台灣護理人員工作職場專業互動經驗意涵探討

目的：本研究試圖以質化研究觀點探討臨床護理人員主位觀點敘說之工作生活經驗，目的在於深入探究護理人員工作互動之深層文化意義及其生活經驗的意義。方法：研究架構則追尋詮釋的路徑，整合詮釋現象學及民族誌多元方法策略，做為研究設計的理論基礎。研究方法包括焦點團體訪談、深度訪談、參與觀察及田野紀錄等資料收集方法。在多樣性與善述性的前提之下進行選樣，選取與研究經驗有關的代表性個案包括新進及各年資之資深護理人員，可以國台語溝通且願意參與研究的參與者總共43位。平均年齡為27.65 ± 7.92歲，平均年資為5.46 ± 7.69年，其中19人屬年資一年以下之新進護理人員。結果：護理人員間專業互動與位置顯現類家庭結構形式，在專業互動的歷程中有三個特色，其一是由先來後到這個單位之年資所形成的階層，其二是因資深護理人員對資淺者之教導與監督彼此產生「我的」學姐、「我的」學妹的從屬關係與連帶責任，其三是知識經驗化所帶來的熟練。而護理人員在這三者之間的落差給出權力展演的空間，不僅成為新人過程有待突破的困境，也是新手融入團體前要先跨越的三個門檻。由護理人員強調團結向心、互助、合作、互動、順從、主動、敏銳警覺及反省等互動美德，可見集體主義社會下的個人服從權威及服膺團體優於個人，其意涵在於符應文化及專業對個人的要求。結論/實務應用：台灣護理人員的文化意念是在自我與他人、和諧、圓滿及自我中的他人之架構下思考，並且影響個人在工作生活中該有的行為表現與因應，以追求整體圓滿及和諧的文化價值。凸顯華人社會之個人要被其所屬團體接納的文化與個人生存適應，交織鋪陳出台灣護理人員專業工作互動經驗具有華人集體主義的文化特性。本研究結果可提供護理人員理解自身在組織文化脈絡下的專業位置與互動經驗意義，以及提供護理教育者、行政主管、護理主管及臨床督導者參考，對我們習以為常的臨床教導及訓練方式進行反思，在真正了解護理人員的臨床處境及需求下，提出更合乎實際需求及兼具創意性的臨床教育策略，讓護理人員在無威脅環境下朝向專業成長，不僅是造福病人更是專業之福。

關鍵字

護理文化；工作互動；生活經驗；適應；焦點團體訪談；詮釋現象學

並列摘要

Purpose: This present research is a qualitative attempt at the explorative discussion of the work and lived experience recounted by clinical nurses from an emic perspective and the purpose is to further explore the cultural meaning of the professional interactions and of the lived experience shred by nurses. Methods: The interpretive design of the study structure is constructed on mixed methods, integrating hermeneutic phenomenology and ethnography as the theoretic basis. Methodology includes data collection methods consisting of focus group interviews, in-depth interviews, participant observations and field notes. Sampling is performed through maximum variation and intensive case with representative cases ranging from new recruits with minimal experience to individual nurses of various seniority levels, relevant to the present research. Participants are fluent in both Mandarin and the Taiwanese dialect, totaling 43 informants, with an average age of 27.65 ± 7.92 and a mean seniority level of 5.46 ± 7.69 years. A group of 19 nurses under one year of nursing experience is also included. Results: A pro-familial structure exists in the interactive relationship of nursing professionals, with 3 distinctive features present in the process of professional interactions, being firstly the formation of hierarchy as a result of the order of arrival in the unit: first come; first served basis. Second of all, supervision and training offered and received give rise to the formation of the concept of the subordination and responsibility: "my" senior or "my" junior colleagues. The third is competency following empiricalized knowledge. Power practice is the result attributed to the considerable latitude exhibited by the above 3 features, which very frequently lead to difficult circumstances encountered by most new recruits. They also represent the 3 thresholds waiting to be crossed before the nurses become accepted into their group. The core nursing value focuses on virtues such as coherence, solidarity, collaboration, interaction, alertness, self reflection and proactive management, subsequently demonstrating that the concept of conformity and subjugation is correspondent with the cultural as well as professional demand for social collectivism in Taiwan. Conclusions/Implications for Practice: That the group is above the individual gives rise to the thought frame of self and others, harmony, wholeness and, above all, others-in-self, conducive to behaviors considered appropriate in the both professional career and personal life of the traditional Taiwanese community. Much emphasis is given to the idea that each participant in a group should both expect and be expected to adapt to and fit into the group in which he or she belongs. And a finely woven cultural uniqueness of Chinese collectivism is thoroughly expressed through interactions experienced by career nurses and experts. The research findings also provide to nurses the comprehension of the meaning of interactive experience and professional placement within the organizational and cultural context, contributing reference to educators, administrators, clinical supervisors, and heads of departments in the field of nursing and allowing for reflection over the clinical instructions and training that have long been taken for granted. The real benefit that can be reaped by both the patient and nurse comes from true understanding of the pragmatic need present in the current clinical climate in order for more creative nursing strategies and clinical education in a threat-free environment.