臨床護理教育的敘事書寫－護理過程紀錄的本質

Narrative Pedagogy in Nursing Education: The Essence of Clinical Nursing Process Recording

10.6224/JN.000006

余玉眉(Yu-Mei Y. Chao)；蔣欣欣(Hsien-Hsien Chiang)

臨床護理過程記錄 ； 臨床教學 ； 反思分析 ； 護病關係 ； 師生關係 ； clinical nursing process recording (CNPR) ； clinical-teaching and learning ； reflective analysis ； nurse-patient relationships ； student-instructor relationships

護理雜誌

64卷1期（2017 / 02 / 01）

32 - 40

繁體中文

背景　臨床實習的「護理過程紀錄」是一項能達成以「學生為中心」之教（與）學的有效工具，但其實際運作的教與學過程及教育意涵，有待更一步認識。目的　探究「護理過程紀錄」作為臨床教學的方法之一，所引發的教學意涵。方法　本研究採用現象學之反思分析方法，收集五次臨床護理教育論壇的討論資料並進行分析，會中邀請6位曾參與臨床教學的教師與會，採用一位護生書寫且經過教師批閱的12回「護理過程紀錄」文本，作為事前閱讀的素材，以促進臨床護理過程紀錄（clinical nursing process recording, CNPR）教學的討論。結果　「護理過程紀錄」作為臨床教學的方法及學生學習護理的過程，所呈現師生互動主要內涵，包括：（一）由為己書寫與經驗再現，啟發主動學習；（二）由持續性與在場，促進師生連結；及（三）由師生共作與護病共融，共創學習情境。結論／實務應用　CNPR教學能引發護生、病人與教師三者之間的相互交流，促成老師、學生及病人在照護情境中，對自身的重新定位。此重新定位促使護生能自我導向的學習，教師學習提問、等待與陪伴，及病人出現自我照顧的能力。

Background: Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. Purpose: To explore the essence of CNPR in the contexts of clinical teaching and learning. Methods: Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. Results: Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. Conclusions: When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by relocating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.

