臺灣博碩士論文加值系統

摘要
一、 背景
『安寧療護』以往多運用於癌症末期病患照護，八大非癌及末期病患於重症單位推行安寧療護為現今醫療趨勢，加護病房護理人員有更多的機會照護到生命末期病患及其家屬，重症護理人員是否已具備足夠的安寧療護知識及態度，以提供家屬面對善終的準備，值得探究。

二、 目的
本研究目的為探討加護病房護理人員對生命末期安寧療護之知識、態度及其相關性。
三、方法
本研究採橫斷式研究設計，以立意取樣方式，採結構式問卷調查南部某區域教學醫院加護病房護理人員，以自擬之「護理人員對生命末期病人安寧療護知識與態度量表」為研究工具，回收有效問卷為180份。使用SPSS 18.0中文版套裝軟體進行t檢定、單因子變異性分析、皮爾森積差相關等統計法。
四、研究結果
研究結果顯示：（一）樣本年齡多介於30～35歲（41.67％）平均31歲，加護病房工作年資以1～未滿5年居多，參加院內安寧教育時數以1～未滿5小時居多72.8％，10.6％未上過院內課程；近半數未參與過院外安寧醫學會或基金會所舉辦之安寧緩和相關課程，由研究結果得知，加護病房護理人員對於安寧緩和療護的課程參與率並不普遍；（二）安寧療護知識平均17.95分（滿分22分），只有5.6％護理人員了解非癌八大疾病的定義；（三）加護護理人員在安寧照護態度平均得分48.8分（總分64分），其婚姻、宗教信仰、參與院內時數、親人死亡經驗及於安寧照護態度有統計上的顯著性差異（p＜.01），認為親人過世會受影響個人對瀕死前照護方式（t＝2.42，p＜0.001）；（四）運用皮爾森積差相關進行統計分析，護理人員在態度總分與其態度各向度間有顯著正相關（r=.257～.674，p＜.01），而知識與態度則無顯著性相關（r=.025，p＞.05）。
五、實務應用
重症單位的護理人員對安寧照護認知是不足的，並未因工作年資、層級而有差異，顯示重症單位若要推行安寧療護，應加強安寧療護教育訓練，且不分層級灌輸正確的概念，以有效提升末期病人生活品質，讓病人及家屬生死兩相安。

Abstract
Background：
In the past applied “Palliative Care” to cancer terminal of patient care, Eight major non-cancer and terminally ill patients in the intensive care unit of the implementation of medical trend for today, ICU nurses have more opportunities to end of life care for patients and their families, icu nurses whether the enough have the knowledge and attitudes of palliative care to provide families facing the good death preparation.
Purpose：
The purpose of this study was to explore relationship between the knowledge of and the attitude toward end-of life palliative care among intensive care unit (ICU) nurses.
Methods：
By purposive sampling, ICU nurses who work in a teaching hospital in southern Taiwan were surveyed using structured questionnaires with the
cross-section design. One hundred and eighty valid questionnaires were collected. One-way ANOVA, t-test, Pearson Product-Moment Correlation were carried out using SPSS 18.0.
Results：
The result showed: 1) Most of the participants worked had the experience of one to five years working at the ICU with their ages ranging from 30 to 35. The majority of them (72.8%) had taken 1~ 5 hours of palliative courses provided by the hospital, 47.8% had taken courses related to palliative care outside the hospital, and 10.6% had never taken any related courses. It is observed that there is a low rate of participation of palliative courses. 2) An average of 17.95 (out of 22) points on palliative knowledge is obtained by the participants, and only 5.6% of the participants possess the understanding of the definition of non-cancer diseases. 3) An average of 48.8 (out of 64) points is obtained. It is shown that there is a significant difference (p<.01) in the attitude of the nurses toward palliative care due to their experiences of marriage, religious beliefs, hours of work in the hospital, and the death of their family members. The attitude toward the death of other family members later in life would also be affected (t＝2.42，p＜0.001). 4) The attitude of the nurses is positively correlated to the dimensionalities in the attitudes (r=.257～.674，p＜.01), while there exists no significant difference or correlation between attitude and knowledge (r=.025，p＞.05).
Implications ：
This study concludes that the understanding of patients with terminal diseases is insufficient among care takers despite their difference in age, experience, or ranks. It is suggested that clinical education and practical training in palliative care are urgently needed so as to improve the quality of life of patients as well as their families.

Key words：Intensive Care Unit Nurses、End-of-life、Palliative Care、
Knowledge、Attitude

誌謝 ----------------------------------------------------------------i
中文摘要 ----------------------------------------------------------------ii
英文摘要 ----------------------------------------------------------------iv
目錄 ----------------------------------------------------------------vi
附錄 ----------------------------------------------------------------ix
圖表目錄 ----------------------------------------------------------------x
第一章 緒論---------------------------------------------------------- 1
第一節 研究背景與重要性---------------------------------------- 1
第二節 研究目的---------------------------------------------------- 5
第三節 研究問題---------------------------------------------------- 6
第四節 名詞解釋---------------------------------------------------- 7
第二章 文獻查證---------------------------------------------------- 9
第一節 生命末期安寧緩和療護---------------------------------- 9
第二節 重症照護與生命末期安寧療護------------------------ 12
第三節 護理人員對生命末期安寧療護認知與態度--------- 16
第四節 護理人員生命末期知識與態度的影響因素--------- 21
第三章 研究方法---------------------------------------------------- 25
第一節 研究架構--------------------------------------------------- 25
第二節 研究設計--------------------------------------------------- 27
第三節 研究對象及地點------------------------------------------ 27
第四節 研究樣本數------------------------------------------------ 27
第五節 研究工具--------------------------------------------------- 28
第六節 研究倫理考量--------------------------------------------- 30
第七節 資料收集和分析------------------------------------------ 31
第四章 研究結果--------------------------------------------------- 33
第一節 研究對象基本屬性--------------------------------------- 33
第二節 重症護理人員對末期病人安寧療護知識程度------ 36
第三節 重症護理人員對安寧療護照護態度------------------- 39
第四節 重症護理人員基本屬性與安寧療護病人照護知識、態度之相關性-----------------41
第五章 討論---------------------------------------------------------- 59
第一節 研究對象基本屬性---------------------------------------- 59
第二節 研究對象基本屬性、安寧療護的知識與態度之相關性------------------------- 60
第六章 結論與建議------------------------------------------------- 62
第一節 研究結論---------------------------------------------------- 62
第二節 研究限制---------------------------------------------------- 64
第三節 護理之應用與建議---------------------------------------- 65
參考文獻 ----------------------------------------------------------------67
中文文獻---------------------------------------------------- 67
英文文獻---------------------------------------------------- 76




附錄目錄
附錄一 基本問卷資料---------------------------------------------- 81
附錄二 加護病房護理人員對生命末期病人安寧療護知識量表-------------------------82
附錄三 重症護理人員對生命末期安寧照護態度量表------ 84
附錄四 專家表面效度---------------------------------------------- 86
附錄五 安寧療護照護態度量表之項目分析表--------------- 90
附錄六 問卷同意書------------------------------------------------ 92
附錄七 人體試驗委員會同意書---------------------------------- 93
附錄八 專家效度名單---------------------------------------------- 94

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