安寧護理人員面對末期病人自覺負擔現象的照護經驗探索

Abstract

本研究主要聚焦於安寧護理人員在照顧末期病人與家庭的過程中，當病人面對家人的照顧而自覺負擔時，安寧護理人員涉入這個現象裡的內在經驗與因應。

研究採立意取樣，分別於北、中、南區醫療院所，邀請4位具合作與訪談意願、能清楚描述與討論、且實際從事安寧照顧三年以上的安寧護理人員，共同參與研究。研究以詮釋學為研究法基礎，透過半結構訪談的形式，個別訪談4位護理年資5～13年的安寧護理人員，每位2～3次，每次1～1.5小時，以匯集安寧護理人員面對自覺負擔現象的照護經驗及內在感受。訪談文本資料參照沈清松、Ricoeur的策略，進行詮釋分析。

研究結論呈現出安寧護理人員所觀察的自覺負擔現象是：（一）自覺負擔是護理照顧的文化背景；（二）自覺負擔涉及關係議題，是病人對照顧依賴的主觀壓力感受；（三）自覺負擔是生理崩解而來的關係焦慮。而安寧護理人員面對自覺負擔現象的內在與因應經驗是：（一）自覺負擔的接觸，牽動安寧護理人員的自身經驗而情緒糾結；（二）奠基安寧護理人員的個人經驗而衍生獨特的因應模式；（三）情感牽動安寧護理人員的自身經驗而啟動學習動能。而從安寧護理人員與自覺負擔現象之間的關聯性來看，則是：（一）角色與自我的斷裂；（二）專業角色與內在自我的拉扯與平衡；（三）融合角色與自我的深度護理陪伴。

最後，依據研究結論提出研究限制與建議。Purpose. In Chinese culture, the caring is the task of family members. When the patients felt self-perceived burden (SPB), it may influence the family’s emotion. And also, it may influence the nurses’ caring task. The aim of this research is to investigate the caring experience of hospice nurse while the terminally ill patients suffered the SPB.

Method. Based on the hermeneutics perspective, semi-structure interview was used to gather the experiences of 4 hospice nurses (worked in hospice around 5-13 years). These interviews (2-3 times each subject, about 60-90 min each interview) were transcribed and analyzed by Ricoeur’s hermeneutics strategies.

Results. For hospice nurses’ experiences, the themes about SPB include “SPB is the background of Chinese culture”, “SPB is a subjective feeling of pressure about being cared”, “SPB comes from the anxiety of the clasped of relationship, not just the physical pain or death anxiety”. The themes about the hospice nurses’ inner and coping experiences of caring SPB are “the caring of SPB triggers nurses’ personal experiences and emotional arousal”, “the coping strategies which based on the nurses’ personal experiences are varied and unique”, “nurses are active in learning by the personal experiences and emotion aroused”. And the themes of the relation between the hospice nurses and SPB are “the broken and struggle of the professional roles and the self”, “the conflict and balance of professional roles and the self”, and “the deeply nursing companion based the infusion of professional roles and the self”.

Conclusion. The findings from this research suggest (1) the nursing training may bridge the professional knowledge and the personal experience, (2) clinical or counseling psychologists and social workers may more involve in hospice teamwork, (3) when patients diagnosed cancer may be the time to concern the SPB, (4) the psychological treatment about SPB may be the emotional contact between the patients and their caregivers, and the meaning reconstruction about their relationship and the caring experience. There are also limitations and suggestions for further research.