| Summary: | 碩士 === 長庚大學 === 商管專業學院碩士學位學程在職專班醫務管理組 === 102 === Child welfare and protection related issues have received growing attention among internaoitnal communities. Clinically, the medical needs of abused children invovled high complixity, and comprehensive professioanl assistance is required. In comparison to general patients, clinical nurses offering care to abused children face more complicated situations and may have more stress during nursing care. An in-depth inteview was conducted to gain an insight into the process of nurses’ stress experiences when offering care to abused children, the topics included stressors, coping strategies, and coutcomes related to clinical cares for abused children.
Qualitative research method was adopted in this study. A total of 20 nurses in ER or ICU were interviewed. Content analysis was used to analyze the interviewed data. Findings show: 1) The nurses’ stressors include lack of care abilities, lack of support and assistance, ethical dilemmas, values conflicts, and difficulties of interaction with the family members; 2) The coping strategies employed by nurses include seeking support and assistance, enhancing care abilities, avoiding to spend time with cases or their family members, or using rationalization for their behaviors; 3) The negative outcomes of coping were observed in terms of psychological, professional competence, and interpersonal aspects; 4) The needs of clinical nurses for providing good care to abused children include clear definition of service provsion, establishing social network for care experience sharing, improving accessibility of operating rules, offering on-the-job training, implementing feedback mechanisms, and adequate ways to ease stress; 5) Should ethical dilemma be a source of pressure, nurses used to adopt avoidance as the major coping strategy by reducing time spent with abused children, using rationalization for their behavior, and holding a skeptical position towards family members.
The results suggest that stress responses are likely to be brought about by offering care to abused children, rwhich in turn has negative impact on the quality of care. Recommendations based on this study include: 1) Clinical care for abused children should be carried out using a multi-disciplinary teamwork model. Education training should be offered to establish consensus of standards for actual execution of clinical care; 2) Information system which integrates laws and operating processes to enhance operation smoothness should be implemented. Furthermore, the results can provide insights for the Ministry of Health and Welfare to implement “Medical institution setup of child protection medical service model plans.”.
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