安寧護理人員生涯選擇歷程敘事研究

Abstract

本文主要呈現安寧護理人員的生涯選擇歷程。目的在於探討生命主題與其發展脈絡對於生涯選擇歷程的影響、安寧護理人員生涯選擇與繼續留任的影響因素，以及在生涯選擇歷程中的社會文化脈絡。研究者採用敘事研究法，以滾雪球的立意取樣，邀請三位安寧護理人員接受訪談，並依據Lieblich et al.(1998) 「整體－內容」與「類別－內容」分析模式進行資料分析與整理。 研究發現如下：一、從「愈挫愈勇的向陽成長」、「破繭而出的蛻變」、「找尋自己的存在感」三位安寧護理人員的生命主題中發現，早期生命經驗為生命主題的形成與發展奠定基礎，且生命主題與其生涯選擇歷程接軌，而重要事件或重要他人突顯了生命主題的轉折。二、影響生涯選擇歷程的因素為：(1)進入護理養成教育乃是經過妥協後的生涯選擇；(2)護理工作的穩定性為護理生涯選擇提供基礎；(3)護理教育養成臨終照護的正向態度，有助於安寧的生涯選擇。三、影響繼續留任的因素為：(1)工作環境中的人際支持與自身的準備有利於安寧新手的留任；(2)安寧護理人員的留任歷經「建構、解構與再建構」的調適歷程；(3)工作理念的建立有助於留任。(4)護理楷模乃是影響護理人員選擇與留任安寧療護的關鍵人物；(5)支持系統的網絡愈趨健全愈有利於留任；(6)照護中所獲得的滿足感激勵了護理人員繼續留任安寧；(7)三班制的輪值與工作上的角色定位影響了資深安寧護理人員的生涯規劃。四、影響生涯選擇歷程的社會文化脈絡為：(1)根植於性別差異的職業期待矮化了護理的專業形象；(2)文憑觀念左右了護理人員的生涯選擇；(3)對安寧療護的抗拒源自對死亡的恐懼。 結論：安寧療護的工作屬性與照護理念讓安寧護理人員肯定了護理的生涯選擇。安寧療護促進了護理人員自我概念的統整，從有限性的接納中學習欣賞生命價值的獨特性，安寧療護的平等性理念也淡化了社會文化脈絡所著重的差異性。 最後，研究者提出本研究的限制與建議，以及研究者的反思。The purpose of this study was to uncover (1) the life themes obtained from hospice nurses’ stories and how they influenced their career choice process, (2) the factors affecting these nurses in making decisions in their career choice process, (3) the factors sustaining them in the hospice field, and (4) how the society and culture interfered in the hospice nurse career choice process. A narrative research format was employed in this study with three female hospice nurses recruited by a snowball sampling. Each participant was interviewed twice for three hours in total. Afterwards, the interview data were analyzed with holistic-content and category-content modes according to Lieblich et al. (1998). The various findings in this study were as follows: 1. The life themes of the three participants in this study were “looking on the bright sides of life”, ” making a breakthrough”, and ”seeking the reason for my existence”. Further, the ways in which hospice nurses’ life themes influenced their career choice process were as follows: (1) Childhood experiences acted as a key to the life theme. (2) Life themes played a crucial role in the hospice nurses’ career choice process. (3) Key events and significant others highlighted the life theme. 2. Factors affecting the hospice nurses in making decisions in their career choice process were: (1) Their decision to apply for a nursing curriculum was a compromised decision. (2) Nurses entered nursing because they wanted to have a stable career. (3) A positive attitude cultivated towards hospice nursing during the nursing education contributed to the nurses’ decision of working in hospice. 3. Factors sustaining nurses in hospice were: (1) Interpersonal support in their work and nurses’ self-preparation for nursing helped new nurses to sustain in hospice nursing. (2) Nurses had to cope with the frustrations of the profession by experiencing a period of “construction–deconstruction–reconstruction” to sustain in hospice. (3) It was helpful for nurses to remain in hospice nursing when they created their own professional concepts of nursing. (4) Encouragement by role models in nursing education could lead to nurses’ entering and staying in the hospice profession. (5) A sound supporting system helped keep nurses in hospice. (6) Satisfaction acquired in work inspired nurses to stay in hospice. (7) Experienced hospice nurses’ career arrangements were altered due to the shift and expectation of their own work. 4. The answers to the question of how the society and culture interfered in the hospice nurses’ career choice process were: (1) The image of the nursing profession has been neglected based on sexual discrimination. (2) The concepts of pursuing a diploma greatly influenced the nurses’ career choice process. (3) The public resisted hospice care due to their fear toward death. 5. Based on the findings of this study, the following conclusions could be drawn : (1) After working in hospice, nurses learned to appreciate themselves and their profession of nursing. (2) The concept of hospice helped nurses to sustain in hospice nursing. For example, to admit the personal and medical limitations in hospice nursing, is to accept one’s uniqueness. (3) Differences to which society and culture pay attention are limited in hospice care where everyone is equally treated. Finally, practical suggestions were proposed based on the findings of the study.