護理系學生回溯被精神病患攻擊的經驗分析與反思

Analysis and Reflection of Student's Retrospective Experience of being Assaulted by Psychotic Patient

精神病患暴力行為的照護是精神科醫療人員養成與繼續教育的重要議題，但以往文章少見捀生在臨床遭遇暴力的經驗探討。本文藉由一名護理系學生（簡稱護生）在精神科實習過程中，遭遇其照顧的精神分裂症病人口語及肢體暴力攻擊的經驗，透過深度訪談回溯事件並進行內容分析，先描述現象本身及所處之脈絡，包括從記錄事件發生經過、護生的情緒感受，以及相關聯的過去成長環境、護生本身、病患、事件的發展過程之脈絡，歸類其經驗的主題與內涵，包括（1）照顧壓力的情緒負荷：對病患的負向情感轉移，（2）進退間的掙兒：「專業角色？自我安全？」，（3）事後的情緒表達：情緒需要自己處理，（4）對病患之攻擊動機之預設：以人際互動去解讀。進一步詮釋現象可能具有的深層意義，包括：象徵互動、情緒與判斷、學習角色與階層三個方向。希冀分析與反思此經驗，提供相關科系教師在指導與輔導學生面對病患暴力攻擊或協助臨床新進醫療人員之暴力攻擊在職教育的參考。Care for psychotic patient's aggressive behavior is an important issue in the education for students and staffs in psychiatry; however, there was rare to report the assaulted experience among students in clinical psychiatric setting. This article described the experience of a nursing student who was orally and physically assaulted by her caring case with schizophrenia in the clinical psychiatric practice. Retrospective data of the assaulted experience was interviewed and using content analysis to approach. At first, the phenomena and the context of the experience were described, including the process recording of the assaulted incidents, her emotion and recognition, and the interrelated context of her grow-up environment, individually personal aspect, the patient case, and the development of the assaulted experience. The themes and meanings of the assaulted experience were categorized, including (1) emotional burden of caring stress: counter-transference toward the patient case, (2) struggle between the forward and backward: 'Professional role? Personal safety?', (3) emotion expression after the incidence: a need to manage emotion by herself, and (4) her assumption toward patient's intention of the assault: using the viewpoint of interpersonal interaction. Then, the interpretation under the phenomena of the assaulted experience could imply the meanings in depth, including three dimensions of the symbolic interaction, the emotion and judgment, and the learning role and hierarchy. Through the analysis and reflection of this sample experience, to look forward the results providing a reference for the related area of teachers to instruct and counsel students, or in the continuous education for the clinical new staff.