「培育專業護理行為」－基本護理學實習學生之經驗歷程

Cultivating Professional Nursing Behaviors - Experiences of Nursing Students for Fundamental Nursing Practicum

10.6386/CGN.201806_29(2).0002

曾明晰(Ming-Sea Tseng)；劉棻(Fen Liu)；林淑君(Shu-Chun Lin)

護理系學生 ； 護理行為 ； 基本護理實習 ； 詮釋現象學 ； nursing student ； nursing behavior ； fundamental nursing practicum ； hermeneutic phenomenology

長庚護理

29卷2期（2018 / 06 / 01）

173 - 189

繁體中文

背景：「護理」是以行動來提供健康照護的專業，護理教育必須重視專業護理行為的養成。基本護理學實習是護理專業的入門及基礎，透過實習經驗，得以瞭解培養專業護理行為的最佳途徑。目的：從基本護理學實習護生的觀點，探討護理專業行為培育的歷程。方法：採質性研究法，以北台灣某科技大學二年級完成四週基本護理學實習之護生為研究對象，共21位護生分3組進行焦點團體訪談以收集實習學習經驗相關資料，訪談內容徵求研究對象同意全程錄音，並轉譯成逐字稿後再以詮釋現象學的方法進行訪談內容分析與歸納。結果：由護生基本護理學實習的學習經驗中，歸納出「培育專業護理行為」之三大主題，分別為（1）「臨床實習指導教師話語引導學生培育專業護理行為」：教師的言語，是引導學生專業言行的指南針；（2）「臨床護理人員啟發學生對護理專業的認同」：觀察楷模典範，領悟護理之真善美；以及（3）「臨床個案反應是學生自我調整之最佳參考」：從被照護個案的真實反應，體認誠實、關懷、公平、同理心及病人為中心之真諦。結論／實務應用：專業護理行為的養成是護理人才培育的基石，亦是護理教育的重要指標。透過護生的實習經驗讓我們更深入的瞭解，護生的專業護理行為可以在實習過程中藉由與臨床實習指導教師、護理師、或是臨床個案的互動啟發，因而建立或修正。臨床實習指導教師應善用語言的正向能量教勉護生，鼓勵護生觀察、分析及省思臨床護理人員哪些言行可視為典範楷模，並增加與病人之互動獲得實際的回饋，作為修正自己專業行為之依據。本研究結果可以作為臨床教師指導初階段實習護生及協助其養成專業護理行為的參考。

Background: ＂Nursing＂ is a profession that uses actions to provide health cares. Nursing education must pay attention to the development of professional nursing behaviors. The Fundamental Nursing Practicum is the foundation of nursing specialty. Through the learning experiences of the fundamental nursing practicum, we can identify the best way to foster professional nursing behaviors. Purpose: Based on the aspects of fundamental nursing practicum students, we can explore the cultivating processes of professional nursing behaviors. Methods & Procedures: Researchers adopted a qualitative research approach and collected learning experience data using focus group interviews. Participants were students enrolled in a Science and Technology University in the northern Taiwan and had completed the fundamental nursing practicum. A total of 21 nursing students were divided into three focus groups to collect the relevant experiences of practice learning. Participants agreed to be audiotaped during the entire data collection process and audiotaped information were transcribed verbatim. Hermeneutic phenomenology was adopted as the method of research data analysis. Results: Three essential categories were identified from the nursing students' perceptions of cultivating nursing behaviors after the fundamental nursing practicum. These included: (1) Clinical nursing teachers' verbal instruction to develop professional nursing behaviors: The teacher's languages were indicators of the performance of the student, (2) Clinical nurses inspired students to recognize the nursing profession: Observe the model, comprehend the truth, goodness, and beauty of nursing, and (3) The responses from clinical patients were the best reference for students to self-adjustment: From patient's responses, students recognized the true meaning of honesty, care, fairness, empathy, and patient-centered. Conclusions / Implications for Practice: The development of professional nursing behavior is the basis for nurturing nursing professionals, is also an important indicator of nursing education. Through understanding the experience of students in clinical practice, we can more in-depth understand how professional nursing behavior can be established and modified during the internship as a result of interaction with clinical teachers, nurses, or clinical patients. Clinical teachers should use the positive power of language to teach nursing students and encourage nursing students to observe, analyze, and think of what can be regarded as a model. Clinical teachers should also encourage students to increase their interaction with the patients to obtain practical feedback as a basis for adjusting their professional conduct. The results of this study can be used as a reference to guide nursing students at the early stage of their career and help them develop professional attitude and behavior.

