探討護理學生臨床實習受新冠肺炎衝擊時的心理感受與因應經驗

Exploring Nursing Students’ Feelings about and Experiences with Clinical Practicums during the COVID-19 Pandemic

研究目的：由於疫情持續增溫之際，對已排定需前往醫療院所學習的學生們，其心理衝擊經驗，迄今所知有限。本文研究目的為探討護理學生臨床實習受新冠肺炎衝擊時，於疫情初期其心理感受與因應經驗，同時也說明疫情期間的替代性實習方案之規劃情形。研究方法：採取質性文本分析與訪談法，運用生態系統模式檢視取自社群媒體的文稿或素材，並以滾雪球抽樣進行質性深度訪談，透過二位受疫情而取消原定實務單位實習者，獲得不同管道的資料，並藉由軟體 NVIVO 8將蒐集的資料，加以彙整並萃取分析相關的主題。研究結果：研究對象於疫情持續升溫時所面對的實習心理感受主要源自微系統：因為設備不足，所導致的心理情緒的焦慮不安、憤怒、無助和無望的情緒感受，形成五個次子題；中系統：護生於疫情直接參與的兩個（含）以上微系統的互動連結，產生四個次子題；大系統：為個體環境的最外層，其包含社會中廣泛的意識形態、文化與次文化，產生四個次子題；時間系統：持續心理動態的平衡發展。最後，於文中也呈現替代性實習方案之規劃結果。研究結論：護生實習期間的心理壓力源自生態各系統的相互作用之結果，故疫情的心理健康維持恆定，也亟需從各系統運作與協調，方能產生最佳的因應調整；且替代性返校實習方案取得課程與實習實踐並重，也可供未來教育政策制定的參考。

Purpose: As the COVID-19 pandemic continues, information about its psychological impact on students interning at medical institutes is limited. We investigated the experiences and perceptions of nursing students in Taiwan working in clinical practicums during the first 5 months of the epidemic. We aimed to provide a basis for and examples of the planning of alternative internship programs during a pandemic. Methods: We applied qualitative text analysis and interview methods, and used the ecosystem model to analyze manuscripts and materials from social media. We conducted qualitative in-depth interviews using snowball sampling, and also obtained data from different sources through 2 participants whose original practicums were cancelled due to the epidemic. Data sorting and content analyses were carried out using NVIVO 8. Results: We analyzed 4 dimensions: microsystem, mesosystem, exosystem, and the chronosystem. Stress in the internship was mainly due to the effects in the microsystem. We identified 5 themes at this level: insufficient equipment, psychological and emotional worry, anxiety, anger, helplessness and feelings of hopelessness. A mesosystem occurs when participants are directly involved and interactive with two or more micro-systems. We identified 4 mesosystems. We identified 4 exosystems that represent the outer layer of the individual’s environment and contain a wide range of ideologies, cultures, and societal subcultures. The effect of the chronosystem was the balanced development of continuous psychological dynamics. Conclusion: Psychological pressure on nursing students during an internship is the result of the interaction of various ecological systems. Mental health challenges are constant during a pandemic so the coordination of various systems is urgently needed to allow for the best adjustment. Based on the analysis, we identified a plan for implementation of alternative internship programs and provided 2 examples. An alternative back-to-school internship program can achieve curriculum development and provide internship experience for nursing students. It can also be used for future formulation of education policies encompassing systems.