非安寧病房護理人員照護臨終病童之困難經驗

Experiences of Pediatric Nurses in Caring for Terminally ill Children on Non-palliative Care Units

照護臨終病童的過程，護理人員的角色及功能不容輕視，因為醫療團隊中以護理人員與病童的接觸最密切。本研究採質性研究法，運用半結構式訪談以深入瞭解非安寧病房護理人員照護臨終病童所面臨的困難經驗，以立意取樣方式募集15位在中部某醫學中心兒科病房及兒科加護病房工作的護理人員，會談時間長約50到100分鐘之間，所有訪談均錄音及轉寫成逐字稿。主題分析法分析訪談資料，研究結果的六大主題包括：忽略病童的自主性及參與性、欠缺心理支持的技巧、缺乏共識的缺憾、無法提供有效疼痛控制的無力感、感受照護時間的壓迫感與需要被關照的情緒。希望藉由瞭解非安寧病房護理人員照護臨終病童面臨的困難，進而思考如何提供更完善的臨終病童照護品質。本研究建議經由在職教育加強專業人員有關照護臨終病童及其家屬的知識及技巧，進而滿足病童與其家屬的需求，達到最佳的臨床照護。

Nurses have a very close professional relationship with terminally ill children and their families. This study applied qualitative research in using semi-structured interviews to better understand the difficult experiences of nurses who took care of dying children on non-palliative care units. A purposeful sampling was used to recruit 15 nurses who worked on the pediatric ward and pediatric intensive care unit in the Medical Center of Central Taiwan. Interviews lasted 50-100 minutes and all interviews were tape-recorded and transcribed verbatim. Thematic analysis was applied. Six areas of concern emerged: 1.ignoring dying children’s autonomy and willingness to cooperate; 2. lacking skills for emotional support; 3. lacking consensus on treatment goals; 4.feeling powerlessness about effective pain management; 5.feeling time pressure; 6. feeling emotion-related stress. The quality of nursing care could be improved through an understanding of the challenges and difficulties that nurses encounter when caring for dying children. We suggest in-service training in knowledge and skills for caring for dying children, especially skills in communicating s with children and their families. Improving these skills will provide health professionals with the ability to understand the needs of the children and their families, satisfy those needs, and achieve optimal practice standards.