護理專業對護病關係義涵的建構承襲南丁格爾時代的護理典範，以及Hildegard E. Peplau 的<護理的人際關係>，將護理的功能位置定義在理解與協助病患的需求，因此護病關係實屬<療癒性>的人際關係。
護士在不容質疑的護理價值中形構自己的護士角色，那是不自覺與缺乏自我省察的護病關係。事實上，護病關係是不對等關係，專業化的助人功能與角色本身蘊含權力關係的互動。本研究參照傅柯的觀點，對權力的體認其實大部分是正面或構成面；傅柯本身並不斥責權力的社會關係，權力的正面效應是構成與塑造人類生活的運作機制，而真理也是人類建構與塑造而成為實際人類生活的「真理」。護士身為照顧者必須提供助人的角色，但是自己也是醫療技術宰制的受困者，面對病患的需求召喚，護士如何承擔被他者喚起的主體，而自我情緒察覺是啟動自身照顧倫理的動能。
人的知識建構與變化受到體制一連串新的權力技術的演變所控制，病房常態的護理活動是受到醫療制度與社會文化的歷史因素的影響。台灣醫療生態在經濟與效用的實務趨向中，護病關係的事實內涵產生形變與爭議。而護士在照護決策中的權力運作展現，同時也承受臨床機構影響護士照護工作的權力因素。
本研究以批判民俗誌的知識論與方法學進行臨床護病關係現象的田野觀察，揭露臨床結構所習以為常且不自覺的權力關係中，以及護士的面對這權力現象的認同政治。研究場域為精神專科療養院的急性病房，進行近半年時期間斷的護理現場觀察，並訪談15位病房護士，透過敘述訪談對話歷程，協助護士自我察覺在護病關係中的權力互動與消長。發現從醫療專業、醫療空間與病房管理等架構脈絡，理解護士被賦予理所當然的權力地位；闡述醫療生態受到健保制度、機構評鑑與精神衛生法等脈絡影響，護病關係也走向經濟成本與價值效率的考驗；從對病患主體的關懷，轉向為配合醫療體制的經濟價值互動，因此病患主體的照護已經被現有體制邊緣化。
本研究的結果企圖啟動護士反思護病關係的質變化與工具化，護士的自覺可以實踐與再構以人文關懷為主的護病關係，並提供給學校護理教育在實務訓練的參照教材。 / Nurse-patient relationship in nursing takes on Florence Nightingale age , as well as Hildegard E. Peplau’s therapeutic relationship, defines the function of care in understanding and contributing to the patient's needs.
Nurses in the nursing care of unquestionable value formulation in their nursing role; it is not self-consciousness and lack of self-examination of nurse-patient relations. In fact, the nurse-patient relationship is unequal relationship, as professional help functionality roles and power relations embedded interaction
This study based on Foucault's power and knowledge view, recognition of power largely positive composition; Foucault does not rebuke the social relations of power, power is the positive effect of composition and operation mechanism of shaping human lives, and truth is the construction and shaping of mankind became the actual human life "truth". Nurse role as helper must be provided need for patient, but medical institute dominate self of nurse, then face to patients’ needs calling, nurses how to assume he associated with herself subject, and emotions awareness is self-care for nurse.
Construction and changes of human knowledge are controlled by the institutional evolution of a series of new power technologies, Ward nursing routine and activity are under the influence of medical systems and factors of socio-cultural history. Taiwan medical ecology trends of eco-economy and effectiveness, nurse-patient relations is deformation and disputes. Power of nurses is in care decisions making, but also is coercion under the factors of clinical institutions.
This research with epistemology and methodology of critical ethnography, observed nurse-patient relations of nursing field, discovered habit and unconsciously power of NPR, and identified politics for power relationship. Research field of mental acute ward of Psychiatry, observation and collection on the half-year, and interviewed 15-Ward nurse, through narrative interviews with dialogue process to help nurse self-awareness flowing power of nurse-patient relations. The outcomes are to be owned power of NPR from the medical profession, medical space and ward management routines.；and elaborated that medical ecology was challenged by health insurance system, the evaluation of medical and mental health law , nurse-patient relationship to economic cost and value efficiency tests; From the subjects care of patient turn to tie in with the economic value of health care system interactions, the subject of patient care has been marginalization of existing institutions.
The results of the research attempts to start reflection on nursing quality for variation and tools of nurse-patient relations, the consciousness of power in NPR and active humanistic concern nurse-patient relations, and made available to schools of nursing education in the practical training of reference materials.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0921525151 |
| Creators | 廖珮君, Liao, Pei-Chun |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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