進階搜尋


   電子論文尚未授權公開,紙本請查館藏目錄
(※如查詢不到或館藏狀況顯示「閉架不公開」,表示該本論文不在書庫,無法取用。)
系統識別號 U0026-0808201913042300
論文名稱(中文) 安寧緩和醫療護理師工作壓力與因應方式之探討
論文名稱(英文) The Qualitative Study of Job Stress and Coping Strategies among Nurses in Hospice and Palliative Care.
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 107
學期 2
出版年 108
研究生(中文) 陳蕙琦
研究生(英文) Hui-Chi Chen
電子信箱 vicky6374@hotmail.com
學號 TC6064013
學位類別 碩士
語文別 中文
論文頁數 96頁
口試委員 指導教授-翁慧卿
召集委員-李雅慧
口試委員-范聖育
中文關鍵字 安寧緩和醫療  護理師  工作壓力  因應 
英文關鍵字 Hospice and Palliative Care  Nurse  Working Stress  Coping 
學科別分類
中文摘要 背景與目的:安寧緩和醫療的目標是幫助與陪伴病人與家屬度過身心靈社會等各樣痛苦,令病人圓滿善終使家屬與病人無憾。但過程中安寧護理師常會面臨病人病況轉變與過世、病人及家屬心理/社會層面的反應、團隊內外溝通協調等方面的壓力源。本研究旨在描繪安寧護理師的臨床工作壓力與壓力調適方法。希望藉此協助安寧護理師及時感知壓力與因應,進而提升工作品質及服務效能。
方法:以質性研究深度訪談法邀請同意接受訪談之現職2年以上之安寧護理師計12位。
結果:依據訪談結果分析安寧緩和醫療護理師工作壓力有二個主題,六個次主題,分別為主題一內在因素:1.缺乏安寧照護的經驗、2.找不到意義與價值;主題二外在因素:1.與病人家屬照護認知不同、2.團隊內效能不佳、3.不同科別專業認知落差、4.缺乏組織後援。壓力因應有三個主題,九個次主題,分別為主題一情緒性支持:1.病人及家屬回饋、2.情緒發洩的多元管道、3.生活與工作平衡;主題二工具性支持:1.前輩帶領與同儕協助、2.多元的對話管道、3.組織人力資源管理、4.增加對病人照護問題的解決能力;主題三反思與轉化:1.心態調整與調適、2.自我成長與改變。
結論:受訪者陳述主要與其工作環境相關的壓力,具體而言,缺乏安寧照顧經驗、找不到工作的意義與價值、組織與團隊效能疲弱、與家屬或不同科別間認知落差是安寧護理師們最常遇到的問題。訪談中發現安寧護理師面對工作壓力每個人都有一套自己調節的方法,了解個人的限制及周邊可利用的資源,也會決定自己可以採用調適壓力的方式。
討論:安寧護理師面對工作壓力如以消極態度因應時,過程中的多重壓力和情緒將會一再被遮蔽,這樣不僅會增加壓力,也可能無法開啟自我反思之路;但如能積極面對自身感受及限制,透過反思、學習與調整的過程而達到自我成長,促使個人專業知能的提升,體悟到健康、親情、時間的可貴及生命的意義與價值。再則,人力是組織的資本,組織支持是職場工作重要的一環,除了既定安排的教育訓練外,如何增進員工的專業知能外更保有員工的身心健康,提供一個友善的工作環境是重要的。
英文摘要 The goal of hospice and palliative care is to help and accompany patients and their families. That will let patients have good death, then family members and patients have no regrets. In the process, the nurses will face a lot of pressure. In particular, the lack of experience in hospice care, can't find meaning and value in their jobs, the poor performance of organization and team, and the gap in family members or different medical departments are the most common problems faced by nurses. We found that when the nurses face work stress, everyone has a self-regulating method by themselves. Knowing the limitations of individuals and the resources available around them will also determine how they can adapt to stress. The study suggests that if nurses can face their own feelings and limitations actively. Through the process of reflection, learning and adjustment, they will grow up by themselves. At the same time, it will promote the improvement of personal professional knowledge, and let them realize the value of health, affection, time and life. Furthermore, human resources are the capital of the organization. Organizational support is an important part of the work. In addition to arranging educational training, it is important to enhance the professional knowledge, to maintain the physical and mental health of employees and to provide a friendly working environment.
