臺灣博碩士論文加值系統

研究背景及目的：護理人員對於安寧緩和醫療條例認知與不施行心肺復甦術(Do Not Resuscitate, DNR)態度，會影響病患及其家屬的決策及善終照護，現有研究多侷限於成人單位之探討，少有新生兒不施行心肺復甦術之相關研究。本研究目的：(1) 探討新生兒加護病房護理人員對於安寧緩和醫療條例的認知；(2) 探討新生兒加護病房護理人員照顧DNR病嬰之態度；(3) 分析影響新生兒加護病房護理人員對於安寧緩和醫療條例認知之相關因素；(4) 分析影響新生兒加護病房護理人員照顧DNR病嬰態度之相關因素。
研究方法：研究為橫斷式描述相關性研究，於2015年5月至6月間，以結構式問卷進行資料的收集。研究對象採立意取樣，選取符合收案條件之新生兒加護病房護理人員共計43人，分別是北部某醫學中心30人及某區域教學醫院13人。問卷包括：基本資料表、安寧緩和醫療條例知識量表(新生兒版)、新生兒加護病房護理人員對照顧DNR病嬰之態度量表三部分，量表題目針對新生兒適用性予以修改，聘請5位安寧緩和照護專家進行專家內容效度審查，安寧緩和醫療條例知識量表(新生兒版)量表 CVI值0.93，量表內在一致性Cronbach’s α值0.547，新生兒加護單位護理人員對照顧DNR病嬰之態度量表CVI值0.92，量表內在一致性Cronbach’s α值0.96，問卷資料收集完畢後，使用SPSS for windows 22 之統計軟體進行分析。
研究結果：安寧緩和醫療條例知識量表(新生兒版)平均得分11.74分，顯示不論醫學中心或區域醫院之新生兒加護病房護理人員，對於新生兒安寧緩和醫療條例的認知皆有一定之水準，但在辨別病嬰是否適用於安緩和醫療條例、DNR政策執行方面，高達88.4%及62.8%答錯，多數的護理人員在此方面有困難。認為自己的宗教信仰對照顧DNR病嬰有幫助者，其在對安寧緩和醫療條例認知程度較高，且p = 0.011具有統計學上的顯著意義。在照顧DNR病嬰態度上，以生理態度的平均分數最高，平均值為4.7(SD0.4)；年齡與心理態度有相關性，p = 0.05達統計學上的顯著意義，年齡較大者，心理態度較為正向；照顧DNR病人的經驗則與照顧DNR病嬰態度上有顯著相關p = 0.005，有經驗者，在照護態度上趨於正向。在本研究中，安寧緩和醫療條例認知程度與照顧DNR病嬰之態度並無顯著相關(p = 0.187)，可能與研究個案數樣本較少有關。
本研究結果希望能提供臨床護理人員、決策者、教育者制定照護政策、教學計畫、訓練課程之參考，建立臨床DNR相關政策及規範、更充足的教育、臨床人員諮詢管道、經驗的分享。

