探討精神科護理人員之照護活動－Foucault權力關係觀點分析

本研究試圖以Foucault權力關係的觀點來探討中部某綜合醫院精神科病房中臨床護理人員照護活動的過程，以探究規訓（discipline）的實施，在精神病房中利用各種機制建構「全景敞視」式的權力運作及探討臨床護理人員的身體如何順從與反抗。本研究以質性研究法、立意取樣，透過深度訪談五位精神科臨床護理人員的權力運作及身體如何順從，發現護理人員在養成教育期間，即不斷到受到知識的灌輸、行為的要求。再經過醫院職場教育，對於時間、空間、考核、與互動的要求都有明確規定，以建立病房的秩序與一致性，同時透過管理者的監視及監視器的挹注，使受監視者轉化成自我的監視，對於違反病室規定的病人給予處置，權力關係確實在精神病房內扮演了重要的角色。然而，看似完備的運作，在面對人權意識(病人及護理人員)高漲及科層管理，部分護理人員為便照護活動運行的自主判斷彈性運用，形成破窗效應，引發從眾心理和行為僵化，累積成照護活動上的「次文化」。因此提出札實教育訓練、增強認同感與歸屬感、調整從業心態以及提升成就感等反思方向，以供臨床從業人員思考培育方向。

關鍵字

精神衛生護理人員；照護活動；權力現象

並列摘要

The study attempted to probe into the process of care activities carried out by clinical nurses in psychiatric wards in a general hospital in central Taiwan from the perspective of Foucault’s power relationship to learn about the implementation of discipline. Additionally, various mechanisms were used to construct the operation of “panopticism” power in psychiatric wards to probe into how clinical nurses’ bodies obeyed and resisted. By adopting the qualitative research method and purposive sampling, the study conducted in-depth interviews with five psychiatric clinical nurses regarding their operation of power and how their bodies obeyed. It found that they were constantly instilled with knowledge and disciplined when they received formative education. Additionally, they received workplace education provided by the hospital, which specifically regulated time, space, assessment and interaction to build the order and consistency of wards. Meanwhile, with the monitoring of supervisors and monitors, the nurses who were monitored began self-monitoring and dealing with patients who violated the regulations of wards. Power relationship truly played an important role in psychiatric wards. However, in facing the challenges of the rise of human rights (of patients and nurses) and bureaucratic management, some nurses elastically operated the principle of self-determination to facilitate the operation of care activities. As a result, the seemingly perfect operation caused the broken windows theory, triggered conformity and behavior rigidity, creating subculture in care activities. In light of this, the study proposed the reflections of steadying educational training, strengthening the sense of identity and belonging, adjusting work mindset and enhancing the sense of achievement to serve as references for clinical nurses in thinking about the direction of cultivation.