論文目次 考試合格證明
i
摘要
ii
誌謝
v
目錄
vi
圖目錄
vii
表目錄
vii

1 章 第一章 緒論 1
第一節
研究背景與動機 2
第二節
研究目的與研究問題 8
第三節
名詞解釋 9

2 章 第二章 文獻探討 12
第一節
安寧療護的發展與理念 12
第二節
安寧緩和醫療工作壓力對安寧護理師工作的影響 18
第三節
安寧護理師工作壓力因應方法 26
第四節
小結 30

3 章 第三章 研究設計與實施 31
第一節
研究設計與架構 31
第二節
研究方法 34
第三節
研究對象 36
第四節
研究工具 44
第五節
資料分析 45
第六節
研究品質 46
第七節
研究倫理 48

4 章 第四章 研究結果 49
第一節
安寧緩和醫療護理師 的工作壓力 49
第二節
安寧緩和醫療護理師工作壓力因應方式 58

5 章 第五章 結論與討論 67
第一節
研究結論 67
第二節
綜合討論 71
第三節
研究限制 79
第四節
未來研究建議 80
參考文獻
84
附錄一
人體研究倫理審查會同 意計畫修正證明書 89
附錄二
同意人體研究證明書 90
附錄三
研究說明及同意書 92
附錄四
訪談大綱 95
參考文獻 參考文獻
內政部統計處. (2017). 106年第38週內政統計通報. 內政統計通報, 1-5. Retrieved from https://www.moi.gov.tw/files/news_file/week10638.pdf
內政部統計處. (2018). 107年第15週內政統計通報. 內政統計通報, 1-4. Retrieved from https://www.moi.gov.tw/files/news_file/107%E5%B9%B4%E7%AC%AC15%E9%80%B1%E5%85%A7%E6%94%BF%E7%B5%B1%E8%A8%88%E9%80%9A%E5%A0%B1_%E9%AB%98%E9%BD%A1%E7%A4%BE%E6%9C%83.pdf
吳英璋. (1994). 從健康、壓力與因應談全方位的身心均衡. 學生輔導通訊, 34, 16-29.
李榕峻. (2006). 安寧療護醫療團隊工作壓力與壓力調適之研究. 慈濟大學社會工作研究所. 碩士論文. 連結.
杜異珍. (1997). 台灣中部地區護理人員對照顧瀕死病患之知識, 態度及其影響因素之探討. 榮總護理, 14(1), 1-10.
紐文英. (2012). 質性研究方法與論文寫作. 臺北市: 雙葉書廊.
張春興. (1991). 張氏心理學辭典 (2 ed.). 臺北: 東華書局.
陳宥蓁, 徐明儀, 尹裕君, 林麗英, & 張淑真. (2012). 醫院護理管理者工作壓力源與工作壓力因應策略之研究. 護理暨健康照護研究, 8(2), 94-105.
劉雄蘭. (1997). 專業人員之培養與耗竭. 安寧療護雜誌(3), 43-49.
歐美, 劉盈君, 黃靖淇, 招雁翔, 李作英, & 蔣欣欣. (2013). 護理人員在護持與承擔中的轉化-以臨終照護反思團體為例. [The Transformation of Nurses in Holding and Containing: A Reflective Group for End-of-Life Care]. 60(3), 31-39. doi:10.6224/jn.60.3.31
蔡佩真. (2011). 安寧療護工作壓力, 耗竭與人力維護. 社區發展季刊, 136, 163-179.
