Huang Ching-Chi, Chen Jih-Yuan, Chiang Hsien-Hsien
1MSN, RN, Former Lecturer, Department of Nursing, Mackay Medicine, Nursing and Management College 2PhD, RN, Associate Professor, School of Nursing, Kaohsiung Medical University 3MSN, RN, Professor, Institute of Clinical Nursing National Yang-Ming University & Professor( joint appointment), School of Nursing, National Defense Medical Center.
J Nurs Res. 2016 Jun;24(2):109-17. doi: 10.1097/jnr.0000000000000160.
Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available.
This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients.
A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively.
A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing practices, focusing on patient needs, and utilizing past experiences enable nurses to develop a heightened sense of responsibility and awareness, thus empowering them to take better care of themselves and their patients.
尽管近期对临终关怀护理的关注度有所提高，但关于护理人员情感或心理转变过程的实证证据却很少。
本研究探讨护士因照顾临终患者所产生的精神痛苦和冲突而发生的转变过程。
采用现象学方法对台北一家医疗中心临终关怀病房的8名护士（年龄在27至40岁之间）进行调查。通过半结构化访谈中的开放式问题收集数据，并进行反思性分析。
观察到参与者情感过程经历了三个阶段的转变。在第一阶段，参与者因面对患者死亡而经历急性情感痛苦，自身对失去家庭成员的记忆可能会加剧这种痛苦。在第二阶段，参与者采取应对策略来改善自我护理。这些策略包括试图安抚患者、帮助患者面对或处理未完成的事务，以及参加葬礼或纪念仪式。在第三阶段，参与者通过解放性反思和重新确立对自我、患者及患者家属的责任，学会提供更好的护理。在第三阶段之后，最初的情感影响转变为自我强化的媒介，参与者变得更善于察觉患者需求并提供护理，从而充分完成转变过程。
结论/对实践的启示：情感痛苦是促使参与者转变个人和职业自我的主要因素。充分的情感自我管理、与其他护士的对话以及个人反思是护士可用于促进个人成长、实施道德实践、与其他护士互动以及进行个人反思的关键行动。诸如照顾患者、实施反思性护理实践、关注患者需求以及利用过往经验等策略，能使护士培养出更强的责任感和意识，从而使他们有能力更好地照顾自己和患者。
