新型冠狀病毒(COVID-19)，自2019年12月份從中國武漢發生後，快速蔓延到全球各國家，造成大量的民眾染疫甚至死亡。在疫情期間，除了染疫的民眾之外，另一首當其衝的就是醫療人員。面對大量的病患造成醫療人力的不足、防疫物資不足，及新興傳染病尚無治療方式等問題，讓醫療人員感受到莫大的壓力。過去雖有研究探討流行疾病對醫療人員知覺壓力的影響，但疫情要如同新冠肺炎般的大規模傳播，造成全球數以萬計人民死亡，卻是相當少見。本研究目的即是想要以質化研究豐富的描述能力，能呈現動態歷程的特性，來探討此種新興、未知且嚴重的COVID-19疫情下，醫療人員對於壓力的知覺與因應，並且藉由意義建構觀點來探討醫療人員對於環境的理解與詮釋。
本研究共訪談了八位臨床上有照顧過COVID-19確診病患的醫療人員，每位約進行90分鐘的訪談。再以紮根理論的技巧，對八篇逐字稿進行開放性編碼、主軸編碼、次類別編碼、主類別編碼後，彙整出「醫療人員壓力感受歷程」，並搭配時間軸繪製出壓力感受程度曲線。此模式顯示，醫療人員在COVID-19疫情衝擊時，壓力知覺與因應過程分成四個階段：擔心、焦慮、學習、適應。一開始面對疫情的「未知與不確定」會產生擔心，並導致負向的壓力感受，但「未知與不確定」中也含有挑戰與期望的意義，進一步引起正向感受。等到真正接觸確診病人之後，這時候出現的是「現實的衝擊」，並使得壓力感受達最高峰。但也在此時，「多元支持」的效果開始介入。在學習階段，會看到醫療人員對於新冠疫情建立起「知識與經驗的累積」，到最後適應階段則產生成功的「行為調適」，用以應對壓力的因應。接著，利用Weick提出的意義建構歷程的七項特性進行分析，發現「醫療專業身份的再定義」、「經驗回溯的焦點在遭遇的當下」、「未知與不確定是最大的壓力源」、「多元支持是意義建構的社會性因素」、「持續發生的壓力知覺歷程模式」、「適應的主觀性」等。最後，本研究提出了七項新命題，相關的理論貢獻，以及管理實務建議給醫療人員、醫療機構、政府單位參考，並整理出研究限制與未來研究方向等。

Coronavirus disease 2019 (COVID-19) broke out in Wuhan, China in December 2019 and has since spread rapidly to countries across the world, causing massive numbers of infections and even deaths. During the pandemic, in addition to infected people, healthcare professionals are the ones most directly affected. In the face of problems such as shortages of medical manpower and epidemic prevention materials resulting from large numbers of patients, and an absence of treatments for the new infectious disease, healthcare professionals have come under overwhelming pressure. Although previous studies have explored the impacts of epidemics on perceived stress in healthcare professionals, epidemics that cause as massive-scale spread as COVID-19 to kill tens of thousands of people worldwide are quite rarely seen. The purpose of this study is to investigate medical professionals’ perception and response to stress under the outbreak of COVID-19, a new, unknown, and severe epidemic, using the rich descriptive capacity of qualitative research and its ability to present dynamic processes. Further, the understanding and interpretation of the environment by healthcare professionals are discussed from the perspective of sensemaking.

In this study, eight clinical staff members who had cared for patients with confirmed COVID-19 were interviewed for about 90 minutes each. Subsequently, open, axial, sub-category, and main-category coding was conducted on eight verbatim transcripts using techniques from grounded theory, whereby the ‘process of stress perception in healthcare professionals’ was derived and the curve of perceived stress levels with the time axis was produced. This model shows that the process of stress perception and response in healthcare professionals during the COVID-19 outbreak is divided into four stages: concern, anxiety, learning, and adaptation. Initially, the ‘unknowingness and uncertainty’ of the epidemic caused concern and led to negative perceptions of stress. Nevertheless, such ‘unknowingness and uncertainty’ also included a sense of challenges and expectations that further aroused positive perceptions. When healthcare professionals came into actual contact with confirmed patients, ‘reality shock’ emerged, leading perceived stress to reach its peak. At the same time, however, the effect of ‘multi-support’ also began to intervene. In the learning stage, healthcare professionals were observed to establish the ‘accumulation of knowledge and experience’ regarding COVID-19, and finally generate successful ‘behavioural adaptation’ to cope with stress in the adaptation phase. Next, the seven properties of the sensemaking process proposed by Weick were used to conduct an analysis, which established such ‘Redefining medical professional identity’, ‘The focus of retrospective experience is the moment of encounter’ , ‘The unknown and uncertainty are the biggest stressors’ , ‘Diversified support is a social factor in sensemaking’ , ‘Ongoing patterns of stress process model’ , ‘Subjectivity of adaptation’. Finally, seven new propositions, related theoretical contributions, and suggestions on management practice are proposed for the reference of healthcare professionals, medical institutions, and government units, and research limitations and directions for future research are summarized.

第一章 緒論 1
第二章 文獻探討 5
第一節 COVID-19新型冠狀病毒的影響 5
第二節 壓力的感受及因應 6
第三節 醫療人員面對大流行病的壓力與因應 8
第四節 意義建構理論(sensemaking) 11
第五節 COVID-19與意義建構 13
第六節 COVID-19大流行的意義建構對於態度與行為之影響 14
第三章 研究方法 17
第一節 質化研究-描述性研究的選擇 17
第二節 資料收集方法與研究設計 18
第三節 研究流程 20
第四節 研究對象 21
第四章 研究結果 25
第一節 未知與不確定的負向影響 26
第二節 正向的行為與心態 30
第三節 現實的衝擊 32
第四節 多元支持 39
第五節 知識與經驗的獲得 44
第六節 行為調適 48
第七節 焦慮 53
第八節 意義建構觀點的壓力知覺與因應 54
第九節 新命題的提出 61
第五章 結論與討論 65
第一節 研究主要貢獻 65
第二節 管理實務與意涵 68
第三節 研究限制與未來研究的建議 71
參考文獻 73
附錄　來源索引 78

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