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研究生:劉盈君
研究生(外文):Ying-Chun Liu
論文名稱:護理人員在加護病房臨終照護中建構之倫理自我
論文名稱(外文):Constructing the ethical self of nurses through providing end-of -life care within intensive care units
指導教授:蔣欣欣蔣欣欣引用關係
指導教授(外文):Hsien-Hsien Chiang
學位類別:博士
校院名稱:國立陽明大學
系所名稱:護理學系
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:142
中文關鍵詞:加護病房臨終照護護理人員倫理自我團體分析
外文關鍵詞:intensive care unitend-of- life carenurseethical selfgroup analysis
相關次數:
  • 被引用被引用:2
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  • 下載下載:132
  • 收藏至我的研究室書目清單書目收藏:1
加護病房一向是以先進的科技引領醫療的方向,救治疾病與延長生命仍是其主要目標。在現代化醫療與高科技主導下,重症加護病房護理人員提供臨終照護的經驗是複雜現象。本研究試著探究臨終照護護理人員在照護過程中的經歷。
本研究採詮釋現象學的質性研究法,以團體分析的對話方式進行12次。參與者13位護理人員皆有加護臨終照護經驗。資料收集包含:團體對話文本、研究者反思日誌及參與者心得。團體過程以錄音並轉錄文本,以詮釋現象學分析法(interpretative phenomenological analysis)進行資料分析。研究結果呈現加護病房臨終照護的護理人員雖是執行醫療科技的主體,但也可從照護中建構出倫理自我。其歷程為:(1)陷落苦境、(2)共感共苦及(3)身心一如。照護是倫理行動,其倫理性無法以簡單化約的倫理原則或規範來彰顯。其倫理性是透過提供照護的護理人員這個主體與所提供的照護行動而展現。護理人員參與在重症加護醫療的處置,目睹死亡醫療化的樣貌,生死交接的照護過程產生悲憫情感,促使護理人員不斷投入照護現場,因希望可以進入更深更美的照護境界而努力,如同修行者的身心修行,實踐而來的領悟是開啟的契機。護理人員能夠以真實的自己,原樣地與照護過程中多樣的處境共感共苦而感到自在,同時也感到身心如一的喜悅。即成為真誠自己的實在(Becoming self for me)時,便已是倫理主體,而真正的護理藝術才可能,亦即當下所展現的已然是護理藝道之美。
The modern medicine field in the intensive care unit (ICU) is geared by advanced technologies, which mainly aim at disease management leading to maintain the patients’ lives. In this kind of modernized technology-driven medical workplace, to provide end-of-life (EOL) care create a complicated phenomenon and experience. To explore and analyze the process experienced by ICU nurses who provide EOL care turns out to be the main theme of this study.
This study was conducted by using interpretative phenomenological qualitative research method to analyze the data drawn from twelve sessions of group dialogues among 13 registered ICU nurses who provided EOL care. Data was gathered from digitally recorded group dialogues and then analyzed alone with the researcher's diaries and participants' feedback sheets. Interestingly, although the ICU nurses provided nursing care using advanced medical devices, meanwhile they may actually get a chance to reconstruct themselves and then turn to ethical selves through the process during providing EOL care. The process can be further divided into three parts including: (1) falling into the suffering, (2) compassion from suffering with, and (3) the oneness of mind and body. Nursing care is actually the ethical action which presented by which the very nurses giving care. It can’t be simplified as or framed by the general goals of medical care driven by guideline recommendations. ICU nurses participate in the medical managements, witness the sufferings, and then generate compassion leading themselves to exercise their body and mind to care patients. Through the practice repeatedly, nurses gain a new understanding and consequently transform themselves to be an ethical self which proactive in giving EOL care to meet the profound beauty behind the nursing work.
誌謝 I
中文摘要 III
英文摘要 IV
第一章 緒論 1
第一節 緣起 1
第二節 背景 2
第三節 探問 5
第二章 文獻查證 6
第一節 死亡醫療化與臨終照護 6
第二節 東方的身體經驗與照護 12
第三節 「他者」意涵與照護 14
第四節 從相遇概念論臨終照護 19
第三章 方法學 28
第一節 列維納斯他者現象學的哲學基礎 28
第二節 他者現象學與團體對話 34
第三節 以詮釋現象學做為一個探究的路徑 36
第四節 研究倫理 37
第五節 資料收集 38
第六節 資料分析 39
第七節 研究的嚴謹度 41
第八節 研究者的位置 42
第四章 研究結果 45
第一節 參與者 45
第二節 重症加護病房護理人員臨終照護經驗 46
(一) 陷落苦境 46
(二) 共感共苦 58
(三) 身心一如 73
第五章 討論 83
第一節 重症加護醫療下的死亡樣貌 83
(一) 死亡的醫療化 83
(二) 加護病房的無法安寧 86
第二節 負傷的療癒者 88
(一) 含容的悲憫 89
(二) 與自我相遇 92
第三節 照護中的自我修鍊 94
(一) 投身於行動 95
(二) 成己的實在 98
第六章 結 論 101
參考資料 104
中文文獻 104
英文文獻: 110
附錄 119
附錄一 行為與社會科學研究倫理委員會審查核可證明 119
附錄二 研究者通過IRB 考試及格證書與研習證明 120
附錄三 研究參與者同意書(簡版) 121
附錄四 研究參與者之基本資料表 122
附錄五 團體摘記 124
附錄六 研究者反思日誌 134
附錄七 前驅研究之發表文章 138
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