倫理性護理照顧意味著什麼？人文臨床學觀點

Exactly What is Ethical Nursing Care? The Perspective of the Clinical Humanities

台灣進入後現代社會的專業年代之後，各種身心疾病的照顧問題勢必日益迫切，使得整個社會必須付出大量醫療成本，而所謂全人式的護理照顧更不是一般專業醫療機構能夠從容應付的。因此，發展全民性的護理照顧，除了做為第一級醫療預防之外，也實質地必須動員「倫理關係者」（譬如家人、近親、朋友、鄰居、社區志工等）做為「關切他人／照顧自己」的身心照顧模式，參與各種身心疾病的照顧資源，用以降低大量的醫療成本。晚近以病人之健康福祉為核心關懷的醫療倫理，對於醫病關係的全盤考量與關注，其論述要旨即在於此。護理專業就像高速公路，可以使用最迅速、最有效率方式處理各種疾苦，但是，最令人滿意的護理照顧卻需要有倫理性的照撫。就精神醫療來說，專業精神科醫師或許可以迅速處理各種身心疾病，而「倫理關係者」則宛若地方道路，是可以通達家裡的。因此，全民性的護理照顧必須深植到本土的生活脈絡裡，才能使病人或受苦者真正有個養護的家巢。不過，長期以來台灣社會的護理專業教育（無論就學理及臨床而言）深受歐美世界生物醫學典範之影響，但其思想理路與意義結構卻迥異於本土社會文化。然而，本土化護理照顧的研究成果與臨床經驗，卻相當程度地足以提供病人或受苦者的「契入理論」與「可疏通的意義」，讓護理照顧逐漸融入本地生活世界；亦即，本土化的護理照顧可以適度地轉化以生物醫學模式為根本思維框架的臨床護理，並提供轉圜之迴旋空間，促進倫理性的護理照顧事業在本土社會生根茁壯、健康成長。

As Taiwan enters the post-modern era of professional medical care, a host of issues relating to nursing care are becoming increasingly pressing. On the one hand, the wide range of ailments of body and mind requiring treatment is placing a major financial burden on the national health care system. On the other hand, few hospitals are able to provide ＂comprehensive care of body and mind.＂ In addition to primary prevention, the most effective way to reduce the overall cost of medical care is to effectively bring volunteer caregivers (those who have an ＂ethical connection＂ with the patient, i.e., family, friends, neighbors, volunteers, etc.) into all levels of the caregiving process. Moreover, as medical ethics becomes increasingly focused on the well-being of the patient, more attention is being given to the healing relationship itself. Due to its ability to swiftly relieve a wide variety of ailments, the Western medical model has become widely accepted in Asia. Yet, a patient may feel a greater sense of healing when treatment is based on the principles of ethical caregiving. For example, in the way it quickly relieves the prevailing symptoms, psychiatric medication is like a freeway. By contrast, volunteer caregiving is more like a local road, which may be slower, but eventually takes one all the way home. Thus, making nursing care more person-centered and indigenized gives the patient a sense of not only being cured, but also being ＂cared for.＂ However, for a long time the theory and practice of nursing education in Taiwan has been based on the Western model of nursing. In this model nursing is treated as a branch of the biological sciences, an overall approach quite different from the traditional view of caregiving in Asian societies. Nonetheless, recent research and clinical practice indicates that an indigenized form of nursing care may be a more suitable approach to comprehensive care, and that such an approach has much potential for widespread application in Taiwan and other Chinese societies.