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研究生:賴霈妤
研究生(外文):Lai, Pei Yu
論文名稱:護理人員投入護理專業生涯之歷程經驗
論文名稱(外文):The Professional Career Experiences of Clinical Nurses - An Exploratory Qualitative Study
指導教授:周傳姜周傳姜引用關係
指導教授(外文):Chou, Chuan-Chiang
口試委員:許麗齡吳麗珍
口試委員(外文):Hsu, Li-LinWu,Lee-jen
口試日期:2012-06-15
學位類別:碩士
校院名稱:長榮大學
系所名稱:護理學系碩士班
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:2012
畢業學年度:100
語文別:中文
論文頁數:105
中文關鍵詞:護理人員專業生涯經驗與感受
外文關鍵詞:Nursing staffprofessional careerexperiences and feelings
相關次數:
  • 被引用被引用:4
  • 點閱點閱:318
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
護理人員是醫療照護團隊不可或缺的人力資源,也是在醫院工作人數中所佔比例最多的。近年來因健保制度變革導致的成本壓力,機構護理人力配置未能合理化,工作負荷日益加重,工作環境越來越惡化。新進護理人員服務未滿一年即離職者占 22.37﹪,兩年離職者更佔 40﹪,不僅增加訓練成本更影響工作士氣與病人照護品質。然而,當護理專業不斷投注心力在改善護理人員流動率時,推估仍有40%的護理人員選擇持續在工作崗位上服務,其中更有投身護理工作二三十載至退休者。這些護理人員為何能長期留在護理行業直到退休?護理生涯發展的歷程經驗如何?內心有哪些轉化及體悟?值得進一步探討。
目前對於退休臨床護理人員護理生涯歷程之研究非常有限,本研究目的在了解退休護理人員投入護理專業生涯之歷程經驗及其感受。採用深度訪談研究法,共訪問3位國立醫學中心退休護理人員。所有的訪談錄音後轉為文字記錄,並以內容分析法進行分析。結果得到以下五個主題:(1)現實考量入護理(2)護理業務多面向(3)多重角色求平衡(4)護理責任承擔重(5)護理甘苦體會深。本研究結果有助對護理專業生涯經驗的整體性了解,可供護理行政管理及護理教育課程設計之參考。

Nurses which account for the largest proportion of health care human resources in a hospital setting provide indispensable services to patients. Under the cost reduction pressure caused by the health care insurance system change in recent years, the number of health care agencies with deteriorated nursing manpower configuration and failed to rationalize nursing staff’s work load is increasing. Clinical nurses’ work environment has become increasingly worse year after year. Currently, the turnover rate is 22.37% among new nursing staff with the working year less than one and 40 % among the staff with working years between one and two. The high turnover rate not only increase the cost of training but also affect the morale and the quality of patient care. However, with the nursing profession institution’s continued efforts to improve nursing staff’s turnover rate, there are still 40% of nurses keep working in the hospitals. Some of them spent twenty to thirty years for their nursing career until retirement. It is worth to explore: Why these nurses could stay in the nursing profession until retirement? Are there distinctive or specific experiences on their nursing career development? How is the transition and perception of their professional life experiences?
Scant studies focusing on the professional experiences of nurses were found. The aim of this study was to explore the professional experiences of nursing staff devoting into nursing career. The in-depth interview method was used for this study. Three retired nurses from a national medical center were recruited for this research. All interviews were tape recorded and then transcribed. Descriptions were analyzed by using content analysis method.
Themes describing the the professional experiences of nursing staff devoting into nursing career include: (1) Selected nursing profession due to reality concern, (2) Nursing duties go variety, (3) Balancing among multiple roles, (4) Nursing work load became more and more heavy, (5) Perceived the bitterness and sweetness of nursing career. The findings of this is study provide better understanding of the experiences of nursing professional devoted to nursing career. It could also serve as useful reference for better nursing administration and nursing curriculum design.

第一章 緒論 1
第一節 動機、目的及重要性 1
第二節 名詞界定 3
一、生涯發展 3
二、護理生涯發展 3
三、護理專業生涯成長 3
第三節 研究目的 5
第四節 研究問題 5
第二章 文獻探討 6
第一節 生涯發展 6
一、Super生涯發展階段 6
二、Schein職業生涯發展階段 9
三、Hall職業生涯發展階段 9
第二節1980年後台灣醫療及護理專業發展簡介 11
第三節 護理專業生涯發展 13
一、新手到專家的護理發展模式 13
二、護理專業自我概念 14
三、護理專業的性別角色議題 15
第三章 研究方法 17
第一節 研究設計 17
第二節 研究參與者 19
第三節 研究者本身 20
第四節 資料收集 21
第五節 資料分析 23
第六節 研究倫理考量 27
第四章 研究結果 28
第一節 現實考量入護理 28
一、現實考量不得已 28
二、現實休克真煎熬 32
第二節 護理業務多面向 36
一、步調緊湊似陀螺、完成常規挑戰多 36
二、醫院評鑑責任重、資料整理須合作 40
三、能力肯定受拔擢、管理經驗作中學 42
四、調動單位多壓力、重新學習忙適應 45
第三節 多重角色求平衡 48
一、在職進修為文憑 48
二、工作家庭難兼顧 50
三、進修家庭難取捨 52
第四節 護理承擔責任重 55
一、臨床照護有責任 55
二、提攜後輩有擔當 57
三、展現自主受肯定 59
第五節 護理甘苦體會深 63
一、漫漫長路學圓融 63
二、包容接納祈平順 65
三、逆境壓力終無悔 66
第五章 討論 70
第一節、護理生涯之開啟為他人定向的過程 70
第二節、護理生涯依循著專業角色階段性的發展,護理責任與日俱增 71
第三節、正向調適克服護理職場挑戰 73
第六章 結論 75
第一節 結論 75
第二節 研究限制 76
第三節 應用與建議 77
一、研究設計的建議 77
二、護理行政方面 77
三、護理教育方面 78
第七章 參考文獻 79
附錄一 (1)同意臨床試驗證明書 91
附錄一 (2)同意書 92
附錄二 訪談大綱 95
附錄三 主題形成歷程(節錄) 96
附錄四-主題命名與群聚表(1)~(5) 97
附錄五 主題命名類目表 102
附錄六 研究參與者檢證 104