蔡麗雲, & 李英芬. (2003). 安寧緩和護理人員的壓力源、壓力反應與調適策略之探討. [A Study of Hospice Nurses' Resource of Stress, Response and Coping Strategy]. 安寧療護雜誌, 8(2), 143-160. doi:10.6537/tjhpc.2003.8(2).3
衛生福利部. (2017). 衛生福利性別統計圖像(106 年 6 月彙編). Retrieved from https://www.mohw.gov.tw/dl-37258-1f0f4a7f-d084-4d64-9433-890689650b45.html
蕭仁釗. (1998). 安寧療護專業人員之壓力問題. 安寧療護雜誌(10), 21-26.
賴維淑, 楊婉萍, & 趙可式. (2009). 安寧療護的教育-護生、一般護理人員及專科護理師. [Hospice Palliative Care Education for Nursing Students, Nurses, and Advanced Nursing Practitioners]. 護理雜誌, 56(1), 11-16. doi:10.6224/jn.56.1.11
鍾進益. (2007). 國民小學主任工作壓力與學校效能關係之研究-以彰雲地區為例. (Master). 國立中正大學, 嘉義.
顏素卿, & 李玉嬋. (2015). 加護病房護理人員被剝奪的悲傷經驗探究. [The Experiences of Disenfranchised Grief in Intensive Care Nurses]. 應用心理研究(62), 59-111. doi:10.3966/156092512015060062003
Ablett, J. R., & Jones, R. (2007). Resilience and well‐being in palliative care staff: a qualitative study of hospice nurses' experience of work. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 16(8), 733-740.
Aspinwall, L. G., & Taylor, S. E. (1997). A stitch in time: Self-regulation and proactive coping. Psychological bulletin, 121(3), 417.
Beehr, T. A., & Newman, J. E. (1978). Job stress, employee health, and organizational effectiveness: A facet analysis, model, and literature review 1. Personnel Psychology, 31(4), 665-699.
Blomberg, K., & Sahlberg-Blom, E. (2007). Closeness and distance: a way of handling difficult situations in daily care. Journal of Clinical Nursing, 16(2), 244-254. doi:10.1111/j.1365-2702.2005.01503.x
Bogdan, R., & Biklen, S. (2007). Qualitative Research for Education (5 ed.). Boston: Pearson Education.
Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in intensive care nurses: a descriptive exploratory study. Nursing in critical care, 15(3), 129-140.
Burnard, P., Edwards, D., Bennett, K., Thaibah, H., Tothova, V., Baldacchino, D., . . . Mytevelli, J. (2008). A comparative, longitudinal study of stress in student nurses in five countries: Albania, Brunei, the Czech Republic, Malta and Wales. Nurse Education Today, 28(2), 134-145. doi:https://doi.org/10.1016/j.nedt.2007.04.002
Butler, M. R., & Felts, J. (2006). Tool kit for the staff mentor: Strategies for improving retention. The Journal of Continuing Education in Nursing, 37(5), 210-213.
Cai, Z. X., Li, K., & Zhang, X. C. (2008). Workplace stressors and coping strategies among Chinese psychiatric nurses. Perspectives in Psychiatric Care, 44(4), 223-231.
Cevik, B., & Kav, S. (2013). Attitudes and experiences of nurses toward death and caring for dying patients in Turkey. Cancer nursing, 36(6), E58-E65.
Chan, W. C. H., Fong, A., Wong, K. L. Y., Tse, D. M. W., Lau, K. S., & Chan, L. N. (2016). Impact of Death Work on Self: Existential and Emotional Challenges and Coping of Palliative Care Professionals. Health & Social Work, 41(1), 33-41. doi:10.1093/hsw/hlv077
Cooper, C. L., Dewe, P. J., & O'Driscoll, M. P. (2001). Organizational Stress: A Review and Critique of Theory, Research, and Applications. Thousand Oaks, CA: SAGE Publications.
Davidson, M., & Cooper, C. L. (1983). Stress and the woman manager: Robertson.
