兒科急重症病房護理人員照護臨終兒童之困境

Acute Pediatric Nursing Barriers of Caring for Terminally Ill Children

國民健康局於2004年開始推行「安寧療護共同照護計畫」，臨終病童被鼓勵在原病房繼續接受照護，急性兒科病房護理人員也一直被賦予臨終兒童照護之重任。本研究目的在探討兒科急重症病房護理人員照護臨終兒童的經驗，採質性研究之半結構式及深入訪談的方式收集資料，以立意取樣方式在中部某醫學中心兒科病房及加護病房之16位護理人員為受訪對象，訪談資料採主題分析法，依照護經驗歸為七大類：(1)臨床上迴避死亡話題；(2)醫護團隊成員對善終照護理念未達共識；(3)深感對父母的虧欠；(4)難以忘懷臨終病童所受的傷害；(5)難以自我肯定臨終照護表現；(6)尋找舒緩照護壓力的方法；(7)病童往生後之釋放感。現階段兒科護理人員以未臻成熟的照護技能參與臨終照護，因為無法自我肯定照護表現，其內心的衝突與掙扎是急待被重視與支持的，所幸在這一連串的照護過程，經由工作之餘的成長與調適照護壓力，最後病童往生後能以一種反思、祝福的情緒跨過那一段難熬的臨終照護經歷。

The Department of Health started performing the plan of hospital-based palliative care in 2004. Children with terminal illnesses were encouraged to receive the palliative care at their original ward, so the nurses were expected to be able to perform palliative care in the acute and intensive pediatric unit, not only in palliative units. This qualitative research was adopted to explore the nurses’ acute pediatric experiences of caring for children with terminal illnesses. To gain a better understanding of their experiences, the purposive sampling and the semi-structured in-depth interview were applied. Sixteen nurses from the general pediatric ward and pediatric intensive care unit were selected from Central Taiwan. Each interview was tape recorded and transcribed verbatim and data analyzed by thematic analysis. The findings indicated seven main experiences: (1) avoiding talking about the issue of death; (2) lack of consensus on the concept of good death; (3) blaming themselves for not performing their duties enough for parents; (4) strong negative impression from children’s injuries; (5) low self-identity in relation to their caring abilities; (6) taking time away from work to accommodate for the stress; (7) felt relief after children’s death. The pediatric nurses, nowadays, were not able to carry out the perfect palliative care skills and knowledge, because of lack of self-belief in their practical caring abilities. The nurses’ feelings and inner conflicts should be appreciated and supported. Fortunately, the nurses could feel their self-growth and self-improvement after they reflected on their everyday caring activities and experiences, and finally they were able to overcome the challenges of caring for children with terminal illnesses.