The Transformation Process in Nurses Caring for Dying Patients

護理人員照顧臨終病人的蛻變歷程

10.1097/jnr.0000000000000160

黃靖淇(Ching-Chi Huang)；陳季員(Jih-Yuan Chen)；蔣欣欣(Hsien-Hsien Chiang)

現象學 ； 安寧照護 ； 自我照護 ； 蛻變 ； phenomenology ； palliative care ； self-care ； transformation

The Journal of Nursing Research

24卷2期（2016 / 06 / 01）

109 - 117

英文

背景　儘管最近對瀕死照護的關注增加，但探討照顧者情緒和心理蛻變之實證文獻很少。目的　本研究欲探究護理人員經歷照顧臨終病人之衝擊後，從心靈痛苦產生蛻變的歷程。方法　本研究應用現象學研究方式，調查8位（年齡27-40歲）工作於台北市某醫學中心安寧病房的護理人員，以半結構式問句深度訪談收集資料，並參考反思分析進行資料處理。結果　護理人員照顧臨終病人蛻變的歷程包括三個階段：第一階段：承受情感勞務包含面對瀕死和死亡病人苦難的痛、喚起自己喪親的痛。第二階段：學習自我照顧，從接觸治療系的病人、處理未完成的心願來學習、參加葬禮；第三階段：開展照顧他人的能力，經由解放自如的反思與關注自己、病人及家屬的責任，經由覺知需要與實踐展開照顧他人的能力，且讓衝擊成為鍛鍊自己的媒介，以轉化自我。結論／實務應用　情感勞務是導致護理人員自身間和專業上蛻變的主因。培養護理人員個人成長和貫徹倫理實踐至關重要的是適當的情感管理與其他護理人員對話和個人自我反思。當護理人員與病人共在，實踐反思的護理及尋求策略關注病人的需求，以及過去覺知的經驗有助於護理人員更好地照顧自己和他人，以學到最佳的照顧責任和對現況的自覺。

Background: Despite the recent increase in attention to end-oflife hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. Purpose: This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. Methods: A phenomenological approach was used to investigate eight nurses (27- 40 years old)working in the hospiceward of amedical center in Taipei. Datawere collected through openended questions using semistructured interviews and were analyzed reflectively. Results: A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. Conclusions/Implications for Practice: Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional selfmanagement, dialogue with other nurses, and personal reflection are crucial actions that nursesmay use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing practices, focusing on patient needs, and utilizing past experiences enable nurses to develop a heightened sense of responsibility and awareness, thus empowering them to take better care of themselves and their patients.

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