2010年9月

臺灣安寧療護團隊成員的工作壓力與其調適歷程
The Adjustment Process for Taiwanese Hospice Care Team Members

研究論文 Research Article

施勝烽, 龍紀萱, 何建德
Sheng-feng Shih, Chi-hsuan Lung, Jonathan C. Ho

303-352

目標：本研究主要探討安寧療護團隊與安寧療護工作之間的關聯性。方法：本研究採用質性研究，針對臺灣設有安寧病房之醫院且團隊成員參與安寧療護至少半年以上者，採取「立意取樣」(purposive sampling)的方式，挑選出五家醫院進行焦點團體訪談，共計40人，並將訪談後之逐字稿，依訪談大綱所列類別進行意義資料編碼。結果：團隊成員因應壓力之方式會隨著個人的成長學習和所處情境的不同，而隨時自我調整。研究發現：面對病患的死亡與未知的恐懼、病患的身心靈需求與情緒變化、家屬的心理支持與情緒處理等，在無意間都會增加安寧療護團隊成員的壓力困境。因此，團隊成員在面對壓力困境與調適方法為後盾之下，透過修復自我的價值觀與經驗複製的分享，來協助家囑適應與渡過哀傷期。結論：團隊成員應先行自我檢視面對病人死亡的悲傷情緒、勝任悲傷輔導的能力與限制，以及面臨不確定與突發狀況的容忍度，方能達成增進事前準備以減輕壓力負荷的較佳調適狀態：本研究整理出團隊成員工作調適之關鍵，並釐清團隊成員面臨工作壓力與調適之要務，統稱為「安寧四重奏」(quartets of hospice care),包括：自我覺察、自我調整、經驗轉換與知識分享。最後，團隊成員並非僅是讓病患得以善終，而是還必須著重改善照護品質，透過臨床實務的活用與敎育訓練，幫助病患及家屬在照護期間取得一個平衡點。

Objectives: The relationship between practitioners and their work on hospice care teams was the main concern of this study. Methods: This study used a qualitative research method. We chose five hospitals (5 groups, n=40) for focus group interviews among Taiwan hospitals by purposive sampling, selecting among those which had instituted palliative care wards and had practitioners with hospice care experience of more than half a year. We edited transcripts of interviews and coded these experiential data into comprehensive text sections based on categories of the interview outline. Results: Practitioners continuously adjusted themselves to care assignments on duty, and the way they would adopt while dealing with stress is dependent on growth experience and workplace environments. The study found that practitioners would unconsciously get stuck in more stress derived from patient's predictable death, unknown fears, body-mind-spirit needs and emotional fluctuations and even for providing mental and emotional support to patient's families affected by the coming death of loved ones Therefore, practitioners often need to adjust their own life values and replicate the clinical experience in order to share it with associated workers and need to help patient's families cope with overwhelming grief. Conclusions: In order to decrease the burden of hospice care, practitioners should actually rea1ize their true emotions arising from patient's death, their competence in as-sisting patients and their families through sadness, and their tolerance of uncertainty and emergencies while on duty. This study summarized the key to practitioners' adjustments to hospice care and clarified the actions practitioners would take, called “quartets of hospice care”, including self-consciousness, self-modulation, translation of care experience and sharing of knowledge. Finally, practitioners should concentrate on improving the qua1ity of hospice care and patient's good death through clinical experience, education and training in order to help patients and their families strike a balance during the periods of hospice care.

安寧療護團隊, 調適歷程, 質性研究, 焦點團體訪談
hospice care team, adjustment process, qualitative research , focus group interviews

社會學
Sociology

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