接受正念自我疼惜團體對照護末期病人的護理人員其情緒調節經驗之影響—以質性研究探討

Abstract

【背景】提供末期照護的護理人員，經常面對病人的死亡與痛苦，而可能引發自身心理困擾、情緒耗弱與倦怠。國外對於末期照護醫療人員的正念疼惜介入，成效以量性研究方法測量，發現此介入能改善其負面情緒。目前較缺乏以質性研究法探討照護末期病人的護理人員接受正念自我疼惜團體經驗，以及介入後其情緒調節影響之過程脈絡。 【目的】探討提供末期病人照護的護理人員之心理困擾與因應，以及接受正念自我疼惜團體後如何影響其情緒調節的歷程經驗。 【方法】本研究為前瞻性，單組前後測類實驗研究設計，採用質性詮釋現象學研究法以瞭解正念自我疼惜在情緒調節經驗的影響脈絡。於某醫學中心以立意取樣招募具有照護末期病人經驗的護理人員，且對正念自我疼惜團體有參與意願並同意接受訪談者為研究對象。第一階段以半結構式訪談指引，進行一對一訪談關於照護末期病人心理困擾與因應，第二階段於接受為期四週之正念自我疼惜團體治療後，採一對一半結構式訪談，收集研究對象參與團體後的正念自我疼惜個人主觀歷程經驗，並以主題分析方法進行資料分析。 【研究結果】收案人數為11人，護理人員照護末期病人的心理困擾包含來自病人家屬（末期病人的受苦、失去與病人或家屬的連結、病人病況急劇惡化之死亡的衝擊、無法善終、結束人的生命）、自我照顧困境（對自己缺乏情緒關照以及忽略自我的需求）、工作職場的壓力（團隊溝通牴觸），以及負面的調適包含自我批判、逃避與壓抑。接受團體介入後，護理人員的經驗可分為正念歷程與正念合併疼惜歷程。在正念的經驗歷程，護理人員於工作或日常壓力刺激下進行正念覺察，經過注意力調整、去中心化、重新評價、達到情緒調節。護理人員提到增加對生活事物的覺察，進而品味生活，產生正向的情緒、感知的敏銳、感受生命、如同開啟新世界。疼惜歷程，從護理人員對情緒困擾給予自己覺察，感受自己的感受與痛苦，給予自己疼惜，包含自我疼惜的投入，同理、或不批判，或是直接透過疼惜行動，如：自我傾聽對話、疼惜的聲音、疼惜撫觸、意象，進而經過去中心化、重新評價而對情緒有所調節，帶來身心舒適、與自己和解、更疼惜自己、自我肯定、人際溝通的改善，以及增進對自己的覺察、看到自己的感受與需求。有護理人員在面對病人受苦的自身難受時，透過放手進而疼惜他人，給予祝福，並對自己帶來正向影響。 【結論】本研究發現正念自我疼惜有助於護理人員藉由正念歷程或同時合併自我疼惜投入及行動達到情緒調節，改善個人身心舒適、工作狀態和人際溝通。

【Background】 Nurses who provided care for terminally ill patients are often encountered in facing patients’ death and suffering, which may result in their psychological distress, emotional exhaustion, and fatigue. The previous studies with using quantitative method found that the mindful self-compassion interventions effectively alleviated negative emotions among end-of-life healthcare providers. However, there is a lack of study adopting qualitative research to explore the experiences of nurses participating in a mindful self-compassion group, and the contextual process of the impacts of interventions on their emotion regulation. 【Objectives】This research aimed to explore the psychological distress and coping strategies among nurses who provided care for terminally ill patients, and their experiences of the changes of emotion regulation after participating in a mindful self-compassion group. 【Methods】This research adopted a prospective one-group pretest and posttest quasi-experimental study. Qualitative interpretative phenomenology method was employed to explore the contextual impacts of mindful self-compassion group on the experiences of nurses’ emotion regulation. Participants were purposively recruited from a medical center when they met the criteria of the nurses caring for terminally ill patients, willing to be interviewed and to participate in mindfulness compassion group. In the pre-test phase, semi-structured interviews were conducted to explore the psychological distress and coping strategies associated with the experience of caring for terminally ill patients. In the post-test phase, after participating in the four-week with two-hour weekly mindful self-compassion group, they would receive the individual interview to collect their experiences of mindful self-compassion group therapy. Thematic analysis was used to analyze the collected data. 【Results】A total of 11 participants participated in the study. The nurses’ psychological distress was associated with different factors: patients and their family members (enourtering in the patients’ suffering, loss of connections with patients or family members, impact of patients’ death due to the rapid deterioration of illness progression, patients’ not having a “good death", and implementing the termination of the patient’s life), the difficulties of nurses’ self-care (lack of taking care of own emotions and neglecting own needs), and workplace stress (conflicts of communication with medical team). Negative coping strategies included self-criticism, avoiding, and suppressing emotions. After the group intervention, the nurses’ experiences of emotion regulation process were analyzed into two processes: “mindfulness process” and “mindful self-compassion process”. In mindfulness process, when nurses experienced stress from work or daily life stress, they started with practicing mindfulness awareness, and then engaging in attention regulation, decentering from stress situation, and reappraisal of stress, which led to positive emotion regulation. The positive outcomes were observed including: increasing awareness of daily life events, leading to a greater savoring of life, positive emotions, sensitivity to various experiences, a deeper connection with life, and a sense of discovering a new world. For the mindful self-compassion process, after nurses were aware of their emotional distress, recognized their feelings and suffering, they practiced self-compassion towards themselves including engaging in self-compassion, being empathy toward self , not criticing self, and taking compassionate actions such as listening to self, using self-compassionate voice, soothing touch, and compassionate imagery. Compassionate engagement and action helped nurses to have positive emotion regulation from decentering from stress situation and having reappraisal of stress. The positive outcomes were observed including physical and mental comfort, self-reconciliation, more self-compassion, self-affirmation, enhanced interpersonal communication, increased self-awareness, and recognitions of their feelings and own needs. Some nurses found that although they felt difficulty when they faced patients’ suffering, they were able to let go their struggle, be compassionated toward others, and offer their blessings for patients and family members. 【Conclusion】The mindful self-compassion group could be helpful for nurses to achieve the positive emotion regulation, nurses’ body-mind well-being, working status and interpersonal communication.