Dean, R. A. (1998). Occupational stress in hospice care: Causes and coping strategies. American Journal of Hospice and Palliative Medicine®, 15(3), 151-154. doi:10.1177/104990919801500309
Denton, F. T., & Spencer, B. G. (2010). Chronic Health Conditions: Changing Prevalence in an Aging Population and Some Implications for the Delivery of Health Care Services. Canadian Journal on Aging / La Revue canadienne du vieillissement, 29(1), 11-21. doi:10.1017/S0714980809990390
DiTullio, M., & MacDonald, D. (1999). The struggle for the soul of hospice: Stress, coping, and change among hospice workers. American Journal of Hospice and Palliative Medicine®, 16(5), 641-655.
Edmunds, M. (2010). Caring too much: compassion fatigue in nursing. Appl Nurs Res, 23(4), 191-197.
Ekedahl, M., & Wengström, Y. (2006). Nurses in cancer care—coping strategies when encountering existential issues. European Journal of Oncology Nursing, 10(2), 128-139. doi:https://doi.org/10.1016/j.ejon.2005.05.003
Fitch, M. I., Matyas, Y., & Robinette, M. (2006). Caring for the caregivers: Innovative program for oncology nurses. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie, 16(2), 110-115.
Fukumori, T., Miyazaki, A., Takaba, C., Taniguchi, S., & Asai, M. (2018). Cognitive reactions of nurses exposed to cancer patients' traumatic experiences: A qualitative study to identify triggers of the onset of compassion fatigue. Psycho - Oncology, 27(2), 620-625. doi:doi:10.1002/pon.4555
Gambles, M., Wilkinson, S., & Dissanayake, C. (2003). What are you like?: A personality profile of cancer and palliative care nurses in the United kingdom. Cancer Nursing, 26(2), 97-104.
Hawkins, A. C., Howard, R. A., & Oyebode, J. R. (2007). Stress and coping in hospice nursing staff. The impact of attachment styles. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 16(6), 563-572.
Hays, M. A., All, A. C., Mannahan, C., Cuaderes, E., & Wallace, D. (2006). Reported Stressors and Ways of Coping Utilized by Intensive Care Unit Nurses. Dimensions of Critical Care Nursing, 25(4), 185-193. Retrieved from https://journals.lww.com/dccnjournal/Fulltext/2006/07000/Reported_Stressors_and_Ways_of_Coping_Utilized_by.16.aspx
Hinds, P. S., Quargnenti, A. G., Hickey, S. S., & Mangum, G. H. (1994). A comparison of the stress--response sequence in new and experienced pediatric oncology nurses. Cancer Nursing, 17(1), 61-71.
Holland, J. M., & Neimeyer, R. A. (2005). Reducing the risk of burnout in end-of-life care settings: The role of daily spiritual experiences and training. Palliative & supportive care, 3(3), 173-181.
Hopkinson, J. B., Hallett, C. E., & Luker, K. A. (2005). Everyday death: how do nurses cope with caring for dying people in hospital? International Journal of Nursing Studies, 42(2), 125-133. doi:https://doi.org/10.1016/j.ijnurstu.2004.06.004
Hui, D., De La Cruz, M., Mori, M., Parsons, H. A., Kwon, J. H., Torres-Vigil, I., . . . Bruera, E. (2013). Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks. Supportive Care in Cancer, 21(3), 659-685. doi:10.1007/s00520-012-1564-y
Jansen, K., Ruths, S., Malterud, K., & Schaufel, M. A. (2016). The impact of existential vulnerability for nursing home doctors in end-of-life care: A focus group study. Patient Education and Counseling, 99(12), 2043-2048. doi:https://doi.org/10.1016/j.pec.2016.07.016
Kassin, S., Fein, S., & Markus, H. R. (2016). Social Psychology (10 Ed.). Boston: Cengage Learning.
