臨床護理教育的敘事書寫－－護理過程紀錄的本質

Narrative Pedagogy in Nursing Education: The Essence of Clinical Nursing Process Recording

背景：臨床實習的「護理過程紀錄」是一項能達成以「學生為中心」之教（與）學的有效工具，但其實際運作的教與學過程及教育意涵，有待更一步認識。目的：探究「護理過程紀錄」作為臨床教學的方法之一，所引發的教學意涵。方法　本研究採用現象學之反思分析方法，收集五次臨床護理教育論壇的討論資料並進行分析，會中邀請6位曾參與臨床教學的教師與會，採用一位護生書寫且經過教師批閱的12回「護理過程紀錄」文本，作為事前閱讀的素材，以促進臨床護理過程紀錄（clinical nursing process recording, CNPR）教學的討論。結果　「護理過程紀錄」作為臨床教學的方法及學生學習護理的過程，所呈現師生互動主要內涵，包括：（一）由為己書寫與經驗再現，啟發主動學習；（二）由持續性與在場，促進師生連結；及（三）由師生共作與護病共融，共創學習情境。結論／實務應用　CNPR教學能引發護生、病人與教師三者之間的相互交流，促成老師、學生及病人在照護情境中，對自身的重新定位。此重新定位促使護生能自我導向的學習，教師學習提問、等待與陪伴，及病人出現自我照顧的能力。

Background: Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. Purpose: To explore the essence of CNPR in the contexts of clinical teaching and learning. Methods: Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. Results: Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. Conclusions: When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by relocating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.