1. 吳木崑(2009)。杜威經驗哲學對課程與教學之啟示。臺北市立教育大學學報，40(1)，35-54。
   連結：
2. 楊惠玲、黃奕清、高毓秀(2010)。臨床護理實習教師工作投入之研究。醫護科技期刊，12(3)，173-182。
   連結：
3. 簡翠薇、劉桂芬、林慧珍、林文絹、林季宜、陳妙言(2014)。「紮根、困頓、成長」 新手護生的臨床實習經驗。健康科技期刊，2(1)，1-19。
   連結：
4. American Association of Colleges of Nursing(2008).The essentials of baccalaureate education for professional nursing practice.Washington, DC:Author.
5. Armstrong, S. J.(Ed.),Fukami, C.(Ed.)(2008).Handbook of management learning, education and development.London, England:Sage Publications.
6. Bandura, A.(1986).Social foundations of thought and action: A social cognitive theory.Englewood Cliffs, NJ:Prentice Hall.
7. Benner, P.,Sutphen, M.,Leonard, V.,Day, L.(2010).Educating nurses: A call for radical transformation.San Francisco, CA:Jossey-Bass.
8. Bhoyrub, J.,Hurley, J.,Neilson, G. R.,Ramsay, M.,Smith, M.(2010).Heutagogy: an alternative practice based learning approach.Nurse Education in Practice,10(6),322-326.
9. Bisholt, B.,Engström, A. K.,Gustafsson, M.,Johansson, A. S.,Ohlsson, U.(2014).Nursing students' assessment of the learning environment in different clinical settings.Nurse Education in Practice,14(3),304-310.
10. Creswell, J. W.(1998).Qualitative inquiry and research design.California:Sage Publication.
11. Dewey, J. (1938). Experience and education. New York, NY: Macmillan.
12. D'Souza, M. S.,Karkada, S. N.,Parahoo, K.,Venkatesaperumal, R.(2015).Perception of and satisfaction with the clinical learning environment among nursing students.Nurse Education Today,35(6),833-840.
13. Du Toit, D.(1995).A sociological analysis of the extent and influence of professional socialization on the development of a nursing identity among nursing students at two universities in Brisbane. Australia.Journal of Advanced Nursing,21(1),164-171.
14. Gray, M.,Smith, L. N.(1999).The professional socialization of diploma of higher education in nursing students (Project 2000): A longitudinal qualitative study.Journal of Advanced Nursing,29(3),639-647.
15. Harmer, V.(2010).Are nurses blurring their identity by extending or delegating roles?.British Journal of Nursing,19(5),295-299.
16. Hegenbarth, M.,Rawe, S.,Murray, L.,Antonia Arnaert, A.,Chambers-Evans, J.(2015).Establishing and maintaining the clinical learning environment for nursing students: A qualitative study.Nurse Education Today,35(2),304-309.
17. Iacoboni, M.、洪蘭譯(2009)。天生愛學樣：發現鏡像神經元。台北市=Taipei City, Taiwan, ROC:遠流=Yuan-Liou Publishing Co., Ltd.。
18. Icli, T. G.,Coban, S.(2011).A Study on the Effects of Family and Delinquent Peers on Juvenile Delinquency in Turkey.Advances in Applied Sociology,2(1),66-72.
19. Ironside, P. M.,McNelis, A. M.,Ebright, P.(2014).Clinical education in nursing: Re-thinking learning in practice settings.Nursing Outlook,62(3),185-191.
20. Kolb, D. A.(1984).Experiential learning: Experience as the source of learning and development.New York, NY:Prentice-Hall, Inc..
21. Lechasseur, K.,Lazure, G.,Guilbert, L.(2011).Knowlcdge mobilized by a critical thinking proccss deployed by nursing students in practica care situations: A qualitative study.Journal of Advanced Nursing,67(9),1930-1940.
22. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Thousand Oaks, CA:Sage.
23. Miers, M. E.,Rickaby, C. E.,Pollard, K. C.(2007).Career choices in health care: Is nursing a special case? A content analysis of survey data.International Journal of Nursing Studies,44(7),1196-1209.
