護理人員在護持與承擔中的轉化－－以臨終照護反思團體為例

The Transformation of Nurses in Holding and Containing: A Reflective Group for End-of-Life Care

背景：護理人員在面對病人死亡時，會產生複雜的情緒勞務。目的：探究臨終照護護理人員，透過反思團體對話，所呈現照護中的轉化經驗與歷程。方法：採用現象學研究方法，邀請某綜合醫院照護臨終病人的護理人員，組成反思團體，進行12次團體對話。根據此團體對話的紀錄，及研究者田野日誌，以主題分析（thematic analysis）進行資料分析。結果：團體對話中，護理人員分享照護臨終病人的護持與承擔，呈現安身立命的轉化，可歸納為三項：㈠承擔著脫離想像的真實，㈡對話中的護持與省察，㈢蘊生的修己安人。這三個主題，引發下列三個面向的討論：㈠負傷的照護者，㈡面對他者，以及㈢利他的照護行動。結論／實務應用：本研究呈現護理人員在照護經驗與團體分享對話交織中出現的轉化軌跡，可提供護理人員省察自身成長的參照。並顯示經由團體對話中自身與他者間的互動，可促成護理人員個人及專業自我的建構，有助於護理人員對臨終病患及家屬的照護品質。

Background: Caring for dying patients is an emotional burden for nurses. Purpose: This study used reflective groups to explore the process of transition that nurses go through in caring for dying patients. Methods: We adopted a phenomenological approach. Data were collected from nurses participating in 12 reflective groups. All nurses worked in oncology / hospice units in a general hospital in Taipei. We used thematic analysis to analyze data. Results: Findings identified a transition in how nurses handled and contained their emotions within three main themes: (1) containing unpredictable reality, (2) cautious ”holding back” in discussion, and (3) self-cultivation in order to serve others. These findings led us to extrapolate the three issues of wounded healer, facing others, and altruism in caring. Conclusions / Implications for practice: This study represented the holding and containing of nurses in caring for dying patients and held group dialogues to facilitate reflection. Findings will be used to facilitate nurse self-awareness and improve end-of-life care quality.