新進護理人員面對死亡之照護經驗

Newly Registered Nurses' Experiences With Patient Death

本研究旨在探討新進護理人員面對病人死亡之護理照護之經驗。研究採現象圖學研究法，運用開放式會談問題進行深度訪談，共有20位參與本研究，以熟悉、濃縮、比較、分類編組、清晰化、標籤化歸類及對比等現象圖學原則進行分析。研究結果發現描述空間(結構面)呈現整體層面涵蓋互動層面和內在層面及六個描述範疇(內涵面)包括：『面對死亡之多重壓力』、『他人支持及回饋』、『自我因應』、『感同身受』、『體會生命消逝與死亡共在』及『自我成長』。新進護理人員面對病人死亡時會因死亡衝擊、個人信念及角色壓力承受多方壓力，此時外在支持在個人因應過程扮演重要角色，充足他人支持可促使其勇於面對壓力與負向感受，方能啟動感受、體會及成長的自我反思歷程，將經驗中的不適轉化為對工作和生命的體悟；倘若外在支持缺乏時則會使其選擇以逃避、隱藏、麻痺面對壓力，這樣不僅無法進入反思和體悟，反而會增加工作壓力，更可能因此影響工作熱忱。研究結果可提供規劃新進人員訓練課程及輔導機制之參考。

The aim of this research was to understand the death-related caring experiences of newly registered nurses. Based on a phenomenographic research approach, in-depth interviews were conducted with 20 nurses, and the data were analyzed according to seven phenomenographic analytical steps: familiarization, condensation, comparison, grouping, articulating, labeling, and contrasting. The findings included an outcome space (a structural aspect) and six description categories (referential aspects) identified as' multiple stresses when facing with death,'' support and feedback from others,'' coping,'' sympathy and empathy,'' being with patients as life is fading away and appreciating death,' and 'self-growth'. The newly registered nurses reported that they encountered multiple stresses when caring for dying patients because of the confrontations that occur during death, personal beliefs about death, and role confl icts. Moreover, the nurses explained that positive support and feedback from others were essential when they experienced stress and negative feelings while caring for dying patients and interacting with the patients' families. Additionally, a series of inner mechanisms initiated by experiences, realizations, and refl ections were recognized as self-growth. The primary mechanism was identifi ed as the transformation of negative experiences into an appreciation of life. Consequently, when the newly registered nurses lacked support while facing patient death, they resorted to using negative coping skills such as engaging in denial, concealing emotions, or being emotionally numb; thus, they would not be able to activate the inner mechanism for transformation, which increase work stress and decreases work passion. The fi ndings provide evidence for planning and implementing supporting policies in the continuing nursing education and debriefi ng newly registered nurses.