Creating the Carative Environment in the Child and Family Care

目的探讨医疗机构共创关怀环境，促进儿童、家庭和临床工作人员的关爱。方法2007~2010年开展参与式行动研究。分析了行动研究对创生环境的创设和促进因素。结果(1)促进护理环境形成的线索是：护士关心什么问题的研讨会，与他人非正式地谈论他们所关心的问题，向从事护理工作的护士反馈态度改变的情况，以及提出护理策略建议。这些线索使护士有机会获得新知识，分享知识，了解自己的情况，吐露自己的感受和想法，意识到其他人的感受和想法也是一样的。(2)创造创造性的环境实地查明的有关情况得到改善，而不是消除。护士的焦虑和丧失工作意愿转向对自己和护理的信心，这可能会提前引起对孩子和家庭的照顾的保证。讨论结果表明，现场的关注只是创造成长环境的起点。本研究中的启蒙环境的创造过程反映了沃森关怀理论中的一些启蒙因素。研究表明，促进性因素是医院加强儿童、家庭和工作人员关怀的有力变革因素。

Purpose The purpose of this research was to identify co-creation of carative environment at medical facilities to enhance child, family and clinical staff care.Methods Participatory action research was conducted from 2007 to 2010. The creation of and facilitating factors of carative environment due to action research were analyzed. The entire research process was supervised by nurse researchers specialized in action research.Results (1) Facilitating Clues The clues to facilitate carative environment were : the seminar regarding concerns what nurses had, informal talk with others about concerns what they had, feedback of the attitude change to nurses who were committed in, and giving the advice on nursing strategies. These clues triggered the opportunity for nurses to gain new knowledge, to share the knowledge, to understand their situation, to disclose their feeling and thoughts, and to realize that the others felt and thought in the same way. (2) Creation of the Carative Environment The concerning situations identified in the fields were improved rather than dissolved. Distress and loss of desired to work in nurses turned to the confidence in oneself and nursing care, which might invite the assurance of child and family care in advance.Discussion The result showed the concerns in the field were just the starting point to create the carative environment. The process of creation of carative environment in this study reflects some of the Carative Factors in Watson's Caring Theory. The study showed the facilitating Carative factors were the powerful change agent in the hospital to enhance child, family, and staff care.