一窺白色巨塔：活動理論視角下台灣護理人員醫院職場英語使用探究

Abstract

因應全球化趨勢、頻繁國際交流以及實證護理實踐的應用等因素，儘管英語在台灣主要作為第二外語，仍舊在台灣醫療溝通中扮演著關鍵角色，這也刻畫出台灣護理師在醫院職場需要使用英語的重要性。過去探討護理專業英文文獻多著重在以英文作為母語的溝通情境使用，極少文獻探討英語作為第二外語的護理職場英文使用，另外台灣的護理專業英文相關文獻也多顯過時。本研究以Engeström的活動理論為研究框架，從社會文化角度來探討台灣護士在醫院中的專業語言使用，並藉由活動理論的六個元素（主體、目標、社群、規則、角色以及工具）來分析台灣護理師在護理職場英語使用的目標, 輔助工具媒介及系統性矛盾。研究參與對象包含十位護理專業人員，三位醫生及三位外籍病患，透過與這三組重要關係人的半結構化及深度訪談，以捕捉全面及多樣化的觀點。研究結果顯示，台灣護理師需要視不同的目的及溝通對象分別使用專業英文(English for Specific Purposes)及一般英文(English for General Purposes)。在追求既定語言目標的過程中，護理師主要依賴他們的語言能力作為臨床英語使用的主要媒介工具。然而當受限於語言能力時，護理師必須借助非語言的輔助工具，例如肢體語言、Google翻譯、圖片和實物，來彌補其不足。研究結果也顯示社群規則、醫院社群和角色分工等社會文化層面，對台灣護士的專業英語使用產生影響。透過活動理論視角，本文也分析各個系統元素之間的衝突而產生矛盾，包含: 護理人員有限的詞彙、過度強調去語境化的醫用術語、過度依賴線上翻譯、臨床英語的衝突使用以及護理社群中的階層權力不對稱等，另外醫生和護士在專業英語養成過程的明顯歧異也造成兩個個系統之間的矛盾。本文透過活動理論重新詮釋護理專業英文在醫院職場應用，對未來的護理專業英文教育實踐，及對未來專業英文相關研究具有參考價值。This study argues for the sociocultural and sociopolitical perspectives to examine Taiwanese nurses’ professional language use in hospitals. The main rationales for the study are twofold: first, to address the scarcity of investigation of more context-based and socially-situated language use in ESP (English for Specific Purposes) settings; second, to fill the gaps in English for Nursing Purposes (ENP) literature that has been limited to English-speaking contexts. Informed by Engeström’s activity theory, the study aims to explore the activity of Taiwanese nurses’ professional language use in terms of their intended goals, mediated strategies, and challenges within nursing contexts. These three aspects are manifested as the object, mediated tools, and inherent contradictions within the activity system, and form the three research questions that guide the current study.Echoing the multi-voiced structure of the activity theory, the study employed semi-structured interviews with three groups of significant stakeholders, namely nurses, doctors, and foreign patients who use English as a lingua franca, to capture diverse perspectives. The study involved a total of sixteen participants, including ten nurses of different levels of nursing experience and clinical roles as the primary participants, and three doctors and three foreign patients as secondary participants.Regarding the object of Taiwanese nurses’ language use, the findings showed that nurses were required to navigate diverse workplace genres to progress toward various goals of using the English language effectively in clinical settings. The appropriateness of genre depends on factors such as communication purpose and intended audience. For specialist communication, nurses need to understand both standard medical English and dialectal variations in verbal communication, while also requiring general English proficiency to translate medical language for non-specialists such as foreign patients, their families, and caregivers. Additionally, for nurses aspiring to advance their professionalism and career, academic language proficiency is also necessary to read domain-specific nursing journals for staying updated with nursing practice and implementing evidence-based nursing.In their pursuit of the intended language goals, nurses relied on their prior knowledge of language skills as the main mediating tool for their clinical English use. Nevertheless, the study revealed that nurses also resorted to non-linguistic artifacts to compensate for language limitations, such as body language, facial expressions, machine translation, pictures, and real objects. The sociocultural aspects of mediation, including rules, community, and division of labor, also exerted influence on Taiwanese nurses’ professional English language use. This study also used an activity system analysis to examine the contradictions that arose in the activity of Taiwanese nurses’ English use for their nursing practices. Several contradictions between the object and various components of the activity system were identified, such as nurses’ limited lexical knowledge (object vs. tools), overemphasis on decontextualized terminology (object vs. tools), overreliance on machine translation (object vs. tools), conflicting use of clinical English (object vs. rules), and hierarchical power asymmetry in the nursing community (object vs. division of labor). A contradiction was also found between doctors’ and nurses’ activity systems, emerging from a significant divergence in the professional training between doctors and nurses. Drawing on the findings, implications for research and pedagogy are discussed in this study.