臺灣博碩士論文加值系統

本研究目的在探討急重症護理人員對心肺復甦術無效醫療的感受與困境及其相關因素。研究採橫斷式研究設計，以立意取樣選取臺灣北部某醫學中心急診及加護單位之護理人員為研究對象。運用自擬式問卷為研究工具，分別以「心肺復甦術無效醫療感受量表」、「心肺復甦術無效醫療困境量表」及「個人心肺復甦術無效醫療經驗」進行資料收集，共發出260份問卷，有效問卷248份，有效問卷回收率95.4％。研究顯示，研究對象在無效醫療照護感受平均得分為3.24±0.48分，教育程度越高、工作職級越高、經歷無效的CPR次數越多者對無效醫療有較深的感受；其中，護理人員最常歷經的感受為「急救過程只是增加病患痛苦」及「我感覺只是延長病患死亡過程」，多數認為執行CPR無效醫療是為了滿足家屬的要求。無效醫療照護困境平均得分為3.00±0.56分，大部分護理人員同意在醫療決策權歸屬上感到困境，最常面臨的情境是「末期病患DNR決策太慢，使病患經歷急救過程的疼痛及痛苦」及「是否繼續無效的CPR，主要遵照醫師的指示」。急重症護理人員對無效醫療感受愈強烈，在照護上會有較高的困境感受，兩者之間呈顯著正相關（r＝0.51, p＜0.001）。
再者發現，安寧緩和療護的相關教育訓練不足會在無效醫療照護上會感受到較高的困境。當急重症護理人員對生命末期病患的照護知識不足，在照護態度上會較缺乏自信心，也難以與病患及家屬討論有關生命末期照護的議題。因此，接受安寧緩和療護相關知識，有助於其在面對是否執行無效CPR決策時，能具備溝通能力與正向態度去因應及面對施行無效CPR的衝擊與困境。期望未來能藉由教育及政策宣導，提升護理人員對生命末期照護之相關知識及態度，以因應臨床執行CPR無效醫療所面臨的困境。

The purpose of this study was to investigate the experience, predicament and related factors of medical futility in cardiopulmonary resuscitation among the nurses in critical care units. The study adopted a cross-sectional study design with mixed methods of a clinical survey at a medical center hospital in northern Taiwan. The instrument was a self-made questionnaire including items on nurse’s basic data as well as experiences and predicaments in caring CPR medical futility for data collection.
In this study, a total of 260 questionnaires were distributed, and 248 effective questionnaires returned. The medical futility perception revealed that those nurses who were different in the level of education, job level and no effect CPR experiences. Predicaments in medical futility were related to ever DNR or palliative education programs. The nurses’ experiences in medical futility were well correlated to their predicaments about such care.
Although the education for palliative care is inadequate which have correlations to predicaments in medical futility. If nurses have the shortage of end-of-life (EOL) care knowledge, their attitudes about caring will also be lack of self-confidence. Nurses will difficult to discuss the issues related to EOL care with patients and their families. Furthermore, the goal of this study is to create a meaningful and useful learning from the process surrounding CPR medical futility. It is anticipated that could provide medical staffs via education program and policy guidance to improve the knowledge and attitudes of EOL care.

目錄
誌謝……………………………………………………………… I
中文摘要………………………………………………………… II
英文摘要………………………………………………………… III
目錄……………………………………………………………… IV
圖目錄…………………………………………………………… VI
表目錄…………………………………………………………… VI

第一章 緒論……………………………………………………… 1
第一節 研究背景與現況………………………………………… 1
第二節 研究動機與重要性……………………………………… 2
第三節 研究目的………………………………………………… 3
第二章 文獻查證………………………………………………… 4
第一節 無效醫療………………………………………… 4
第二節 心肺復甦術………………………………………… 6
第三節 心肺復甦術與無效醫療之關係…………………… 8
第四節 急重症護理人員之心肺復甦術無效醫療感受及其相
關因素……………………………………………… 10
第五節 急重症護理人員之心肺復甦術無效醫療困境及其相
關因素……………………………………………… 16
第六節 研究變項相關文獻探討…………………………… 23
第三章 研究架構及問題………………………………………… 24
第一節 研究架構…………………………………………… 24
第二節 名詞解釋…………………………………………… 25
第三節 研究問題…………………………………………… 26
第四章 研究方法………………………………………………… 27
第一節 研究設計…………………………………………… 27
第二節 研究對象…………………………………………… 28
第三節 研究過程…………………………………………… 29
第四節 研究工具…………………………………………… 30
第五節 倫理考量…………………………………………… 35
第六節 資料分析…………………………………………… 35
第五章 研究結果………………………………………………… 37
第一節 護理人員屬性及無效醫療感受與困境…………… 37
第二節 護理人員屬性在無效醫療感受與困境上之差異… 45
第三節 臨床心肺復甦術無效醫療實例與困境之現況… 49
第六章 討論……………………………………………………… 51
第一節 護理人員對無效醫療的感受與困境…………… 51
第二節 護理人員屬性在無效醫療感受與困境上之差異… 54
第三節 臨床心肺復甦術無效醫療實例與現況………… 56
第七章 結論與建議……………………………………………… 57
第一節 結論……………………………………………… 57
第二節 研究限制………………………………………… 58
第三節 建議……………………………………………… 59
參考文獻…………………………………………………………… 61
附錄………………………………………………………………… 72

圖表目錄

圖3-1 研究架構圖………………………………………………… 24
圖4-1 研究流程圖………………………………………………… 29

表4-1 心肺復甦術無效醫療感受量表之向度與內容…………… 33
表4-2 心肺復甦術無效醫療困境量表之向度及內容…………… 34
表5-1 護理人員基本資料………………………………………… 38
表5-2 心肺復甦術無效醫療感受量表得分……………………… 40
表5-3 心肺復甦術無效醫療感受排序統計……………………… 41
表5-4 心肺復甦術無效醫療困境量表得分……………………… 43
表5-5 心肺復甦術無效醫療困境排序統計……………………… 44
表5-6 護理人員屬性與無效醫療感受之變異數分析…………… 46
表5-7 護理人員屬性與無效醫療困境之變異數分析…………… 48
表5-8 臨床執行無效CPR之實例分析…………………………… 50

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