| Summary: | 博士 === 國立高雄師範大學 === 成人教育研究所 === 104 === The purpose of this study was to explore the transformative learning phenomenon of hospice nurses in the workplace, in order to understand the predicaments they face and the transformative learning approaches they adopt, and the changes in their attitudes attributable to their learning experience. A qualitative study design was employed, and the research subjects were 10 full-time nurses working in the palliative care ward in middle and southern Taiwan. Open-end questionnaire survey, in-depth interviews and document analysis were adopted to collect data. On the basis of the findings, the following conclusions were drawn:
1. The nurses enter the hospice and palliative care profession because of internal factors (e.g., identification with the concepts of hospice and palliative care, pursuit of different experiences and personal development, and loss of loved ones) and external factors (e.g., job transfer and appointment, recommendations from teachers or family members, and a supervisor’s charisma).
2. The predicaments faced by hospice nurses are outlined as follows: hospice and palliative care knowledge, patient care, nurse–patient relationship, and teamwork. These predicaments triggered the nurses’ transformative learning, conflicted with their inherent thinking framework, and guided them in perceiving and reflecting on their existing values and beliefs.
3. Religious beliefs, professional faith, self-vow and emotional detachment are the internal resources that support hospice nurses when they resolve their predicaments, whereas team support, support from others, educational training and initiative reading are external resources that help nurses respond to predicaments.
4. Being open-minded about the unknown, identifying with patients and their family members, listening to their intuition, and falling back on their core values and beliefs are the transformation of hospice nurses when they confront their predicaments.
5. Through transformative learning, hospice nurses can enhance their professionalism, caring, and propriety of emotional expression; reshape their rules of thinking; continue realizing their values; and incorporate newfound ideas as their code of conduct in activities of daily living.
6. Through transformative learning, hospice nurses feel more capable of delivering their care services in a good death and holistic manner and establishing autonomy in their practice.
7. Transformativealearningapositively influencesahospice nurses’ attitudes toward life, confidence, self-worth, attitudes toward their lifestyle, personal conduct, and family relationship.
According to the preceding conclusions, this study proposes the following suggestions:
1. Recommendations for nursing education at school
(1)Promote hospice and palliative care education and train nursing students in holistic health care and end-of-life care.
(2)Increase the diversity of audiovisual and reading materials in the nursing literature and life care, and integrate such materials into the planning of curricula or extracurricular activities, thereby enabling students to engage in reflective thinking and cultivate the inner strength necessary to resolve predicaments inherent in clinical practices.
(3)Incorporate educational topics on religion into the general education curriculum to provide students with the mental support required to face predicaments in clinical settings and guidance toward personal transformation.
(4)Develop courses that encourage reflection and empathy, or similar courses executed through narrative approaches, to prepare students for personal transformation when entering the nursing profession.
(5) Apply findings of this study to the hospice and palliative care curriculum for nursing students to learn and understand the nursing practices involved
in hospice and palliative care.
2. Recommendations for institutions and organizations involved in hospice and palliative care
(1)Train novice nurses in hospice and palliative care to enable them to develop knowledge and attitudes that prepare them for the clinical practice.
(2)Apply findings of this study to developing scenario-based courses for in-service training to improve hospice nurses’ problem-solving skills.
(3)Create peer support groups that enable members to assist one another in improving together.
(4)Use the transformative learning experiences explored in the present study as materials for educating new hospice nurses and nonhospice nurses.
(5)Ensure that the government or private organizations dedicated to the promotion of hospice and palliative care disseminate the predicaments covered in the findings to facilitate educating the general public on hospice and palliative care.
3. Recommendations for nursing practitioners
(1)Develop a comprehensive understanding and concept of hospice and palliative care through various learning resources
(2)Complete training in hospice and palliative care to develop knowledge and attitudes regarding clinical practice before officially working in the hospice division.
(3)Develop reflection ability and empathy to facilitate engagement in transformative learning.
(4)Search for support systems and seek help whenever needed
Keywords: hospice nurse, predicament, transformative learning
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