Kavalieratos, D., Siconolfi, D. E., Steinhauser, K. E., Bull, J., Arnold, R. M., Swetz, K. M., & Kamal, A. H. (2017). “It Is Like Heart Failure. It Is Chronic … and It Will Kill You”: A Qualitative Analysis of Burnout Among Hospice and Palliative Care Clinicians. Journal of Pain and Symptom Management, 53(5), 901-910.e901. doi:https://doi.org/10.1016/j.jpainsymman.2016.12.337
Keidel, G. C. (2002). Burnout and compassion fatigue among hospice caregivers. American Journal of Hospice and Palliative Medicine®, 19(3), 200-205. doi:10.1177/104990910201900312
Kim, M., & Windsor, C. (2015). Resilience and Work-life Balance in First-line Nurse Manager. Asian Nursing Research, 9(1), 21-27. doi:https://doi.org/10.1016/j.anr.2014.09.003
Lange, M., Thom, B., & Kline, N. E. (2008). Assessing nurses' attitudes toward death and caring for dying patients in a comprehensive cancer center. Paper presented at the Oncology nursing forum.
LaRocco, J. M., House, J. S., & John R. P. French, Jr. (1980). Social Support, Occupational Stress, and Health. Journal of Health and Social Behavior, 21(3), 202-218. doi:10.2307/2136616
Laschinger, H. K. S., Finegan, J., & Wilk, P. (2009). New graduate burnout: The impact of professional practice environment, workplace civility, and empowerment. Nursing Economic$, 27(6), 377.
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer Publishing Company.
MedlinePlus Medical Encyclopedia. Hospice Care. In National Library of Medicine. (Ed.): National Institutes of Health.,.
Melvin, C. S. (2015). Historical review in understanding burnout, professional compassion fatigue, and secondary traumatic stress disorder from a hospice and palliative nursing perspective. Journal of Hospice & Palliative Nursing, 17(1), 66-72.
Monat, A., Lazarus, R. S., Reevy, G., & Duncan, D. F. (2007). The praeger handbook on stress and coping: Westport, CT: Praeger, c2007. 2 v.(xxxvi, 601 p.): illustrations; 24 cm.
Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2005). Illness trajectories and palliative care. BMJ: British Medical Journal, 330(7498), 1007-1011. doi:10.1136/bmj.330.7498.1007 %J BMJ
Najjar, N., Davis, L. W., Beck-Coon, K., & Carney Doebbeling, C. (2009). Compassion fatigue: A review of the research to date and relevance to cancer-care providers. Journal of Health Psychology, 14(2), 267-277.
Newman, J. E., & Beehr, T. A. J. P. P. (1979). Personal and organizational strategies for handling job stress: A review of research and opinion. Personnel Psychology, 32(1), 1-43.
Parker, D. F., & DeCotiis, T. A. (1983). Organizational determinants of job stress. Organizational Behavior and Human Performance, 32(2), 160-177. doi:https://doi.org/10.1016/0030-5073(83)90145-9
Parsons, M. L., & Stonestreet, J. (2004). Staff nurse retention. Laying the groundwork by listening. Nursing leadership forum, 8(3), 107-113. Retrieved from http://europepmc.org/abstract/MED/15160633
Payne, N. (2001). Occupational stressors and coping as determinants of burnout in female hospice nurses. Journal of Advanced Nursing, 33(3), 396-405. doi:10.1046/j.1365-2648.2001.01677.x
Penley, J. A., Tomaka, J., & Wiebe, J. S. (2002). The association of coping to physical and psychological health outcomes: A meta-analytic review. Journal of behavioral medicine, 25(6), 551-603.
Perez, G. K., Haime, V., Jackson, V., Chittenden, E., Mehta, D. H., & Park, E. R. (2015). Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs. Journal of palliative medicine, 18(4), 332-337.
