| 摘要: | 本研究旨在探討感染科病房護理人員之照護經驗，透過深度訪談10位研究參與者及田野參與觀察蒐集資料，再以詮釋現象學研究法了解護理人員在每個護理歷程中的置身處境、死亡焦慮、壓力的因應，及護病關係。 本研究發現，感染科護理人員普遍的壓力大致可分為：人際孤獨、類污名化的壓力、生疏的知識、情境空間的不確定感、如履薄冰的壓力，以及臨界經驗所造成的衝擊，其中「如履薄冰的壓力」源自於自身的死亡焦慮，其從初期「瀰漫性」的廣度往「無常」及「無形」的向度行走。經研究發現她們在死亡態度上普遍為：1.「投到未來式去」；2.「不願多想」；3.「口頭表示不喜歡」；4.「對生命建立意義」等。而其因應方式為：1.人際關係的支持；2.尋求家人認同；3.學習新知；4.從事或執行有利健康的活動；5.藉由獨處滋養自我；6.經驗的累積；7.重視自我內在的觀照。 護理人員的死亡焦慮引發在場域中的薄立克現象，在實際照護的處境中，引起護理人員對自身對死亡的害怕，本研究者特別將此從事高危險職業的工作人員的處境，稱之為『瀕臨邊界處境』，其存有特色呈現出一種非本真的存有狀態。雖然「臨界經驗」的遭逢開啟她們的「良知」，使存有朝本真的狀態，但死亡此濃烈的議題，又將其逆滲透到「瀕臨邊界處境」之中，故本真與非本真之間呈現一種游離的狀態。 本研究結果得出感染科病房護理人員照護歷程分別有戒慎恐懼期、融入期及跳脫期三個階段。其護理的關懷由初期背立的狀態，到中期的「體貼型」，乃至於到後期，展現出護理的「慈悲」。最後，本研究者提出相關建議，以提供醫療院所、醫護教育、護理人員臨床反思與覺察。
This study aims to investigate the care experience of infectious ward nurses, through in-depth interview with ten participants of the study and the medical field observation to collect the data, and then with hermeneutic phenomenological research method in order to understand the exposed situation, death anxiety, pressure coping, and nursing-patient relationship of the nursing staffs in the course of each stage. This study found that general pressure of nursing staffs in the Department of Infectious Disease broadly divided into the interpersonal loneliness, the pressure of class stigma, unfamiliar knowledge, the uncertainty of space situation, the pressure of walking on thin ice, and the impact resulting from critical experience, in which ＂the pressure of walking on thin ice＂ was derived from their own death anxiety, running from the initial scope of ＂diffusion＂ to the dimension of ＂impermanence＂ and ＂invisible＂. The study found that their death attitude generally were: 1. ＂put into the future tense＂; 2. ＂did not want to think about＂; 3. ＂ orally expressed they didn't like ＂; 4. ＂established the meaning of life＂, etc. Their ways to coping were: 1. support of interpersonal relationships; 2.＂seek recognition of their families＂; 3. ＂ learn something new＂; 4. engage in or perform activities conducive to health; 5. nourish themselves by being alone; 6. the accumulation of experience; 7. pay attention to the inner contemplation of the self. The Bliks phenomenon in the field caused by death anxiety of nurses, in the actual care situation, caused nurses for their own fear of death. The researcher especially called the situation of the staff who undertook a high-risk task as ＂Facing Boundary Situation＂, and its existent characteristic showed an inauthentic existent state. Although the encountering critical experience of the ＂Facing Boundary Situation＂ opened their ＂conscience＂ , that made the being towards an authentic state. Because that death was a strong topic and would reverse osmosis to the ＂Facing Boundary Situation＂, therefore it showed a sort of free state between authentic and inauthentic. The findings of this study showed that care course of infectious ward nurses divided into three stages-the cautious phase, the integrated phase and the escapable phase. Their nursing care was from the back status in the beginning, to ＂the considerate type＂ in the medium, and then in the late showed the care of ＂mercy＂. Finally, the researcher proposed related suggestions to provide clinical reflection and awareness for medical institutions, health care education as well as nurses. |
