安寧病房護理人員的照護困境與轉化學習

Difficulties and Transformative Learning of Hospice Nurses

10.6880/TJON.201912_19(2).02

程紋貞(Wen-Chen Cheng)；陳淑齡(Shu-Ling Chen)；蔡麗雲(Li-Yun Tsai)

安寧病房護理人員 ； 困境 ； 轉化學習 ； hospice nurse ； difficulties ； transformative learning

腫瘤護理雜誌

19卷2期（2019 / 12 / 01）

23 - 35

繁體中文

從事安寧療護是一項辛苦的工作，在過程中有許多的困難、挑戰、壓力、與悲傷，如何因應與轉化是一大挑戰。研究目的：本研究旨在瞭解護理人員在安寧病房遇到的困境、因應資源、轉化學習的過程。方法：採質性研究設計，透過立意及滾雪球取樣方法，共訪十位安寧病房護理人員為研究參與者，透過半結構式訪談蒐集資料後進行分析。結果：安寧療護護理人員照護的困境為理念認知、病人照顧、護病關係與團隊合作。面對照護困境時因應的內在資源有宗教信仰、專業信念、自我宣誓與跳脫轉移，外在資源則包括專業團隊的支持、重要他人的支持、課程研習與自主閱讀等。而面對困境時轉化學習的經驗有開放心智、瞭解同理、聆聽內在、回歸核心、付諸行動與體認安寧工作意義與價值。結論：研究發現安寧病房護理人員面臨困境時，可觸發其個體轉化的過程，從而有所學習和改變。本研究並針對學校及職場提出相關建議。

Hospice care is a hard work. There are many difficulties, challenges, stresses, and sorrows. How to transform and cope with it is quite a challenge. Purpose: The aim of this study was to explore the transformative learning phenomenon of hospice nurses in the workplace, in order to understand the difficulties they face and the transformative learning approaches they adopt, and the changes in their attitudes attributable to their learning experience. Method: A qualitative study design was employed, and the research subjects were 10 full-time nurses working in the palliative care ward in Taiwan. In-depth interviews and document analysis were adopted to collect data. Result: The difficulties faced by hospice nurses are outlined as follows: hospice and palliative care knowledge, patient care, nurse-patient relationship, and teamwork. Religious beliefs, professional faith, self-vow and emotional detachment are the internal resources that support hospice nurses when they resolve their difficulties, whereas team support, support from others, educational training and initiative reading are external resources that help nurses respond to difficulties. Being open-minded, understanding empathy, listening to the inner voice, returning to the core value, putting into action, and recognizing the significance and value of hospice work are the experience of transformative learning of hospice nurses when they confront their difficulties. Conclusion: The difficulties that hospice nurses face could trigger the process of their individual transformation which would lead to individual learning and changing. This study also provides suggestions applicable for school and workplace settings.