Peterson, J. L., Johnson, M. A., Halvorsen, B., Apmann, L., Chang, P.-C., Kershek, S., . . . Pincon, D. (2010). Where do nurses go for help? A qualitative study of coping with death and dying. International Journal of Palliative Nursing, 16(9), 432-438. doi:10.12968/ijpn.2010.16.9.78636
Powell, M. (2019). Understanding the mixed economy of welfare (2 ed.). Bristol, UK: Policy Press.
Quinn-Lee, L., Olson-McBride, L., & Unterberger, A. (2014). Burnout and death anxiety in hospice social workers. Journal of social work in end-of-life & palliative care, 10(3), 219-239.
Robbins, S. P., & Judge, T. (2012). Essentials of organizational behavior.
Rudman, A., & Gustavsson, J. P. (2011). Early-career burnout among new graduate nurses: A prospective observational study of intra-individual change trajectories. International Journal of Nursing Studies, 48(3), 292-306. doi:https://doi.org/10.1016/j.ijnurstu.2010.07.012
Selye, H. (1976). The Stress of Life (Revised ed.). New York: McGraw-Hill.
Sepúlveda, C., Marlin, A., Yoshida, T., & Ullrich, A. (2002). Palliative Care. Journal of Pain and Symptom Management, 24(2), 91-96. doi:10.1016/S0885-3924(02)00440-2
Slocum-Gori, S., Hemsworth, D., Chan, W. W., Carson, A., & Kazanjian, A. (2013). Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce. Palliative medicine, 27(2), 172-178.
Steers, R. M., & Black, J. S. (1994). Organizational Behavior (5 Ed.). New York: Harper Collins.
Strom-Gottfried, K., & Mowbray, N. D. (2006). Who heals the helper? Facilitating the social worker's grief. Families in Society, 87(1), 9-15.
Swetz, K. M., Harrington, S. E., Matsuyama, R. K., Shanafelt, T. D., & Lyckholm, L. J. (2009). Strategies for avoiding burnout in hospice and palliative medicine: peer advice for physicians on achieving longevity and fulfillment. Journal of palliative medicine, 12(9), 773-777.
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., . . . Lynch, T. J. (2010). Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. New England Journal of Medicine, 363(8), 733-742. doi:10.1056/NEJMoa1000678
Tunnah, K., Jones, A., & Johnstone, R. (2012). Stress in hospice at home nurses: a qualitative study of their experiences of their work and wellbeing. International journal of palliative nursing, 18(6), 283-289.
Vachon, M. L. (1995). Staff stress in hospice/palliative care: a review. Palliative Medicine, 9(2), 91-122. doi:10.1177/026921639500900202
Volker, D. L. (2009). Living with death and dying: the experience of Taiwanese hospice nurses. Paper presented at the Oncology nursing forum.
Yi, J., Kim, M. A., Choi, K., Kim, S., & O’Connor, A. (2018). When does compassion fatigue hit social workers? Caring for oncology patients in Korea. Qualitative Social Work, 17(3), 337-354. doi:10.1177/1473325016670484
Zambrano, S. C., Chur-Hansen, A., & Crawford, G. B. (2014). The experiences, coping mechanisms, and impact of death and dying on palliative medicine specialists. Palliative and Supportive Care, 12(4), 309-316. doi:10.1017/S1478951513000138
Zander, M., Hutton, A., & King, L. (2010). Coping and Resilience Factors in Pediatric Oncology Nurses CE. Journal of Pediatric Oncology Nursing, 27(2), 94-108. doi:10.1177/1043454209350154
Zheng, R.-S., Guo, Q.-H., Dong, F.-Q., & Owens, R. G. (2015). Chinese oncology nurses’ experience on caring for dying patients who are on their final days: A qualitative study. International Journal of Nursing Studies, 52(1), 288-296.
Zheng, R., Lee, S. F., & Bloomer, M. J. (2018). How nurses cope with patient death: A systematic review and qualitative meta-synthesis. Journal of Clinical Nursing, 27(1-2), e39-e49. doi:doi:10.1111/jocn.13975
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2021-07-30起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2021-07-30起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw