas can cooperate to provide diverse medical consulting services for patients. Thus, the self-care abilities of patients would be improved as well. Additionally, discrimination against the disease should be reduced; (4) Obligatory courses (elementary and advanced) should be arranged, and nursing staff should complete the courses within a stipulated period of time to strengthen their nursing skills, and reduce their fears. We expect that the study results can provide advice for clinics, policies, education, and related studies, and offer references of first-time nursing experiences with AIDS patients to nursing staff so as to improve the nursing quality.