The Personal Constructs of Spirituality toward Terminally Ill Patients-A Study of Nurses from One Hospice Ward in Central Taiwan

台灣中部地區一所安寧病房護理人員對臨終病人靈性之個人建構

張利中(Li-Jung Chang)

《安寧療護雜誌》 13卷4期 (2008/11) Pp. 381-393

https://doi.org/10.6537/TJHPC.2008.13(4).1

摘要

靈性是安寧療護中一項重要的議題，護理人員對於靈性的認知與覺察會影響其進行靈性照顧的能力與表現。個人建構是一個心理實在，是個人用來解釋與預期內外在人、事與心理事物的參考架構，本研究應用Kelly提出之個人建構理論與「三一導出法」，來探索與安寧護理人員覺知臨終病人靈性的建構與向度。本研究以半結構式的訪談程序來收集台灣中部地區一所安寧病房的16 位護理人員的質性資料。在「三一導出法」的訪談過程，要求受訪護理人員首先舉出五位在靈性上具有特色的病人，並以這五位病人爲元素，再以五取三數學組合的方式形成10個「三元素組合」(triads)，每一個組合都有三位病人。受訪之護理人員之後被要求在每一個組合中，將三位病人依其靈性特色之不同分成兩組，並且提出分組的理由，這些口頭表達的理由則被錄音、轉錄成文本資料，並以內容分析的方法界定出受訪護理人員之二分性建構，也就是受訪之護理人員知覺臨終病人靈性狀態的個人建構。研究發現「宗教」、「家庭支持」、「性格」、「死亡觀點」、「靈性安適」、「疾病態度」、「社經地位」、「生命意義」、「生理面向」等九個建構向度。值得注意的是除了家人支持與宗教信仰外，性格成爲受訪護理人員看待臨終病人靈性態度的一個重要的建構，而此性格的向度，有許多負面性格的表述。研究也發現受訪之護理人員未呈現的靈性建構向度爲「生命意義」，受訪之護理人員傾向以「系統」的觀點，甚於應用「存有」與「整全」的概念取向來看待靈性的問題。本研究建議在未來的研究應以安寧病房護理人員及實際提供靈性照顧資深的護理人員爲對象，找出資深護理人員對於「靈性照顧」的各種知覺向度，進而提昇生命末期照護中靈性照顧的品質。

關鍵字

個人建構 ； 靈性 ； 臨終病人 ； 安寧療護

並列摘要

Personal constructs are the ”frames of reference” for individual to interpret and expect persons, events, and psychological realities in the world. The Personal Construct Theory and the triadic elicitation technique are applied to explore and identify the constructs and construct dimensions hospice nurses have to recognize the spirituality of terminally ill patients. A semi-structured interview was executed with all sixteen nurses in one hospice ward in central Taiwan to collect qualitative data. With the triadic elicitation interview, each nurse was asked first to identify 5 patients with unique spirituality status. These 5 patients served as elements and for a mathematic combination 3 out of 5, a total of 10 different triads were obtained. Each triad is constituted of 3 patients. Then, at each of 10 triads, the nurse was asked to divide the 3 patients listed (i.e. triad) into two groups. The verbal expressions for each division were recorded and transcribed as texts. Through the process of content analysis, personal constructs of each and every hospice nurses were identified. A total of 9 construct dimensions were found including religion, family support, personality, death perspectives, spiritual well-being, illness attitudes, meaning of life, social-economic status, and physical aspects. Personality/trait, other than family and religion, is considered an important spiritual construct by the respondents. It should be noted that there exist many narratives regarding the negative personality of terminally ill patients. It was found that meaning of life is a construct dimension overlooked by the hospice nurses. Results indicated that ”meaning of life” dimension was relatively less employed by the investigated nurses. I addition, nurses' personal constructs of terminally ill patients' spirituality is dominated by a systematic perspective. Holistic and existential perspectives are relatively less salient. It is suggested that. It is also suggested that future studies should be focused on personal constructs of spiritual care of senior hospice nurses. By the identification of various construct dimensions and perspectives of spiritual care, hopefully, our knowledge and practice can be further advanced.

並列關鍵字

personal construct ； spirituality ； terminally ill ； hospice