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1. 尹裕君(2005).新制醫院評鑑與護理品質管理.榮總護理﹐22(2)﹐109-116。[Yin,Y.C.(2005).The New Hospital Accreditation and Nursing Quality Management. VGH Nursing,22(2),109-116.]
2. 王憲華. (2008). 從新制醫院評鑑談護理照護. 醫療品質雜誌, 2(2), 52-57.
3. 李慧鶯、李選(2004).在職進修學士學位護理人員生涯定位與生涯發展需求研究.長庚護理﹐15(1)﹐33-43。[Lee,H.I.&Lee,S.(2004). A Study of the Career Anchor and the Needs of Career Development for the Registered Nurses in BSN Program. Chang Gung Nursing,15(1),33-43.]
4. 汪蘋、洪世欣、謝佑珊、尹祚芊(2003).醫學中心基層護理人員臨床專業能力進階制度實施經驗分享.護理雜誌﹐50(2)﹐30-36。[Wang,P., H,S.H., S,Y.S.&Yin,J.C.( 2003).Sharing the experience of implementation a clinical ladder system in medical center.The Journal of Nursing﹐50(2), 30-36.]
5. 呂佩佩、丁興祥、陳美伶、唐婉如(2005).學術洪流中護理研究的定位-從質性研究與量化研究之源流談起.護理雜誌﹐52(6)﹐76-81。[Lu,P.P., Ting,S.S., Chen,M.L.,&Tang, W.R.(2005)The Positioning of Nursing Research in the Academic Studies: The Origin and Development of Qualitative and Quantitative Studies.The Journal
6. 吳姿蓉、鄧慶華、池美華、曾淑梅、袁素娟(2007).某醫學中心護理人員護理能力及其相關因素之探討.中山醫學雜誌﹐8(2)﹐303-316。[Wu,T.J., Teng,C.H., Chih, M.H., Tseng,S.M.,&Yuan, S.C. (2007). Nursing Competencies and Its Related Factors in a Medical Center. The Chung Shan Medical Journal,8(2) , 303-316.]
7. 高鳳儀、吳孟嬪、蔡欣玲、邱艶芬(2008).護理人員對2007年版臺灣醫院評鑑標準之認知、態度與行為.北市醫學雜誌﹐5(6)﹐593-608。[Gau,F.Y., Wu, M.P., Chao,Y.F.,&Tsai,S.L.(2008).Knowledge, Attitude and Behavior of Nursing Staff toward the Taiwan 2007 Version of Hospital Accreditation .Taipei City Medical Journal,
8. 徐南麗、李茹萍、李芸茹、賴正芬、彭台珠(2003).護理人員進階制度實施後主客觀護理能力差異之比較.志為護理-慈濟護理雜誌﹐2(1)﹐53-62。[Hsu,N.L., Lee, R.P., Lee,Y.J., Lai,C.F.,&Peng,T.C. (2003).A Comparison between Objective and Subjective Nursing Competence in Post Implementing Clinical Ladder Systems. Tzu Chi Nurs
9. 陳淑雯(2002).網際網路-護理專業新領域.護理雜誌﹐49(6)﹐73-76。[Chen, S. W. (2002).The Internet: A New Terrain for the Nursing Professional.The Journal of Nursing﹐49(6),73-76.]
10. 陳小蓮、盧美秀、陳品玲(2001).臨床護理輔導員制度對新進護理人員輔導成效之探討.新臺北護理期刊﹐3(1)﹐35-44。[Chen,H.,Lu,M.S.,&Chen,P.L.(2001).Effectiveness of a Clinical Preceptor Program for New Staff Nurses.New Taipei Journal of Nursing,3(1),35-44.]
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12. 張敏、林璟淑、張元玫、李亭亭(2008).護理資訊應用簡介-某醫院護理資訊系統推行之經驗分享.護理雜誌﹐55(3)﹐75-80。[Chang, M., Lin, J.S., Chang, Y.M.,&Lee, T.T. (2008). Applications of Nursing Information Systems: Sharing the Experience of Implementation in a Hospital. The Journal of ursing,55(3),75-80.]
13. 張云孆、許怡欣、薛亞聖(2006).新制醫院評鑑推行現況之探討-六位專業人士之深入訪談分析.醫護科技學刊﹐8(4)﹐287-297。[Chung,Y.Y. , Hsu,Y.H. , &Hsueh,Y.S. (2006). Qualitative Analysis of the Implementation of the New Hospital Accreditation System. The Journal of Health Science ,8(4) ,287-297.]
14. 張瑛瑛、王曼溪(2008).探討護理人員主觀之護理能力及其相關因素.榮總護理﹐25(4) ﹐334-341。[Chang, Y.Y. , &Wang, M. H. , (2008). Subjective Nursing Competence and the Related Factors of Nurses in a Medical Center. VGH Nursing,25(4) ,334-341.]
15. 黃美華、郭倩琳. (2009). 女性護理人員生涯阻礙與因應策略之相關性研究. 護理暨健康照護研究, 5(2), 91-99. [Correlation Study of Career Barriers and Coping Strategies among Female Nurses, Journal of Nursing and Healthcare Research, 5(2), 91-99.]