本研究之目的是藉由臨床護理人員與醫師描述標籤困難照顧病人/家屬的經驗進而了解現象之本質。研究對象採用立意取樣，於南部某醫學中心選取6位因目前住院病人/家屬的語言或所表現的行為讓其感到困擾而用負面之形容詞歸類或描述他們之臨床護理人員，同時本研究也訪談3位住院醫師，藉由多方面收集資料進而還原現象的原貌。使用現象學為本研究之方法論，經研究對象知情同意下進行深度訪談，於93年11月至12月進行資料收集，訪談資料依Giorgi(1985)之分析步驟進行。研究結果共呈17個類別模型，屬於臨床護理人員視為困難照顧病人/家屬之情境為「不合作，難溝通」、「指使護士，有損威嚴」、「紅燈不斷、要求立即滿足」及「超出常模、無法預測」；屬於歸因的類別模型為「無法認同疼痛之反應」、「無法處理止痛之需求」、「溝通障礙」、「欠缺社會支持」及「害怕出事」；屬於反應之類別模型則為「煩」、「氣憤」、「無力無奈」、「複雜情緒交錯」、「同情同理」、「無法溫柔以對」、「速戰速決，敷衍了事」及「歸納原因反思自己」。透過本研究結果可增加對於臨床護理人員標籤困難照顧病人/家屬的背景知識，且深入了解臨床護理人員標籤困難照顧者背後的真正原因。在臨床上提供臨床護理人員反省之材料及呈現臨床護理人員運用護理過程解決問題不足的實例；在教育上則可提供負面之教材；對行政管理者提供問題解決過程的參考並可做為輔導新進人員之知識背景。藉由指出影響護病關係不佳的原因，以期能對症下藥擬定改善方案，進而促進護病關係，提升護理品質。

　The aim of this study is to understand the essence of the phenomenon of labeling “difficult patients/families” thoroughly by analyzing the experience of clinical nurses and doctors. Six clinical nurses with experiences of using negative words/phrases to describe or categorize the patients/families that have unacceptable verbal words or behaviors to make them feel uncomfortable are chosen as the research subjects, in which these clinical nurses are from one of the medical centers in the southern part of Taiwan. In addition, by gathering information from different kinds of sources so that the truth behind the phenomenon can be revealed, three resident doctors are also interviewed. The investigator used phenomenology study method in which in-depth interviews and participant observations were conducted under the consent of each research subject. These interviews were conducted during the period of September 2004 to November 2004. These interview data were analyzed using the approach developed by Giorgi (1985), in which these interview data can be divided into 17 categories. In particular, categories such as “uncooperative; hard to communicate”, “dominating; like to order”, “demanding; frequently and consistently pressing red lights; needs must be satisfied immediately”, and “abnormal; unpredictable” can be considered as the behaviors of the patients/families that will make the clinical nurses label those patients/families as “difficult”. As for the categories such as “unwilling to consider patient’s pain complaint is true”, “unable to deal with the need of pain relief”, “communication barrier between nurses and patients/families”, “a lack of social support” and “afraid of wrong doing” can be considered as the reasons/causes why clinical nurses label difficult patients/families. As for the categories such as “boring”, “anger”, “incapable”, “complex emotion”, “sympathy”, “unfriendly; unkind”, “unserious; negligent; rush to finish something” and “make self-examination; reflection” can be considered as the response by the clinical nurses when they face “difficult patients/families” It is believed that the results of this study can increase the knowledge about the phenomenon of labeling difficult patients/ families by the clinical nurses and also help understand the reason/cause behind it. In summary, the contributions of this paper are three folds. 1). Provide the materials for clinical nurses to perform self-examination and also be an example of incapable of solving problems using nursing processes. 2). Provide a negative example to be used in nursing training/education 3). Benefit the nurse administration so that they can take appropriate actions to improve the nurse-patient relation and the quality of nursing care.

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