[[alternative]]A Study about the Experiences of Patients’ Deathamong the Hemodialysis Nurses

[[abstract]]本研究探討洗腎室護理師面對病人死亡的經驗，瞭解他們在面對病人死亡的情緒和存在現象及其悲傷轉化。本研究經人體試驗委員會審查通過，以北部某區域教學醫院四位血液透析室護理師為研究對象，深入訪談進行資料收集，以詮釋現象學為研究取向，採取ATLAS.ti 8.0分析軟體輔助資料分析，分析步驟為資料蒐集、沈浸閱讀、意義單元之拆解與改寫、構成主題、置身結構和普遍結構等，進行文本資料之主要分析。 本研究結果為，血液透析室護理人員的置身結構經驗為在自身上「思及死亡」，透過存在抉擇而獲得徹悟，因而「願意接受良心」，即聽取它的呼聲，包括「純然在一起的感受」、「掛慮是作為一種照顧責任」、「傾聽良心呼喚的聲音」。由此置身處境結構歷程觀之，護理人員在初期面對病人死亡的失落、自責，至後期之意義對話、改變認同的歷程，有三大主題，一、「邊界處境、共在關係」―遭逢生命的有限性、不預期性及不能等待，護理人員經歷到「存在上的掛慮」、「同情共感與超越」及「內咎存在」，乃至於尋求內在自我的調適，找尋生命的出口；二、「存有相隨、尋獲益處」―護理人員經歷病人死亡承受個人內在與專業困頓，經由自身反省原有專業學習經驗，而能超越原有的立場，進入與病人互動現場，藉以反思護理專業角色，進而成長和自我超越；三、「知者洞識、意義再建」―護理人員體會到死亡並非只有洗腎病人須面對，而是每個人都必須經歷的生命週期和共有的宿命，此外，腎臟末期的邊界處境其照護已不同於一般的醫療，所需要的是「善終」的照顧。本研究結論為，病人死亡的經驗促使血液透析室護理人員在護病關係中以「共在處境」回應，且在「自我開顯」傾聽良心呼喚的聲音，以生命陪伴病友共行朝向臨終處境。而護理人員面對病人死亡的悲傷經驗是讓情緒的流動、適應與接受失去，以及意義再創造的意涵。[[abstract]]The purpose of this study is to explore the experience of nurses in the hemodialysis room in the face of patients' death, and to understand their emotions and existing phenomena in the face of patients' death and their grief transformation. This study has been examined and approved by the Joint Institutional Review Board. Four nurses in the hemodialysis room of a teaching hospital in north Taiwan were selected as the research subjects, and qualitative hermeneutic phenomenology was adopted as the research orientation. Data were collected through in-depth interview and qualitative research analysis software ATLAS.ti 8.0 was used as an assistant tool to help organize the data. The analysis steps are data collection, immersive reading, disassembly and rewriting of meaning units, theme formation, participation structure and general structure for text data analysis. The result of this study is that, through participation structure experience, the nurses in the hemodialysis room is to "think about death" in themselves and gain a thorough understanding through the choice of existence, so they are willing to accept conscience, that is, to listen to its voices, including “the feeling of simply coming together,” “worry is a kind of care responsibility,” and “listening to the voice of conscience”. From the perspective of situational structure, there are three main themes in the process of nurses' loss and self-accusation in the initial stage of patients' death, meaningful dialog and change of identity in the later stage. 1."Border situation and co-relationship" when they encounter the limitation, unexpectedness and no waiting of life, nurses experience “worry in existence,” “sympathy and transcendence,” and the “existence of internal blame,” as well as seeking inner self-adaptation and searching for an outlet to life. 2. Experience the personal and professional dilemmas suffered by nurses when the patients die in the context of "existence of companionship and benefit seeking". When performing the role of nurses, they can go beyond their original position and enter the scene of interaction with patients through self-reflection on their original professional learning experience, so as to reflect on the growth and self-transcendence of the professional role of nursing. 3. From the perspective of “insight of the knower and meaning reconstruction”, death is the life cycle and common destiny that everyone must experience. Death is not only for nephropathy washers, but also for nurses. Different from general medical treatment, the border situation of terminal kidney patients is hospice care. The conclusion of this study is that the experience of patients' death prompts nurses in the hemodialysis room to respond to the "coexistence situation" in the nurse-patient relationship, listen to the voice of conscience in the "self-openness", and accompany patients with their lives toward the terminal situation. Henceforth, the grievivg experience of nurses facing the death of patients is the implication of emotional ventilation, loss of adaptation and acceptance, and meaning re-creation