好的護理－－病人與家屬的觀點

Good Nursing: Perspectives of Patients and Family

本研究目的在瞭解病人與家屬觀點之「好的護理」行為，並與護理人員的觀點做比較。以立意取樣法從三所醫學中心和三所區域醫院取得53位病人及6位家屬同意參加「焦點團體」接受訪談，共組成九個團體，於2003年3月至6月完成資料收集。受訪者男性居多，佔62.7%，年齡介於18至81歲（mean=51.9±15.6）；住院至少3天，體力及精神容許參與60-90分鐘團體討論。經取得受訪者的同意，訪談過程全程紀錄並錄音，並寫成敘事體逐字稿。訪談資料包括好的護理及不太好的護理行為，經內容分析法辨識出受訪者所描述之「好的護理」行為可歸納為「守護神般地照護」、「人本的技能」、「良好的執業表現」和「專業成長」等四大主題。本研究發現病人與家屬肯定護理人員的專業能力，能如守護神般地守護他們；且執行照護工作時能有視病猶親般的表現。與護理人員觀點的比較發現：兩者在主題歸類上是相近的，但是，病人與家屬傾向於用規範性道德語詞或負向的舉例，如「應該」、「最好當然如果」等來表達他們對「好的護理」的期待。

This qualitative study aimed to explore patients’ perspectives on good nursing for comparison with nurses' perspectives, as identified in a previous study. Purposive sampling was employed to recruit 53 patients and six family members from three medical centers and three regional hospitals, in northern, central, and southern Taiwan. The 59 participants were clustered into nine groups for focus-group interviews for data collection purposes, from March to June, 2003. Most of the participants were male (62.7%), and their mean age was 51.9 years (SD=15.6), with a range from 18 to 81 years old. All of the participants were hospitalized for at least three days and had the physical and mental strength to participate in a 60-90 minute group interview. The interviews were both hand-recorded and audio-taped on site, with permission from the participants, and then transcribed into verbatim narratives for data analysis. Content analysis was used to identify items in relation to good nursing/not-good nursing across narratives. The findings showed that four major categories of good nursing inductively emerged, including: (1) Providing professional nursing as a guardian angel, (2) Demonstrating professional skills with humanity, (3) Being accountable and competent, and (4) Showing self-improvement. The findings indicated that professional nursing competence is the essence of good nursing. Treating patients as relatives is also perceived as good nursing. In comparing the patients definitions of good nursing with those of nurses it was observed that there are similarities in terms of the main categories of the definitions. Patients, however, tend to use negative examples or normative moral terms, such as ”should” or ”ought to” to connote what is expected of good nursing and how good nursing is expressed in the context of patient-nurse interaction.