透過專業讀書會轉化護理師對疼痛的理解

A Reappraisal of Pain Using a Nurses’Professional Study Circle

背景：疼痛是一種主觀感覺與個人經驗，病人的疼痛常因疾病、語言表達限制而被忽略或誤解。 目的：探索專業讀書會介入前後，護理師對病人疼痛評估與處置之反思和觀點轉化。 方法：研究者於泌尿外科病房創立一個專業讀書會，邀請護理師共同閱讀聆聽疼痛一書並定期分享與討論。在一年半時間內，共舉辦9場次，每次由一位成員領讀，並有主持人引導議題討論；成員需提出由閱讀聯想到的臨床個案，進而將所學運用於臨床照護工作。待讀書會結束後，以半結構式訪談收集質性資料並做現象學取向分析，以了解護理師對疼痛感知的反思和觀點變化。 結果：藉由讀書會之閱讀與導引式討論，9位護理師能覺察彼此對疼痛信念之差異，並經歷(1)因刻板印象而懷疑真偽；(2)從傾聽進而同理；(3)個別化照護與專業成長之歷程後，更能同理病人，對語彙使用更為敏感，亦提升疼痛評估能力。 結論／實務應用：專業讀書會以團體閱讀與導引式討論，可增進護理人員的反思與觀點轉化，進而提供個別化之疼痛評估與處置。

Background: Pain relates to the highly personal and subjective experience of feelings and emotions. Patients are often misunderstood because of language-related limitations and the conditions of their disease. Purpose: In this research, a professional study circle was held to help nurses reconstruct their understanding of patient pain to enhance their awareness / empathy for differences in pain perception between others and themselves and to improve their ability to provide professional, individualized care. Method: Nine nurses were invited from the urology department to join the developed professional study circle. We spent one year and a half reading “Listening to Pain: Finding Words, Compassion, and Relief” and held a sharing and discussion roundtable meeting every month. The study circle included: (1) assigned reading and the appointment of a leader on rotation to direct the sharing and discussion, (2) presentation of clinical cases related to the reading, (3) discussions of how to apply what they had learned in clinical practice, and (4) an interview of study circle members and a full analysis of their reflections and changes of view regarding pain perceptions. Results: After a close reading and guided discussions, these nine nurses began to change their perceptions of pain and, in general, passed through three stages, including: (1) cast doubt on the authenticity of patient expressions of pain because of stereotyped biases; (2) develop a new empathy based on careful listening; (3) providing individualized care and experiencing professional growth. After successfully transiting through these stages, the nurses held a more profound understanding of their patients, practiced a more sensitive use of language, and reflected an enhanced professional ability to assess pain. Conclusions/Implications for Practice: This professional study circle successfully helped the nurses internalize a more empathetic understanding of pain and exhibit greater skill in designing individualized care for their patients.