간호사가 경험한 어려운 환자와의 대인관계 이해 = Understanding Experience of Nurses Dealing with Difficult Patients

다국어 초록 (Multilingual Abstract)

Nurse-patient relationships are the dynamic process which are built day by day as nurses interact with their patients. In order to understand nursing phenomena in the nurse-client domain in depth, it is essential for both to understand the meaning and the cognition of nurse-patient relationships. This study tried to answer the questions : How do nurses experience relationship with difficult patients in the general hospital?. A micro-ethnographic research method was used to answer these questions. The data was collected from March through September 2001. through the method of in-depth one to one interview, observation of the participants and group interview. The research participants consisted of 9 nurses who were working at medical unit in 2 private hospitals in Seoul. The results of the study are as follows: The harmonious partnership between nurses and difficult patients are established after nurse and difficult patient have progressed through four preceding interlocking phases. These adjusted phases are: (1) the exploration phase, (2) the resistance phase, (3) the negotiation phase, (4) the integration/collaboration phase. The maladjusted phases are : (1) the exploration phase, (2) the resistance phase, (3) the oppression phase, (4) the avoidance phase. All of these adjusted phases culminate in nurses` acknowledging the partnership through knowing the difficult patient and the awareness of the nurses` caring role. There may be a sequence of progression followed by retrogression to the previous phase. Major argument is as follows: Nurse-difficult patient relationships are the process in balancing their power. This process divides into two branches the adjusted phases and the maladjusted phases. These depend on the degree of efficiency of power balance. Nurse-difficult patient relationships ultimately establish Harmonious Partnership, getting through theses adjusted phases. The processes in balancing power are : (1) weighing on power proportion. (2) struggling for hegemony, (3) collaborating relationship with harmonious partnership or subordinating relationship between the oppressor and the oppressed. Nurses` strategies at each phase are as follows : At the exploration phase, nurse discern difficult patients with patient information and nurse`s past experience. At the resistance phase, nurses use the strategies such as taking the initiative, confrontation, establishing the defence, approaching with the ulterior strategy, sticking with policies and principles, and using the tactics of delayed action. At the negotiation phase, nurses take a position of stepping back, steading their mind, keeping the mind under control, enduring, tailoring the patient`s needs, careful concerning, and understanding the patient behaviors. At the integration phase as a final phase, nurses are reawakened with their caring role and personal knowledge of difficult patients. Therefore, nurses acknowledge harmonious partnerships with difficult patients. At the oppression phase in the maladjusted phases, nurses express emotional response and obey the patients` needs passively. Also, nurses use strategies of distancing manner, being strained and directing all attention to difficult patients. At the crippled phase, nurses take the attitude avoiding difficult patients.