臺灣中醫門診護理人員之專業發展

The clinical traditional Chinese medicine in ambulatory department career development process of Taiwan's nurses with one year

洪愛琇(Ai-hsiu Hung)

指導教授 ： 施富金

臺北醫學大學/護理學院/護理學研究所/碩士(2005年)

摘要

本研究目的是透過臨床中醫門診護理人員的觀點，瞭解護理人員從事臨床中醫護理的動機、滿意及不滿意之工作經驗、專業發展以及對中醫護理未來發展的期望。本研究採質性研究，針對北部及中部六家具中醫醫療聲望之醫療機構的中醫門診護理人員收案，以半結構訪談指引進行深入訪談，訪談內容採質性內容分析法整理。 共三十位臨床中醫護理人員參與本研究，皆為女性，介於23-56歲（mean = 32.9 + 8.1），19位已婚，護理師25位，護士5位。護理總年資介於1年8個月至33年（mean = 11年5個月），中醫護理相關工作年資由1年到9年6個月（mean = 4年7個月）。在中醫護理訓練方面，僅有3位接受過學校相關課程訓練，有13位已經完成臨床基礎訓練，12位正訓練中，另5位完全未接受訓練。 從事臨床中醫護理的動機方面，除一位表示高普考分發外，其餘為主動或配合醫院發展，選擇至中醫門診學習。主要理由依次為中醫護理具未來發展性、中醫門診工作時間穩定，以及減緩原工作壓力。 個案主觀的工作經驗有滿意及不滿意兩部分。滿意經驗為其中醫護理專業能力與經驗獲得成長，主因來自他人對其心理、專業知識技能，及家庭角色之支持。結果除了影響個案改變就醫行為，亦主動影響他人接受中醫醫療。藉由認識不同醫療環境及專業能力獲得認同，進而提升學習中醫護理的意願。 不滿意經驗為個案自覺護理專業表現不佳、專業能力與經驗不足，以及角色缺乏他人及個人的認同。形成原因依次為（1）缺乏完整的中醫護理專業訓練；（2）缺乏他人的支持；（3）病患抱怨就醫流程等待時間過長；（4）工作量繁重；（5）個人因素；及（6）未獲得實質性回饋。結果導致個案執行臨床工作受到限制，避免深入回答問題以求自我保護，甚至考慮離開職場。雖然這些經驗產生消極態度之影響，但在研究結果發現，個案仍持續不斷自我調適，採行中西醫護理合併、尋求情緒支持、期許自我成長，以及主動尋求解決方式之因應方式，為改善現有瓶頸。 透過臨床護理經驗及任務檢視，顯示其專業生涯發展目的為求勝任專業角色。過程分為摸索適應期、角色定位期，以及專業認同期三個階段，進行方式為具階段性，且對臨床中醫護理現況及未來發展提出建議。因應各階段任務及工作環境不同，其提出的建議有所差異。探究最終目標為改善現況，獲得專業的成長及能力的發揮，提供病患專業服務品質。 最後針對本研究的結果與發現，分別對護理臨床實務、教育、行政及研究四方面提出建議，以作為各界參考。

關鍵字

中醫門診護理人員 ； 動機 ； 滿意/不滿意工作經驗

並列摘要

The purpose of this research was via the clinical traditional Chinese medicine nurses’ points of view to understand the motives of them devoted to the clinical traditional Chinese medicine nursing, their nursing experiences, as well as the process of profession development and expectations of the future. This research adopted qualitative research, which having a purpose sample of ambulatory department nurses with one year from six famous institutions of clinical traditional Chinese medicine in the northern and the middle areas in Taiwan. Data were gathered by in-depth interviews, according to a semi- structural instruction, and analyzed by Shih’s qualitative content analysis method. 30 subjects participated in this study. They aged 23 to 56 years old（mean = 23 years old and 9 months）and were all female. 19 subjects were married. The duration of nursing experience ranged from 1 year and 8 months to 33 years（mean = 11 years and 5 months）, and the working period related to clinical traditional Chinese medicine nursing was from 1 to 9 years and 6 months（mean = 4 years and 7 months）. Only 3 subjects had received relevant training course in school. 13 subjects had accomplished the complete basic training of Clinical Chinese medicine nursing, 5 subjects did not accept any relevant courses, and the others were under training. In respect of the motives of engaging in this career, one was attributed to governmental assignment after passing the national exam, and the others either volunteer or follow the development of their institutions. The main reasons were the potential of the traditional Chinese medicine nursing, stable working hours as well as less pressure. The subjective nursing experience included satisfied and unsatisfied parts. The satisfied part included the growth of professional ability and clinical experience, which had influenced them to change their medical behavior and actively encouraged other people to accept traditional Chinese medicine. They were more willing to devote to this field after understanding different medical circumstances and appreciation of their profession. Contrarily, the unsatisfied nursing experiences included self-unsatisfied performance, inadequate professional ability and experience as well as lack of appreciation. These experiences resulted in limitation of them in their clinical practice, self-protection to avoid replying our questions thoroughly and even ideas of quitting. Although they had passive thoughts due to these unsatisfied experiences, our study noticed that they could self-adjust, seek emotional support and self-growth, adopted several methods blending the modern and the Chinese medicine nursing, and searched for the solution to solve the existing bottleneck. The profession development process of them could be divided into three stages: seeking and adaptation stage, the role localization stage and profession reorganization stage and proceeded in a sequential order. In different stages and circumstances, they brought up diverse opinions, but what were common were improvement of the present situation, growth of professional abilities, self-realization, and further improving the quality of the nursing. In conclusion, this study brought up suggestions as to four aspects of clinical nursing, education, administration, and research respectively.

並列關鍵字

clinical traditional Chinese medicine nurse ； motives ； satisfied/unsatisfied nursing experience

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