臺灣博碩士論文加值系統

醫療科技的進步使重症患者得以延長壽命，然而，醫療終究有其極限。在某些情況下，臨床上任憑再努力對重症病人施予醫療處置，其結果是徒勞無功的無效醫療仍是時有所見。我國政策上欲對重症末期無效醫療制定評估與照護標準，但國內對於何謂無效醫療尚無一致性的定論與共識，有關台灣重症患者的無效醫療現況了解也很有限，故本研究經由現象學研究法，由加護病房護理人員的觀點，瞭解我國的無效醫療經驗。
本研究以台灣中部一家醫學中心、一家區域醫院為研究場域，立意取樣及滾雪球取樣方式選擇在成人加護病房工作資歷一年以上之護理人員，進行一對一的半結構式深度訪談並錄音，共有8位護理人員參與，研究過程以Lincoln與Guba(1985) 提出的可信賴性(trustworthiness)作為嚴謹度之控制，採Colaizzi(1978)所提出的步驟進行資料分析，研究結果共涵蓋五個主題：一、護理人員對無效醫療的定義；二、演變成無效醫療的病人；三、無效醫療的考量；四、無效醫療的發生；五、護理人員面對無效醫療。此研究結果能幫助台灣重症患者無效醫療情況上的瞭解，並作為臨床照護、教育與相關政策擬定之參考。

Advanced medical technology could extend life of critical patients, but it has its limitations. Medical interventions that prolong life without effect that someone can appreciate as a benefit. It is imperative to develop a policy of medical futility for critical patients. However, medical futility of critical patients not only lacks of knowing but also has no consensus about its definition in Taiwan. The purpose of this phenomenological study was to explore the ICU nurses'' medical futility experience on taking care of critical patients.
Snowball sampling and purposeful sampling were used to recruit nurses at one medical center and a regional hospital located in central Taiwan. Researcher collected data using in-depth, semi-structured and tape-recorded interviews. Eight participants participated in this study. The trustworthiness of the study was examined using Lincoln and Guba (1985) principles. Data were analyzed using the Colaizzi (1978) method. Five major themes emerged, including ICU nurse’s definition of futility; the patients evolved into medical futility; consideration of medical futility; reasons for providing futilely care; and facing futile care. The study findings could help understand medical futility in critical patients, and provide clinical care, education and medical policy development.

誌謝 I
中文摘要 III
Abstract IV
目次 V
第一章　緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 3
第三節　名詞界定 4
第二章　文獻探討 5
第一節 無效醫療的定義 5
第二節 無效醫療的生命倫理觀點 8
第三節 加護病房特性 10
第四節 國外無效醫療的相關研究 12
第五節 台灣的無效醫療現況 15
第三章 研究設計 19
第一節 現象學研究法簡介 19
第二節 研究對象及場所 20
第三節 資料收集方法與過程 22
第四節 資料分析 27
第五節 嚴謹度的控制 30
第六節 研究倫理考量 33
第四章　研究結果 35
一、護理人員對無效醫療的定義 36
（一）持續治療對病人病情無明顯的好處時 36
（二）持續治療只延長病人的死亡過程時 37
二、演變成無效醫療的病人 37
（一）高死亡風險的病人 38
（二）高惡化風險的病人 39
三、無效醫療的考量 39
（一）生理徵象的觀察 40
（二）生活品質的衡量 41
四、無效醫療的發生 42
（一）病情變化難以預料 42
（二）無效的認定因人而異 43
（三）溝通不足 44
（四）家屬放不下 46
（五）文化習俗的考量 47
五、護理人員面對無效醫療 49
（一）法律壓力的牽制 49
（二）配合醫囑，避免衝突 50
（三）取得治療的共識 51
第五章 討論及結論 55
第一節 研究的發現 55
第二節 研究者的省思 66
第三節 研究結論與建議 68
第四節 研究限制 70
參考資料 71
附錄一：人體試驗委員會研究計畫許可書 80
附錄二：研究計畫簡介的信函內容 82
附錄三：受試者同意書 83
附錄四：訪談指引 94

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