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研究生:鄧文章
研究生(外文):Teng, Wen-Chang
論文名稱:安寧護理人員面對末期病人自覺負擔現象的照護經驗探索
論文名稱(外文):The hospice nurses’ experiences of caring the terminally ill patients’ self-perceived burden: a hermeneutics perspective
指導教授:李佩怡李佩怡引用關係
指導教授(外文):Li, Pei-Yi
學位類別:博士
校院名稱:國立臺灣師範大學
系所名稱:教育心理與輔導學系
學門:教育學門
學類:綜合教育學類
論文種類:學術論文
論文出版年:2015
畢業學年度:104
語文別:中文
論文頁數:280
中文關鍵詞:安寧護理人員自覺負擔護理經驗末期病人
外文關鍵詞:hospice nurseself-perceived burdennursing experienceterminally ill patient
相關次數:
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本研究主要聚焦於安寧護理人員在照顧末期病人與家庭的過程中,當病人面對家人的照顧而自覺負擔時,安寧護理人員涉入這個現象裡的內在經驗與因應。

研究採立意取樣,分別於北、中、南區醫療院所,邀請4位具合作與訪談意願、能清楚描述與討論、且實際從事安寧照顧三年以上的安寧護理人員,共同參與研究。研究以詮釋學為研究法基礎,透過半結構訪談的形式,個別訪談4位護理年資5~13年的安寧護理人員,每位2~3次,每次1~1.5小時,以匯集安寧護理人員面對自覺負擔現象的照護經驗及內在感受。訪談文本資料參照沈清松、Ricoeur的策略,進行詮釋分析。

研究結論呈現出安寧護理人員所觀察的自覺負擔現象是:(一)自覺負擔是護理照顧的文化背景;(二)自覺負擔涉及關係議題,是病人對照顧依賴的主觀壓力感受;(三)自覺負擔是生理崩解而來的關係焦慮。而安寧護理人員面對自覺負擔現象的內在與因應經驗是:(一)自覺負擔的接觸,牽動安寧護理人員的自身經驗而情緒糾結;(二)奠基安寧護理人員的個人經驗而衍生獨特的因應模式;(三)情感牽動安寧護理人員的自身經驗而啟動學習動能。而從安寧護理人員與自覺負擔現象之間的關聯性來看,則是:(一)角色與自我的斷裂;(二)專業角色與內在自我的拉扯與平衡;(三)融合角色與自我的深度護理陪伴。

最後,依據研究結論提出研究限制與建議。
Purpose. In Chinese culture, the caring is the task of family members. When the patients felt self-perceived burden (SPB), it may influence the family’s emotion. And also, it may influence the nurses’ caring task. The aim of this research is to investigate the caring experience of hospice nurse while the terminally ill patients suffered the SPB.

Method. Based on the hermeneutics perspective, semi-structure interview was used to gather the experiences of 4 hospice nurses (worked in hospice around 5-13 years). These interviews (2-3 times each subject, about 60-90 min each interview) were transcribed and analyzed by Ricoeur’s hermeneutics strategies.

Results. For hospice nurses’ experiences, the themes about SPB include “SPB is the background of Chinese culture”, “SPB is a subjective feeling of pressure about being cared”, “SPB comes from the anxiety of the clasped of relationship, not just the physical pain or death anxiety”. The themes about the hospice nurses’ inner and coping experiences of caring SPB are “the caring of SPB triggers nurses’ personal experiences and emotional arousal”, “the coping strategies which based on the nurses’ personal experiences are varied and unique”, “nurses are active in learning by the personal experiences and emotion aroused”. And the themes of the relation between the hospice nurses and SPB are “the broken and struggle of the professional roles and the self”, “the conflict and balance of professional roles and the self”, and “the deeply nursing companion based the infusion of professional roles and the self”.

Conclusion. The findings from this research suggest (1) the nursing training may bridge the professional knowledge and the personal experience, (2) clinical or counseling psychologists and social workers may more involve in hospice teamwork, (3) when patients diagnosed cancer may be the time to concern the SPB, (4) the psychological treatment about SPB may be the emotional contact between the patients and their caregivers, and the meaning reconstruction about their relationship and the caring experience. There are also limitations and suggestions for further research.
致謝詞 i
摘要 iii
Abstract iv
目次 vi
表次 viii
圖次 ix
第一章 緒論 1
第一節 研究緣起 1
第二節 研究目的與問題 3
第三節 名詞涵義 4
第二章 文獻探討 5
第一節 護理的情緒照顧 5
第二節 自覺負擔現象 22
第三節 方法論:詮釋學 42
第三章 研究方法 53
第一節 研究方法與架構 53
第二節 研究設計 55
第三節 研究者 68
第四節 研究嚴謹度 74
第五節 研究倫理 78
第四章 研究結果 81
第一節 朝向「光」的小葵 81
第二節 若即若離的小貓 112
第三節 漸次消融的夏雪 146
第四節 江湖義氣的二娘 177
第五章 綜合詮釋與討論 207
第一節 自覺負擔現象的護理觀察 207
第二節 面對自覺負擔的內在經驗與因應 218
第三節 安寧護理與自覺負擔的相互凝視 228
第六章 結論與建議 241
第一節 結論 241
第二節 限制與建議 246
第三節 反思 252
參考文獻 259
中文文獻 259
英文文獻 262
附錄 270
附錄一:研究邀請函 270
附錄二:研究同意書 273
附錄三:訪談大綱 277
附錄四:研究參與者檢核函 278
附錄五:研究倫理審查核可證明 279
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