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題名:安寧病房護理人員困境與轉化學習之探究
作者:程紋貞 引用關係
作者(外文):Cheng, wen-chen
校院名稱:國立高雄師範大學
系所名稱:成人教育研究所
指導教授:蔡培村
學位類別:博士
出版日期:2016
主題關鍵詞:安寧病房護理人員困境轉化學習hospice nursepredicamenttransformative learning
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本研究旨在探究安寧病房護理人員轉化學習的過程,以瞭解護理人員在安寧病房遇到的困境、因應資源、轉化學習的現象及影響。採質性研究方法設計,以台灣中、南部十位安寧病房護理人員為研究對象,透過半結構式訪談蒐集資料後進行分析。根據研究發現,所獲致之研究結論摘錄如下:
壹、護理人員投入安寧病房工作的緣由,來自於認同安寧療護理念、追尋不同體驗與成長、喪親經驗的觸發等內在因素;及組織需求的調動與規畫、重要他人的建議和影響等外在因素。
貳、安寧療護理念的認知、病人照顧、護病關係與團隊合作是護理人員在安寧病房遇到的困境,且為引發轉化的觸發事件,撞擊護理人員原有的思考框架,引導其覺察及反思既有的意義觀點。
參、安寧病房護理人員面對困境時,宗教信仰、專業信念、自我宣誓與跳脫轉移是因應的內在力量;而專業團隊的支持、重要他人的支持、課程研習與自主閱讀是因應的外在資源。
肆、開放心智、瞭解同理、聆聽內在與回歸核心是安寧病房護理人員面對困境時轉化之現象。
伍、安寧病房護理人員轉化後,將新的觀點引至生活結構,做為處事之基礎,展現專業增能、傳遞關懷、適切表意、重塑規準及延續價值等行為或態度。
陸、歷經轉化學習後,安寧病房護理人員確認在安寧病房具有證實善終照護精神、人性化的全人照護及樹立護理專業自主等意義。
柒、歷經轉化學習後,對安寧病房護理人員的生命態度、自信與自我價值、生活態度、為人處事及家庭關係等有正面之影響。
根據研究結果,研究者提出以下建議:
壹、對學校護理教育的建議
ㄧ、積極推動安寧療護護理教育,培育護理學生全人照護與臨終關懷素養
二、豐富醫護文學與生命關懷圖書視聽設備,融入課程或課外活動設計,引導學生從閱讀中省思,提供反思的機會與建立個體因應的內在力量
三、通識課程多元開設信仰教育課題,以為日後因應困境之內在資源或轉化之指引
四、結合反思與同理心的課程設計或敘事教學,培育學生觀點轉化之能力
五、應用本研究困境與轉化學習之發現,融入安寧療護相關課程,創造護理學生學習機會,更認識與貼近安寧療護護理工作
貳、對安寧療護所屬或相關機構的建議
一、初任安寧病房護理人員職前完成安寧緩和基礎培訓課程,具有安寧療護應有的知識與態度
二、應用本研究之發現,規劃在職教育議題,融入情境模擬教學,提升安寧病房護理人員解決問題能力
三、建立同儕支持團體,相互扶持與成長
四、應用本研究轉化學習的正向經驗做為宣傳,讓初任安寧療護與非安寧療護護理人員更能體會與理解安寧療護
五、政府或民間推廣安寧療護機構可應用本研究結果中與社會大眾相關之困境為議題,加強宣導與教育
參、對安寧病房護理人員的建議
一、透過多元學習管道認識安寧療護,建立正確的觀念
二、進入安寧療護職場前完成基礎培訓課程,具備安寧療護護理應有的認知與準備
三、培養反思與同理能力,從而促進轉化學習的機會
四、瞭解自己的支持系統,且適時地尋求協助
關鍵字:安寧病房護理人員、困境、轉化學習
The purpose of this study was to explore the transformative learning phenomenon of hospice nurses in the workplace, in order to understand the predicaments they face and the transformative learning approaches they adopt, and the changes in their attitudes attributable to their learning experience. A qualitative study design was employed, and the research subjects were 10 full-time nurses working in the palliative care ward in middle and southern Taiwan. Open-end questionnaire survey, in-depth interviews and document analysis were adopted to collect data. On the basis of the findings, the following conclusions were drawn:
1. The nurses enter the hospice and palliative care profession because of internal factors (e.g., identification with the concepts of hospice and palliative care, pursuit of different experiences and personal development, and loss of loved ones) and external factors (e.g., job transfer and appointment, recommendations from teachers or family members, and a supervisor’s charisma).
