中部某醫學中心之護理人員的臨終兒童照護經驗

Abstract

本研究的目的是瞭解護理人員的臨終兒童照護經驗，此研究以質性研究之低結構性訪談指引，訪談中部某醫學中心之兒科病房與兒科加護病房之護理人員共16位，訪談時間介於50至100分鐘，平均為61分鐘，將訪談內容撰寫成描述性資料，運用內容分析法將描述性資料作歸類分析共得1218個行為單元。將行為單元作量化分析，在臨終兒童照護經驗內涵方面共有四類，分別是：令人惋惜的臨終照護佔49.84﹪、值得欣慰的臨終照護佔37.44﹪、懇切的臨床實務建言佔8.46﹪、企盼中的臨床照護藍圖佔2.27﹪。令人惋惜的臨終照護又分為五類，分別是：社會民情的牽絆、對醫療政策的無奈、組織團隊無法同心、病童與家屬的心結及醫療照護活動的傷害。值得欣慰的臨終照護又分為六類，分別是：舒適的身體照護、窩心的情緒支持、深植人心的靈性照護、實用的照護指導、圓融的情境因素、溫暖的追蹤照護等因素。懇切的臨床實務建言分為三類，分別是：涵括民意的醫療、專業照護的充電、醫療團隊研討營。企盼中的臨床照護藍圖分為三類，分別是：照護者的醒思、團隊合作一致、兒科病房勝任臨終照護。 本研究資料提供護理教育、行政、研究、臨床實務參考，並促進兒科護理人員之臨終照護能力。

The purpose of this study was to investigate nurses’ experiences of caring for terminally ill children at a medical center in central Taiwan. The researcher conducted a descriptive qualitative study through semi-structured interviews. Sixteen nurses who fit the inclusion criteria and worked in either the pediatric ward or the pediatric intensive care unit were interviewed. Each interview lasted for 50-100 minutes (average: 61 minutes). Tape-recorded transcribed into narrative data. After analyzing the data using a content analysis approach, the researcher derived 1218 behavior units. Using quantitative analysis, the researcher classified these behavior units into 4 categories in terms of caring for terminally ill children, including inadequate nursing care (49.84%); adequate nursing care (37.44%); care strategies (8.46%) and future plans (2.27%). There were 5 types of inadequate nursing care, including public opinion, medical policy, teamwork, sick children and their families, and medical treatment and nursing care. There were 6 types of adequate nursing care, including physiological care, motion support, spiritual care, hygiene education, situation factors, and follow-up care. In addition, there were 3 types of strategies, including medical policy, educational training, and meetings of doctors and nurses. Furthermore, there were 3 types of future plans, including professional assessment, team cooperation, and competent terminal care provided by pediatric wards. It is hoped that the results of this study will not only benefit nursing education, administration, research and clinical practice, but also encourage pediatric nurses who provide terminal care.