24. Moustakas, C.(1994).Phenomenological research method.California:Sage Publications.
25. Nasrin, H.,Soroor, P.,Soodabeh, J.(2012).Nursing Challenges in Motivating Nursing Students through Clinical Education: A Grounded Theory Study.Nursing Research and Practice,1-7.
26. Odell, E.,Barta, K.(2011).Teaching evidence-bases practice: The bachelor of science in nursing essentials at work at the bedside.Journal of Professional Nursing,27(6),370-377.
27. Ousey, K.(2009).Socialization of student nurses - the role of the mentor.Learning in Health & Social Care,8(3),175-184.
28. Oxendine, C., Robinson, J., & Willson, G. (2004). Experiential learning. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Retrieved April 3, 2012, from http://projects.coe.uga.edu/epltt/
29. Papathanasiou, I. V.,Tsaras, K.,Sarafis, P.(2014).Views and perceptions of nursing students on their clinical learning environment: Teaching and learning.Nurse Education Today,34(1),57-60.
30. Peyrovi, H.,Yadavar-Nikravesh, M.,Oskouie, S. F.,Berter, Ö, C.(2005).Iranian student nurses' experiences of clinical placement.International Nursing Review,52(2),134-141.
31. Ulfvarson, J.,Oxelmark, L.(2012).Developing an assessment tool for intended learning outcomes in clinical practice for nursing students.Nurse Education Today,32(6),703-708.
32. Valle, R. S.(Ed.),Halling, S.(Ed.)(1989).Existential-phenomenological perspectives in psychology: Exploring the breadth of human experiences.New York:Plenum Press.
33. Van Manen, M.、高淑清譯、連雅慧譯、林月琴譯(2004)。探究生活經驗。嘉義市=Chiayi City, Taiwan, ROC:濤石文化=Tao Stone Culture。
34. 中華民國護理師護士公會全國聯合會(2015)．護理人員相關法規． 取自http://www.nurse.org.tw/Enactment/Enactment1.aspx.[Taiwan Union of Nurses Association, Taiwan, ROC. (2015). Nurses regulations. Retrieved from http://www.nurse.org.tw/Enactment/Enactment1.aspx]
35. 方又圓、唐福瑩(2006)。臨床護理教師專業態度。志為護理─ 慈濟護理雜誌，5(4)，73-79。
36. 王淑俐(2003)。做個「教學溝通」的智者。臺北市=Taipei City, Taiwan, ROC:師大書苑=Shtabook。
37. 王愛惠(2010)。臺北市=Taipei City, Taiwan, ROC，國立臺北教育大學數學教育研究所=National Taipei University of Education, Department of Mathematics and Information。
38. 王靜琳、李小璐、呂桂雲(2010)。影響護專學生初次實習憂鬱及其相關因素之探討。護理暨健康照護研究，6(1)，65-75。
39. 伍麗珠、楊玉娥(2011)。人文科學與臨床護理。榮總護理，28(1)，104-110。
40. 朱耀明(2011)。「動手做」的學習意涵分析—杜威的經驗學習觀點。生活科技教育月刊，44(2)，32-43。
41. 江青桂、林英姬、江宜娜(2013)。優良護理實習指導教師的教學實踐。教師專業研究期刊，5，85-105。
42. 江桂芬、王秀紅(2014)。僕人式領導在護理專業的意涵與運用。領導護理，15(3)，78-87。
43. 林慧珍、林季宜、簡翠薇、劉桂芬、陳妙言、林文絹(2013)。選擇方法、等待成長基本護理學實習教師之教學經驗。護理雜誌，60(1)，38-47。
44. 孫嘉璟、孫惠玲(2011)。「面對、認同、成長和期許」─護生初次實習之經驗歷程。護理雜誌，58(2)，49-56。
45. 張世彗(2013)。行為改變技術。臺北市=Taipei City, Taiwan, ROC:五南=Wu-Nan Book。
46. 張育禎(2008)。台北=Taipei City, Taiwan, ROC.，國立臺灣師範大學=National Taiwan Normal University。
47. 許麗齡(2001)。護理行為之原動力—護理理念。護理雜誌，48(5)，69-73。
48. 陳榮華(2009)。行為改變技術。臺北市=Taipei City, Taiwan, ROC:五南=Wu-Nan Book。
49. 章美英、許麗齡(2006)。質性研究—焦點團體訪談法之簡介與應用。護理雜誌，53(2)，67-72。
50. 賈馥茗(1999)。人格教育學。臺北市=Taipei City, Taiwan, ROC:五南=Wu-Nan Book。
51. 蔣立琦(2014)。實護理新視界 實證護理的演變與發展。護理雜誌，61(4)，85-94。
52. 蔣立琦、林佳慧、王桂芸(2013)。實證護理的新時代 全面啟動發展護理科學。護理雜誌，60(5)，11-17。
53. 蔡錚雲(2013)。照護知識的藝術性格。護理雜誌，60(4)，5-8。
54. 盧美秀(2006)。護理倫理與法律。臺北市=Taipei City, Taiwan, ROC:華杏=Farseeing。
55. 盧純華、夏萍絅、林麗嬋(1998)。護理活動與護理專業人員之職責規範。護理新象，8(2)，14-17。
56. 盧孳艷、陳威麗、陳海焦、歐美、林雪貴(2009)。科技與護理專業發展之反思。護理雜誌，56(3)，88-92。
57. 謝美慧、王秀紅(2011)。護病互為主體的陪伴概念與意涵。志為護理，10(4)，58-63。
58. 謝素玫、張碧如、曾櫻花(2014)。臨床護理實習與教學策略運用之歷程。護理暨健康照護研究，10(1)，61-69。
59. 鍾聿琳(2004)。現今台灣技職護理教育的關鍵課題。護理雜誌，51(4)，18-21。

1. (2024)。東部某科技大學五專學制護理科學生自願停止臨床實習之相關因子。慈濟科技大學學報，13，1-26。