Background and objective: Nurses’ knowledge of Hospice Palliative Care Act and attitude toward “Do Not Resuscitation (DNR)” will affect patients and their families in decision-making and hospice care. As most of the studies focued on adults, few studies explored the issues of neonatal do not resuscitation. The purpose of this study was: (1) to investigate nurses’ knowledge of Hospice Palliative Care Act in the neonatal intensive care unit (NICU), (2) to investigate nurses’ attitude toward caring DNR infants in the NICU, (3) to analysis related factors that affect nurses’ knowledge of Hospice and Palliative Care Act in the NICU, (4) to analysis related factors that affect nurses’ attitude toward DNR in the NICU.
Methods: A cross-sectional descriptive correlational design of purposive sampling approach was conducted. A total of 43 subjects were recruited, 30 from a medical center and and 13 from a regional teaching hospital in northern Taiwan. during May to June, 2015. A structured questionnaire was used, including basic data, Hospice Palliative Care Act knowledge (Newborn), the attitude toward caring DNR infants in the NICU. The questionnaire was modified and consulted 5 reference experts to develop and establish reliability and validity. The CVI of Hospice Palliative Care Act knowledge (Newborn) was 0.93 and the attitude toward caring DNR infants in the NICU was 0.92. The Cronbach’s α value of Hospice Palliative Care Act knowledge (Newborn) was 0.547 and the attitude toward caring DNR infants in the NICU was 0.96.The collected data were analyzed in SPSS for windows 22 software.
Result: The mean score of Hospice Palliative Care Act knowledge (Newborn version) was 11.74, results showed both nurses in medical center and regional teaching hospital had correct knowledge. Almost 88.4% and 62.8% nurses had wrong answer at distinguishing suitable cases and implementing DNR policies that means nurses had difficulty in these parts. Nurses who thought their religious beliefs were helpful at caring DNR infants, had more correct knowledge about Hospice Palliative Care Act, the p-value was 0.011. The attitude toward caring DNR infants, compared the mean score to physiological, psychological, social and spiritual attitude, physiological attitude (mean = 4.7) was the highest. Age was significantly positive correlation to psychological attitude (p = 0.05), nursing experience of caring DNR patients was significantly positive correlation to the attitude toward caring DNR infants (p = 0.005). In this study, Hospice Palliative Care Act knowledge (Newborn version) and the attitude toward caring DNR infants in the NICU were not correlated (p = 0.187), maybe caused by insufficient subjects .
This research can provide a valuable reference for clinical nurses and nursing educators, decision-makers for establishing the DNR guidelines, policies and training programs for ill infants. Also, it is hoped to develop an interface of clinical counseling services for nurses to have experience sharing of caring DNR infants.

致謝.................................................... i
中文摘要 ...............................................ii
英文摘要 ...............................................iv
目錄...................................................vi
表目錄.................................................ix
圖目錄..................................................x
第一章 續論..............................................1
第一節 研究動機與重要性...................................1
第二節 研究目的..........................................3
第三節 研究問題..........................................4
第四節 名詞界定..........................................5
第二章 文獻查證..........................................7
第一節 不施行心肺復甦術相關法規...........................7
第二節 不施行心肺復甦術的病嬰之疾病及形式.................10
第三節 影響不施行心肺復甦術決策因子.......................12
第四節 安寧緩和醫療條例認知與不施行心肺復甦術態度..........15
第三章 研究方法..........................................19
第一節 研究設計..........................................19
第二節 研究架構..........................................20
第三節 研究對象及場所.....................................21
第四節 研究工具..........................................22
第五節 研究過程..........................................25
第六節 倫理考量..........................................26
第七節 分析方法..........................................27
第四章 分析及結果 ........................................29
第一節 研究對象基本資料...................................29
第二節 新生兒加護病房護理人員對安寧緩和醫療條例(新生兒版)認知.33
第三節 新生兒加護病房護理人員對照顧DNR病嬰之態度............37
第四節 影響新生兒加護病房護理人員對於安寧緩和醫療條例認知與照顧
DNR病嬰之態度的相關因素...........................41
第五節 研究結果小結.......................................50
第五章 討論..............................................51
第一節 新生兒加護病房護理人員對新生兒安寧緩和醫療條例認知及影響 因素.....................................................51
第二節 新生兒加護病房護理人員對照顧DNR病嬰的態度及影響因素..53
第三節 新生兒加護病房護理執行DNR及安寧緩和照護的挑戰........56
第六章 結論與建議 .........................................59
第一節 結論...............................................59
第二節 研究限制...........................................60
第三節 應用與建議 .........................................60
參考資料..................................................63
附錄一 新生兒加護病房護理人員對安寧緩和醫療條例認知與不施行心肺復甦術態度問卷之專家內容效度評分表.........................69
附錄二 基本資料表 .........................................79
附錄三-1安寧緩和醫療條例知識量表(新生兒版)..................80
附錄三-2安寧緩和醫療條例知識量表正確答案(新生兒版)...........82
附錄三-3安寧緩和醫療條例知識量表(原量表)....................84
附錄四-1 新生兒加護單位護理人員對照顧DNR病嬰之態度量表.......86
附錄四-2護理人員對照顧DNR病患之態度量表.....................88
附錄五 臺大醫院研究倫理委員會審查通過公文...................89
附錄六 臺北醫學大學暨附屬醫院聯合人體研究倫理委員會通過證明函.91

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