1. 施勝烽,龍紀萱,何建德(2010)。臺灣安寧療護團隊成員的工作壓力與其調適歷程。人文及社會科學集刊，22(3)，303-352。
   連結：
2. 蔡昌雄,蔡淑玲,劉鎮嘉(2006)。死亡焦慮下的自我照顧—以安寧護理人員為例。生死學研究，3，133-164。
   連結：
3. Barnard, A.,Hollingum, C.,Hartfiel, B.(2006).Going on a journey: Uunderstanding palliative care nursing.International Journal of Pallia-tive Nursing,12(1),6-12.
4. Baumgartner, L. M.(2001).An update on transfor-mational learning.New Directions for Adult and Continuing Education,89,15-24.
5. Clark, M. C.(1993).Transformational learning.New Directions for Adult and Continuing Education,57,47-56.
6. Cranton, P.(2006).Understanding and promoting transformative learning.John Wiley & Sons, Inc.
7. Dobrina, R.,Tenze, M.,Palese, A.(2014).An overview of hospice and palliative care nursing models and theories.International Journal of Palliative Nursing,20(2),75-81.
8. Gaydos, H. L. B.(2004).The living end: Life jour-neys of hospice nurses.Journal of Hospice & Palliative Nursing,6(1),17-26.
9. Georges, J. J.,Grypdonck, M.(2002).Moral problems experienced by nurses when caring for terminally ill people: A literature review.Nursing Ethics,9(2),155-178.
10. Hawkins, A. C.,Howard, R. A.,Oyebode, J. R.(2007).Stress and coping in hospice nursing staff: The impact of attachment styles.Psy-cho-Oncology,16(6),563-572.
11. Hopkinson, J. B.,Hallett, C. E.,Luker, K. A.(2005).Everyday death: How do nurses cope with caring for dying people in hospital?.In-ternational Journal of Nursing Studies,42(2),125-133.
12. Kear, T. M.(2013).Transformative learning during nursing education: A model of interconnectiv-ity.Nurse Education Today,33(9),1083-1087.
13. Lee, J. K.(2003).Job stress, coping and health per-ceptions of Hong Kong primary care nurses.International Journal of Nursing Practice,9(2),86-91.
14. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Beverly Hills:Sage.
15. Merriam, S. B.,Caffarella, R. S.,Baumgartner, L. M.(2007).Trasformational learning.Learning in adulthood: A comprehensive guide,San Francisco:
16. Mezirow, J.(1991).Transformative dimensions of adult learning.San Franciso:Jossey-Bass.
17. Mezirow, J.(2000).Learning to think like an adult.Learning as transforma-tion-Critical perspective on a theory in prog-ress,San Francisco:
18. Morris, A. H.,Faulk, D. R.(2012).Transformative learning as an innovative pedagogy for nursing education.Transformative Learning in Nursing,New York:
19. Peters, L.,Cant, R.,Sellick, K.,O’connor, M,Lee, S.,Burney, S.,Karimi, L.(2012).Is work stress in palliative care nurses a cause for con-cern? A literature review.International Journal of Palliative Nursing,18(11),561-567.
20. Rasmussen, B. H.,Sandman, P. O.,Norberg, A.(1997).Stories of being a hospice nurse: A journey towards finding one’s footing.Cancer Nursing,20(5),330-341.
21. Rothaug, E. R.(2012).University of East London.
22. Sletteboe, A.(1997).Dilemma: A concept analysis.Journal of Advanced Nursing,26(3),449-454.
23. Wu, H. L.(2008).School of Nursing, University of Texas at Austin.
24. 張芬芬(2010)。質性資料分析的五步驟：在抽象階梯上爬升。初等教育學刊，35，87-120。
25. 張群昌,黃志強,張秉庠,蔡依蓉(2010)。運用模糊層級分析法於安寧團隊壓力源之探討。安寧療護雜誌，15(2)，171-186。
26. 陳向明(2002).社會科學質的研究.臺北:五南.
27. 陳美碧,蔣欣欣(2008)。安寧緩和療護的困頓與成長—護理人員的經驗。實證護理，4(3)，191-199。
28. 鈕文英(2014).質性研究方法與論文寫作.臺北:雙葉.
29. 黃有志(2007)。悲傷輔導。生死學概論，台北市:
30. 黃富順(2002).成人學習.臺北:五南.
31. 趙可式(2007).安寧伴行.臺北:天下文化.
32. 趙可式(2009)。台灣安寧療護的發展與前瞻。護理雜誌，56(1)，5-10。
33. 蔡淑玲,蔡昌雄,周傳姜(2009)。安寧護理人員自我照顧模式的探討。安寧療護雜誌，14(2)，115-126。
34. 藍育慧,趙淑員,陳淑齡,莊照明,郭容美(2007)。非安寧單位護理人員安寧認知、死亡恐懼與情緒困境之探討。安寧療護雜誌，12(2)，156-171。

1. 謝懷棣,謝孟蓁,楊政議,彭芷瑜,留美萍,李麗紅,李品萱(2023)。修格蘭氏症候群病人之求醫經驗。護理雜誌，70(5)，36-43。