護理人員照顧藥癮愛滋病患的經驗

The Experience of Nurses Caring for HIV-Positive Injection Drug Users

台灣的靜脈藥癮族群因不安全注射行為於2004年爆發HIV流行。靜脈藥癮者常因愛滋病相關合併感染症須住院治療，護理人員面臨靜脈藥癮將行為問題帶進醫院續發的挑戰。本研究以現象學研究法，探討護理人員照顧藥癮愛滋病患過程中的經驗與策略，採立意取樣選取7位曾照顧藥癮愛滋感染者的護理人員為研究對象，以半結構式訪談指引進行深度訪談。所得文本以Colaizzi現象學研究法進行分析。結果發現照顧過程中護理人員感受到：衛教成效低，沒有成就感、病人防禦性高，信任關係難建立、擔心病人住院時用毒、家屬參與照護程度低、遭受威脅恐嚇、及團隊的退縮與緩不濟急的反應。護理人員的運用的策略為：主管與同儕相互支持、學習與愛滋藥癮病患的溝通技巧－－融入其文化、自我充權－－照護病人的價值與力量。結果可供相關行政措施及政府制定政策之依據，以改善護理人員焦慮不安的情緒及增加照顧安全措施，促進照顧意願，而照顧過程對專業及個人成長的正向回饋經驗，亦可作為其他專業人員及未來從事醫療照顧學生的典範。

Taiwan has experienced a clear upswing in HIV infection among injection drug users (IDUs) since 2004. Unsafe drug injection behavior has led to complicated infections including HIV and hepatitis C virus infection among IDUs. Nurses face challenges and threats in caring for this group due to the widespread criminal and behavioral problems related to drug use. The purpose of this phenomenological study was to explore nurses’ experiences in caring for HIV positive IDUs. Purposive sampling was used to recruit 7 nurses with experience working with HIV positive IDUs. In-depth semi-structured interviews were conducted 1~2 times with each nurse. The length of interviews ranged from 1.5~3 hours. Interviews were tape recorded and transcribed verbatim. Data was analyzed using the Colaizzi method for phenomenology. Nurse experiences reflected low achievement level, difficulty in establishing rapport with IDUs, fear of drug use incidences during hospitalization, insufficiency and complications with family caregivers, fear of being threatened, and lack of support from other medical disciplines. Nurses used strategies that included being supportive of one another, learning appropriate communication skills, positive thinking, and anticipating substantial compensation from administrators. The results of this study provide essential information for in-service education and healthcare policy reform on IDU care. Interventions to ease nurse anxieties and feelings of insecurity in order to increase safe care should be developed and implemented. Positive feedback from IDUs with HIV infection enhances nurses’ professional and personal growth.