2. The predicaments faced by hospice nurses are outlined as follows: hospice and palliative care knowledge, patient care, nurse–patient relationship, and teamwork. These predicaments triggered the nurses’ transformative learning, conflicted with their inherent thinking framework, and guided them in perceiving and reflecting on their existing values and beliefs.
3. Religious beliefs, professional faith, self-vow and emotional detachment are the internal resources that support hospice nurses when they resolve their predicaments, whereas team support, support from others, educational training and initiative reading are external resources that help nurses respond to predicaments.
4. Being open-minded about the unknown, identifying with patients and their family members, listening to their intuition, and falling back on their core values and beliefs are the transformation of hospice nurses when they confront their predicaments.
5. Through transformative learning, hospice nurses can enhance their professionalism, caring, and propriety of emotional expression; reshape their rules of thinking; continue realizing their values; and incorporate newfound ideas as their code of conduct in activities of daily living.
6. Through transformative learning, hospice nurses feel more capable of delivering their care services in a good death and holistic manner and establishing autonomy in their practice.
7. Transformativealearningapositively influencesahospice nurses’ attitudes toward life, confidence, self-worth, attitudes toward their lifestyle, personal conduct, and family relationship.
According to the preceding conclusions, this study proposes the following suggestions:
1. Recommendations for nursing education at school
(1)Promote hospice and palliative care education and train nursing students in holistic health care and end-of-life care.
(2)Increase the diversity of audiovisual and reading materials in the nursing literature and life care, and integrate such materials into the planning of curricula or extracurricular activities, thereby enabling students to engage in reflective thinking and cultivate the inner strength necessary to resolve predicaments inherent in clinical practices.
(3)Incorporate educational topics on religion into the general education curriculum to provide students with the mental support required to face predicaments in clinical settings and guidance toward personal transformation.
(4)Develop courses that encourage reflection and empathy, or similar courses executed through narrative approaches, to prepare students for personal transformation when entering the nursing profession.
(5) Apply findings of this study to the hospice and palliative care curriculum for nursing students to learn and understand the nursing practices involved
in hospice and palliative care.
2. Recommendations for institutions and organizations involved in hospice and palliative care
(1)Train novice nurses in hospice and palliative care to enable them to develop knowledge and attitudes that prepare them for the clinical practice.
(2)Apply findings of this study to developing scenario-based courses for in-service training to improve hospice nurses’ problem-solving skills.
(3)Create peer support groups that enable members to assist one another in improving together.
(4)Use the transformative learning experiences explored in the present study as materials for educating new hospice nurses and nonhospice nurses.
(5)Ensure that the government or private organizations dedicated to the promotion of hospice and palliative care disseminate the predicaments covered in the findings to facilitate educating the general public on hospice and palliative care.
3. Recommendations for nursing practitioners
(1)Develop a comprehensive understanding and concept of hospice and palliative care through various learning resources
(2)Complete training in hospice and palliative care to develop knowledge and attitudes regarding clinical practice before officially working in the hospice division.
(3)Develop reflection ability and empathy to facilitate engagement in transformative learning.
(4)Search for support systems and seek help whenever needed
Keywords: hospice nurse, predicament, transformative learning
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