安寧護理人員對臨終照顧情境的知覺感受

The Perceptions and Feelings of Hospice Nurses toward the Situations of Terminal Care

蔡淑玲(Shu-Ling Tsai) ； 蔡昌雄(Chang-Hsiung Tsai) ； 楊麗靜(Li-Ching Yang)

《安寧療護雜誌》 12卷1期 (2007/02) Pp. 1-12

https://doi.org/10.6537/TJHPC.2007.12(1).1

摘要

本研究旨在探討安寧護理人員對臨終照顧情境的知覺感受。採取詮釋現象學的質性研究方法，依立意取樣，選取嘉義某區域教學醫院安寧病房護理人員為研究參與者，共十二位，本研究者自九十三年七月開始，進入病房參與觀察及田野記錄，為期一年。資料分析依詮釋循環原則反覆閱讀文本，將安寧護理人員知覺感受內容，整理成空間、時間、關係與死亡四個範疇，逐一進行現象描述與詮釋。研究結果發現：(1)情境空間的知覺感受，正負向皆有，初期比較正向，隨著照顧經驗的深化則有敏銳的知覺感受；(2)內在時間的知覺感受，主要透過照顧工作的階段，以及過往照顧的記憶呈顯出來；(3)護病關係被知覺，主要表現在與病人間親情般的感受，以及關係解離時的痛苦感受；(4)死亡的知覺經驗，主要來自於病人關係的解離，使她們覺察到生命的邊界處境，恐懼悲傷之餘，也體會到死亡平等的奧秘與神聖。綜合而言，與病人關係的解離，是構成護理人員對臨終照顧死亡情境覺察的主要來源，也是各種負向情緒的因由，不過四個範疇的知覺感受是交互影響構成的。建議未來應強化安寧護理人員的現場支持及教育。

關鍵字

安寧療護 ； 臨終照顧 ； 詮釋現象學

並列摘要

The objective of this study was to explore the perceptions and feelings of hospice nurses toward the situations of terminal care. The researchers adopted hermeneutic phenomenology as the method. The twelve research participants were selected through purposive sampling from the nurses of hospice ward of a local teaching hospital in Chia-Yi. From July 2004 to June 2005, the researchers conducted the participative observations and field study therein. The data analysis was conducted by the principle of hermeneutic circling. The text was analyzed into four thematic categories: space, time, relationship, and death, which were delineated and interpreted accordingly. The findings showed that, firstly, the hospice nurses had both positive and negative perceptions toward the situational space, while more positively in the early stages and became sensitively and keenly as caring went deeper. Secondly, what the nurses had regarding the internal temporal perceptions and feelings were mainly manifested in terms of the caring stages and the past caring memories. Thirdly, nurse-patient relationship was perceived through their family-like feelings with patients and suffering as this relationship became disassociated. Fourthly, death perception arose from the disassociation of the relationship, propelling them to be aware of the boundary situation of life. It made them feel feared and sorrowed, but see the mystery and sacredness of equality of death as well.All in all, the disassociation of the relationship with dying patients remained the major source of nurses’ awareness of the death situation. It also caused a variety of negative emotions. However, the four categories of perception and feeling were constitutively interrelated. It was suggested to strengthen the program of immediate support and education for hospice nurses.

並列關鍵字

hospice ； terminal care ； hermeneutic phenomenology