透過專業讀書會轉化護理師對疼痛的理解

A Reappraisal of Pain Using a Nurses' Professional Study Circle

10.6224/JN.202206_69(3).08

郭莉娟(Li-Chuan KUO)；王琬詳(Wan-Hsiang WANG)；李彥錚(Yen-Chen LEE)

疼痛評估 ； 疼痛處置 ； 專業讀書會 ； 臨床護理教育 ； 觀點轉化 ； pain assessment ； pain management ； professional study circle ； clinical nursing education ； perspective transformation

護理雜誌

69卷3期（2022 / 06 / 01）

50 - 57

繁體中文

背景：疼痛是一種主觀感覺與個人經驗，病人的疼痛常因疾病、語言表達限制而被忽略或誤解。目的：探索專業讀書會介入前後，護理師對病人疼痛評估與處置之反思和觀點轉化。方法：研究者於泌尿外科病房創立一個專業讀書會，邀請護理師共同閱讀聆聽疼痛一書並定期分享與討論。在一年半時間內，共舉辦9場次，每次由一位成員領讀，並有主持人引導議題討論；成員需提出由閱讀聯想到的臨床個案，進而將所學運用於臨床照護工作。待讀書會結束後，以半結構式訪談收集質性資料並做現象學取向分析，以了解護理師對疼痛感知的反思和觀點變化。結果：藉由讀書會之閱讀與導引式討論，9位護理師能覺察彼此對疼痛信念之差異，並經歷（1）因刻板印象而懷疑真偽；（2）從傾聽進而同理；（3）個別化照護與專業成長之歷程後，更能同理病人，對語彙使用更為敏感，亦提升疼痛評估能力。結論／實務應用：專業讀書會以團體閱讀與導引式討論，可增進護理人員的反思與觀點轉化，進而提供個別化之疼痛評估與處置。

Background: Pain relates to the highly personal and subjective experience of feelings and emotions. Patients are often misunderstood because of language-related limitations and the conditions of their disease. Purpose: In this research, a professional study circle was held to help nurses reconstruct their understanding of patient pain to enhance their awareness / empathy for differences in pain perception between others and themselves and to improve their ability to provide professional, individualized care. Method: Nine nurses were invited from the urology department to join the developed professional study circle. We spent one year and a half reading ＂Listening to Pain: Finding Words, Compassion, and Relief＂ and held a sharing and discussion roundtable meeting every month. The study circle included: (1) assigned reading and the appointment of a leader on rotation to direct the sharing and discussion, (2) presentation of clinical cases related to the reading, (3) discussions of how to apply what they had learned in clinical practice, and (4) an interview of study circle members and a full analysis of their reflections and changes of view regarding pain perceptions. Results: After a close reading and guided discussions, these nine nurses began to change their perceptions of pain and, in general, passed through three stages, including: (1) cast doubt on the authenticity of patient expressions of pain because of stereotyped biases; (2) develop a new empathy based on careful listening; (3) providing individualized care and experiencing professional growth. After successfully transiting through these stages, the nurses held a more profound understanding of their patients, practiced a more sensitive use of language, and reflected an enhanced professional ability to assess pain. Conclusions/Implications for Practice: This professional study circle successfully helped the nurses internalize a more empathetic understanding of pain and exhibit greater skill in designing individualized care for their patients.

1. 李素真, S.-C.,鄭湘鈴, H.-L.(2019)。護理團隊應用學習型組織於代謝症候群病友團體照護。護理雜誌，66(6)，27-32。
   連結：
2. 蔣欣欣, H.-H.,楊秋月, C.-Y.,陳美碧, M.-B.,廖珍娟, J.-J.(2018)。閱讀療法的團體運作－一堂護理實作課程的分析。中華團體心理治療，24(1)，25-35。
   連結：
3. 蔣欣欣, H.-H.,廖珍娟, J.-J.(2017)。人性化照護的感通。護理雜誌，64(5)，50-58。
   連結：
4. Bassot, B.(2016).The reflective practice guide: An interdisciplinary approach to critical reflection.Routledge.
5. Biro、 D.,彭榮邦（譯）, R.-B.(Trans.)(2014).聆聽疼痛：為痛苦尋找話語、慈悲與寬慰.木馬文化=ECUS Publishing House.
6. Charon, R.,DasGupta, S.,Hermann, N.,Irvine, C.,Marcus, E. R.,Colon, E. R.,Spencer, D.,Spiegel, M.(2017).The principles and practice of narrative medicine.Oxford University Press.
7. Di Giacomo, D.,Ranieri, J.,Nasta, L.,Moscato, S.,Guerra, F.,Passafiume, D.(2019).Psychological distress in interstitial cystitis/bladder pain syndrome: A cross sectional study on emotional pattern.Mediterranean Journal of Clinical Psychology,7(2)
8. Homma, Y.,Akiyama, Y.,Tomoe, H.,Furuta, A.,Ueda, T.,Maeda, D.,Lin, A. T.,Kuo, H.-C.,Lee, M.-H.,Oh, S.-J.,Kim, J. C.,Lee, K.-S.(2020).Clinical guidelines for interstitial cystitis/bladder pain syndrome.International Journal of Urology,27(7),578-589.
9. Kidd, D. C.,Castano, E.(2013).Reading literary fiction improves theory of mind.Science,342(6156),377-380.
10. Mar, R. A.,Oatley, K.(2008).The function of fiction is the abstraction and simulation of social experience.Perspective on Psychological Science,3(3),173-192.
11. Mezirow, J.(2000).Learning to think like an adult: Core concepts of transformation theory.Learning as transformation. Critical perspectives on a theory in progress
12. Mezirow, J.(1997).Transformative learning: Theory to practice.New Directions for Adult & Continuing Education,74,5-12.
13. Petca, R.-C.,Popescu, R.-I.,Toma, C.,Dumitrascu, M. C.,Petca, A.,Sandru, F.,Chibelean, C. B.(2021).Chemical hemorrhagic cystitis: Diagnostic and therapeutic pitfalls (Review).Experimental and Therapeutic Medicine,21(6),Article 624.
14. Porter, R.(1989).Review of The illness narratives: Suffering healing and the human condition, by A. Kleinman.Bulletin of the History of Medicine,63(1),168-169.
15. Scher, C.,Meador, L.,Van Cleave, J. H.,Reid, M. C.(2018).Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st century.Pain Management Nursing,19(2),125-129.
16. Stein, M.(2008).The lonely patient: How we experience illness.Harper Collins Publishers.
17. Thexton, T.,Prasad, A.,Mills, A. J.(2019).Learning empathy through literature.Culture and Organization,25(2),83-90.
18. 明金蓮, J.-L.,洪曉佩, S.-P.(2010)。急性疼痛評估與症狀護理。源遠護理，5(1)，11-16。
19. 張新慶（編）, X.-Q.(Ed.),蔡篤堅（編）, D.-J.(Ed.)(2018).生命文化核心概念解析.中國華僑出版社=The Chinese Overseas Publishing House.
20. 陳書梅, C. S.-M.(2008)。閱讀與情緒療癒─淺談書目療法。全國新書資訊月刊，120，4-9。
21. 葉美玉, M.-Y.,李選, S.(2011)。護理專業應致力提升的人文素養。護理雜誌，58(5)，12-16。
22. 蔣欣欣, H.-H.(2013).團體心理治療.五南圖書=Wu-Nan Book.
23. 謝美慧, M.-H.,王秀紅, H.-H.(2011)。護病互為主體的陪伴概念與意涵。志為護理—慈濟護理雜誌，10(4)，56-63。