[[alternative]]From Conflict to Existence--A Study on The Mental Process of The Psychiatric Nurses Caring For The Psychotic Patients

[[abstract]] 本研究主要從一個精神科照護者的角色出發，探討精神科病房護理人員與病患之共構處境中，如何透過自身視域去觀看精神病患之存在、及試由一種角色交換的同感理解去反思自身，並促發專業自我反省，進而能在照護病患的過程經驗中獲得體悟與自我超越。 研究對象採立意取樣，為四位具五年以上急慢性精神科工作經驗之護理人員，以高達美Gadamer詮釋學作為文本詮釋之分析導引，並透過半結構式深度訪談及田野觀察進行文本資料蒐集。研究結果發現： 一、護理人員對「精神病患」這個角色多呈現孤獨、無望之負面認知。二、從角色交換反思中，護理人員對罹病時之「生命自主性喪失」、「遭受親友疏離之孤獨感」及「被烙上標纖」感到恐懼。三、護理人員對自身扮演「護士」角色所呈顯之「堅強」形象，相對於「作為一個人」時所存有之「軟弱」，兩者間具內在衝突性。四、「治療性人際關係」依持之倫理準則，在與病患的實際面對面關係中，護理人員面臨人性上的困惑與不一致。五、「同修」的概念隱藏在傳統護病關係中，並作為護理人員靈性超越與成長之觸媒。六、精神科護理人員之專業自我成長會通過：恐懼 衝突 探索 接納欣賞等階段歷程。 並依據研究結果提出：對「病」與「患病受苦之人」的同感理解應涵括於專業護理訓練之中，並應在護理教育中強化跟人性價值系統相關之哲學課程，更敞開地與其他學門進行對話交流，轉換另一種「希望」的概念來看待生病處境及建立同儕間彼此關照管道等建議，期能對醫護臨床工作者及專業養成訓練有所助益。[[abstract]] From the perspective of a psychiatric care giver, the study, primarily focuses on how psychiatric nurses probe the existence of psychiatric clients from their territory built up by both psychiatric nurses and clients. The empathy realizes by role transmission; the professional self-awareness is evoked. Further, viewing from the life experience of clients, acknowledgement and self-transcendence are perceived. Purposeful sampling is predominately in favor of four psychiatric nurses with more than five-year acute and chronic psychiatric working experience. Analytic interpretation is conducted upon Hans George Gadamer’s hermeneutic theory; and data collection is completed throughout both semi-structured in-depth interviews and field observation. Outcomes of this paper reveals as followed: 1. Facing the psychotic patients, nurses tend to be engaged with negative images of loneliness and hopelessness. 2. Regarding the role transmission, profound fear is conceived while psychiatric nurses witness autonomy and consciousness depleted in ill status; shortage of supportive system and label with social stigma. 3. ＂Psychiatric nurses＂ often self delineate as a portrait of the perseverance; in correspondence to the weakness represented as human, inner confrontation is raised between these boundaries. 4. Considering ethic parameters of therapeutic relationship and＂face-to-face＂relation, psychiatric nurses encounter with conscience disturbance and contradiction.5. The concept of ＂Monastic practice＂ in nurse-patient relationship is the key to facilitate psychiatric nurses toward self development and spiritual transcendence. 6. The professional self growth and development of psychiatric nurses will be attained through the process : fear-conflict-exploring stress-acceptance and admiration. Recommendations are provoked based on the outcomes; the concept of empathy realization toward ＂illness＂ and ＂persons in suffering＂ should be coordinated into professional nursing curriculum; and the philosophy relating to the human value should also be enhanced in nursing education. A more comprehensive dialogue with other disciplines should be preceded and the channel for caring for each other should be established within coworkers. Hopefully, the above recommendations can benefit medical and nursing clinical practitioners and nursing education