生命中可承受之重－－探究臨終照護護理人員的倫理自我

Living With Tolerable Burden: Exploring the Ethical Self of Nurses Who Provide End-of-Life Care

背景：在現代化醫療與高科技主導下，提供臨終照護會產生複雜的內在情感，不僅是疾病或死亡本身，還有目睹臨終病人受苦而苦的處遇。目的：本研究旨在試著從列維納斯（Levinas）所提出的「他者」觀點，說明臨終照護護理人員在現代化醫療下建構倫理自我的可能性。方法　本研究為質性研究，採詮釋現象學的質性研究法，以團體對話方式共進行6次。參與者13位護理人員皆有臨終照護經驗。資料收集包含：團體對話文本、研究者反思日誌及參與者心得。團體過程以錄音並轉錄文本，以詮釋現象學分析法（interpretative phenomenological analysis）進行資料分析。結果　研究結果呈現臨終照護的護理人員雖是執行醫療科技的主體，也可從照護中因「為他者」建立倫理的自我。其歷程為：(1)與死亡相遇、(2)遇見自己、及(3)迎接死亡。結論／實務應用　臨終照護需要的不是抽象、去脈絡化的理性知識，而是從經驗中獲得的照護智慧，這也是護理專業的恩寵。本研究結果說明臨終照護需要護理人員跳脫教條式的倫理原則，以回應他者的態度返回照護的核心，才可能成為一個倫理性的照護者。

Background: Providing end-of-life (EOL) care elicits complex emotions in nurses in the context of modern medicine. Nurses must not only watch their patients succumb to disease and death but also witness their suffering. Purpose: This qualitative study adopted the perspective of ＂the other＂, as proposed by Emmanuel Levinas, to understand the experience of nurses who provide EOL care and the possibilities of nurses build up their ethical selves within the context of modern medicine. Method: The study used interpretative phenomenology and group dialogue. Thirteen nurses who had EOL care experience were included. Data were drawn from the six transcripts of the group sessions, the researcher's diaries, and participants' feedback sheets. Interpretative phenomenological analysis was used to analyze the data. Results: The findings showed that nurses not only execute medical procedures but are also capable of self-molding into ethical subjects. The categories of participant experiences included: (1) encountering the death; (2) encountering my inner self; and (3) greeting the death. Conclusions/ Implications for Practice: EOL nursing does not require abstract or decontextualized knowledge, but rather requires more experiential knowledge. EOL care may inspire nurses to become ethical persons and to gain wisdom if they shift away from a self-centered perspective to receive ＂the other＂. This study illustrates that EOL care should not depend solely on ethical codes or principles but should also adopt the attitudes of ＂for the other＂.