1. Bevis, E. O.(1982).Curriculum building in nursing: A process.St. Louis, MO:The C.V. Mosby.
2. Brown, S. T.,Kirkpatrick, M. K.,Mangum, D.,Avery, J.(2008).A review of narrative pedagogy strategies to transform traditional nursing education.Journal of Nursing Education,47(6),283-286.
3. Buber, M.,Smith, R. G.(trans.)(2002).Between man and man.London, England:Routledge.
4. Chao, Y. M. Y.(1991).An inductive approach in clinical teaching.Excellence in Clinical Nursing Conference,Bloemfontein, The Republic of South Africa:
5. Clandinin, D. J.、Connelly, F. M.、蔡敏玲譯、余曉雯譯(2004)。敘說探究質性研究中的經驗與故事。台北市=Taipei City, Taiwan, ROC:心理=Psychological Publishing。
6. Corbally, M.,Grant, A.(2016).Narrative competence: A neglected area in undergraduate curricula.Nurse Education Today,36(1),7-9.
7. Diekelmann, N.(2001).Narrative pedagogy: Heideggerian hermeneutical analyses of lived experiences of students, teachers, and clinicians.Advances in Nursing Science,23(3),53-71.
8. Embree, L. E.(2006).Reflective analysis.Bucharest, Romania:Zeta Books.
9. Foucault, M.,Hurley, R.(Trans.)(1997).Ethics: Subjectivity and truth.New York, NY:The New Press.
10. Freire, P.(2000).Pedagogy of the oppressed.New York, NY:Continuum.
11. French, P.,Cross, D.(1992).An interpersonal-epistemological curriculum model for nurse education.Journal of Advanced Nursing,17(1),83-89.
12. Grant, A.,Leigh‐Phippard, H.,Short, N. P.(2015).Restorying narrative identity: A dialogical study of mental health recovery and survival.Journal of Psychiatric and Mental Health Nursing,22(4),278-286.
13. Ironside, P. M.(2014).Enabling narrative pedagogy: Inviting, waiting, and letting be.Nursing Education Perspectives,35(4),212-218.
14. Ironside, P. M.(2015).Narrative pedagogy: Transforming nursing education through 15 years of research in nursing education.Nursing Education Perspectives,36(2),83-88.
15. Lengelle, R.,Meijers, F.,Poell, R.,Post, M.(2014).Career writing: Creative, expressive and reflective approaches to narrative identity formation in students in higher education.Journal of Vocational Behavior,85(1),75-84.
16. Mikol, C.(2005).Teaching nursing without lecturing: Critical pedagogy as communicative dialogue.Nursing Education Perspectives,26(2),86-89.
17. Moore, P.,Cagle, C. S.(2012).The lived experience of new nurses: Importance of the clinical preceptor.The Journal of Continuing Education in Nursing,43(12),555-565.
18. Noddings, N.(2003).Happiness and education.Cambridge, NY:Cambridge University Press.
19. Noddings, N.(2003).Caring: A feminine approach to ethics and moral education.Oakland, CA:University of California Press.
20. Peplau, H. E.(Ed.)(1996).Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing.New York, NY:Springer.
21. Rodgers, C. R.(2002).Seeing student learning: Teacher change and the role of reflection.Harvard Educational Review,72(2),230-253.
22. Rodgers, C. R.(2002).Defining reflection: Another look at John Dewey and reflective thinking.Teachers College Record,104(4),842-866.
23. Rodgers, C. R.,Raider-Roth, M. B.(2006).Presence in teaching.Teachers and Teaching: Theory and Practice,12(3),265-287.
24. Rogers, C. R.(1969).Freedom to learn.Columbus, OH:C. E. Merrill.
25. Ruiz, B. M.,Fernández-Balboa, J. M.(2005).Physical education teacher educators' personal perspectives regarding their practice of critical pedagogy.Journal of Teaching in Physical Education,24(3),243-264.
26. Schumacher, E. F.、李華夏譯(2000)。小即是美—M型社會的出路：拒絕貧窮。新北市=New Taipei City, Taiwan, ROC:立緒文化事業=New Century。
27. Van Manen, M.(1994).Pedagogy, virtue, and narrative identity in teaching.Curriculum Inquiry,24(2),135-170.
28. Wood, P. J.(2014).Historical imagination, narrative learning and nursing practice: Graduate nursing students' reader-responses to a nurse's storytelling from the past.Nurse Education in Practice,14(5),473-478.
29. 王心運編、林慧如編、林育志編(2013)。敘事醫學—臨床倫理案例集。高雄市=Kaohsiung City, Taiwan, ROC:高雄醫學大學=Kaohsiung Medical University。
30. 余玉眉、田聖芳、蔣欣欣(1991)。質性研究—田野研究法於護理學之應用。台北市=Taipei City, Taiwan, ROC:巨流圖書= Chuliu Book。
31. 宋文里(1995)。「批判教育學」的問題陳顯。通識教育，2(4)，1-15。
32. 沈清松(2000)。呂格爾。台北市=Taipei City, Taiwan, ROC:東大圖書=Dongda Book。
33. 林慧如、謝朝唐、唐守志、沈眉君(2008)。敘事書寫─情境倫理思惟的展演。護理雜誌，55(1)，5-8。
34. 陳榮華(1998)。葛達瑪詮釋學與中國哲學的詮釋。台北市=Taipei City, Taiwan, ROC:明文書局=Ming Wen Book Co., Ltd.。

1. 蔣欣欣(2019)。臨床教學的反思實踐－精神衛生護理學實習課程。源遠護理，13(2)，21-29。
2. 羅彥傑,林琦華(2021)。敘事護理學在護理研究、實務與教育的發展與應用：以護病溝通為例。彰化護理，28(1)，2-9。