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研究生:魏碧青
研究生(外文):Pi-Ching Wei
論文名稱:急重症護理人員對無效醫療知識之探討-以CPR為例
論文名稱(外文):Evaluation of Critical Care Nurse’s Knowledge of the Medical Futility when CPR
指導教授:唐福瑩唐福瑩引用關係
指導教授(外文):Fu-In Tang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:101
中文關鍵詞:急重症護理人員無效醫療心肺復甦術知識
外文關鍵詞:Critical care nursesMedical futilityCardiopulmonary resuscitationKnowledge
相關次數:
  • 被引用被引用:3
  • 點閱點閱:737
  • 評分評分:
  • 下載下載:86
  • 收藏至我的研究室書目清單書目收藏:3
背景:根據世界衛生組織建議,生命末期照護首要目標是提昇生活品質,而不是極
盡延長生命。一次次施行心肺復甦術來試圖延長末期病人生命,便可視為無
效醫療。急重症護理人員在臨床實務上常根據病人、家屬與社會上的種種期
望,需與醫師溝通,因此需要相當知識背景來思考,是否對末期病人提供了
無效醫療。
目的:探究急重症護理人員執行人心肺復甦術時,有關無效醫療專業知識程度及其
相關因素,早期推動相關教育,希望透過以知識背景為基礎的溝通,停止無
效醫療之照護。
方法:採橫斷性調查研究,運用三部分(基本資料、知識評估、教育需求)的自擬結
構式問卷,採立意取樣來評量急重症護理人員相關知識程度與其教育需求。
樣本來自北部某醫學中心同意參與本研究的248位急診與加護單位(排除兒
科、燒燙傷病房)護理人員。
結果:急重症護理人員平均為34.4歲、護理年資11.1年、急重症工作年資6.1
年,98.0%曾照護過心肺復甦術無效醫療病人。顯示(1)當心肺復甦術時,
無效醫療知識平均得分67.8分。(2)無效醫療知識以倫理知識得分較高,概
念知識得分較低。(3)護理人員職稱、職級愈高,定期接受過相關訓練課程
者有較高知識得分。(4)自覺知識大致充足者僅50.4%,自覺需要相關教育
訓練者高達83.0%。(5)主要知識來源是醫院在職教育,當有疑問時依序會
詢問護理同仁、醫師、安寧共照師等來解決 (6)主觀的自覺知識程度與客觀
的知識評量呈現正相關,主觀自覺知識程度愈高,客觀知識程度也愈 高,與
知識需求間則未呈現明顯相關性及差異。
結論:本研究結果顯示急重護理人員對急救時的無效醫療相關知識不足。急重護
理人員職稱、職級愈高,定期接受過相關訓練課程者有較高知識得分,可
做為新進護理人員良好的諮商對象。期望藉由研究結果,增加專門諮詢場
所、跨團隊討論及相關訓練課程,來提升急重症護理人員面對執行心肺復
甦術時,無效醫療之相關照護知識。

Background: According to the World Health Organization
recommends that end of life care, the primary
goal is to enhance the quality of life, rather
than the culmination of prolonged life.
Resuscitate again to try to extend the life of
terminally ill patients, health care can be
regarded as invalid. Critical Care Nurses often
based on patients, their families and the
various expectations of the community, the need
to communicate with physicians in clinical
practice, it requires considerable background
knowledge to think about whether to provide a
medical futility for terminally ill patients.
Objective: To explore critical nurses face medical futility
when CPR in the professional level of knowledge,
through a knowledge-based communication
background, early push to stop medical futility.
Methods: A cross-sectional survey study, the use of three
parts (basic information, knowledge assessment,
educational needs) self-structured questionnaire,
purposive sampling to evaluate critical nurses’
knowledge and their educational needs. Samples
from a medical center agreed to participate in
this study 248 emergency and intensive care units
(excluding pediatrics, burns ward) nurses.
Results: Critical care nurses averaged 34.4 years, 11.1
years in nursing, emergency and intensive working
years 6.1 years, 98.0% had medical futility care
when CPR. Display (1) When CPR, medical futility
knowledge average score 67.8 points. (2)Medical
futility knowledge in order to score high ethical
knowledge, conceptual knowledge score low. (3)
Nursing titles, occupation level higher, regularly
received relevant training courses had higher
knowledge scores. (4) Subjective conscious
knowledge broadly adequate in only 50.4%, but
perceived need for relevant education trainers up
to 83.0%. (5) The main source of knowledge is the
hospital service education, when in doubt order to
ask the nursing staff, physicians, according to
the division of tranquility to the settlement (6)
The degree of knowledge of the conscious
subjective and objective knowledge assessment
showed a positive correlation, subjective
consciousness the higher level of consciousness,
the higher the degree of objective knowledge, and
knowledge between the demand is not showing
significant correlation and differences.
Conclusion: Critical nursing titles, occupation level
higher, regularly received relevant training
courses had higher knowledge scores, new nurses
can be used as a good counseling object.
Expectation with the results, increase
specialized consulting establishments, the cross-
team discussions and related training courses, to
mention critical care nurses’ knowledge of medical
futility when CPR.

目錄
誌謝.................................................. .i
中文摘要................................................ii
英文摘要................................................iii
目錄....................................................iv
圖目錄..................................................vii
表目錄................................................. viii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
第二章 文獻查證.........................................4
第一節 無效醫療......................................4
(一)無效醫療相關概念..................................4
(二)無效醫療決策.....................................6
(三)影響無效醫療因素..................................8
第二節 心肺復甦術 ...................................10
(一)心肺復甦術發展史.................................10
(二)心肺復甦術運用..................................10
(三)心肺復甦術成效..................................12
(四)不予心肺復甦術..................................16
(五)停止心肺復甦術時之無效醫療........................17
第三節 心肺復甦術時之無效醫療知識及其相關研究............19
(一)臨床急救情境....................................19
(二)不予或撤除.....................................20
(三)影響因素........... ...........................22
(四)教育需求.......................................24
第三章 研究方法........................................27
第一節 研究架構.....................................27
第二節 名詞定義.....................................28
第三節 研究問題.....................................29
第四節 研究設計與對象................................29
第五節 研究工具.....................................31
第六節 研究工具之信效度..............................31
第七節 倫理考量.....................................36
第八節 資料分析.....................................37
第四章 研究結果........................................38
第一節 急重症護理人員基本資料.........................38
第二節 急重症護理人員心肺復甦術時,無效醫療知識及教育需求
測驗結果.....................................41
第三節 急重症護理人員心肺復甦術時,無效醫療知識及教育需求
影響因素.....................................46
第四節 心肺復甦術時,無效醫療知識問卷鑑別度分析..........52
第五章 討論...........................................54
第一節 知識程度.....................................54
第二節 相關因素.....................................56
第三節 需求與訓練...................................57
第六章 結論與建議......................................61
第一節 結論........................................61
第二節 建議與限制...................................62
第七章 文獻查證........................................64
附錄
附錄一 問卷.........................................75
附錄二 知識問卷(說明) ...............................80
附錄三 研究同意書...................................100
附錄四 專家效度名單.........................101
圖表目錄
圖目次
圖3-1急重症護理人員心肺復甦術時,無效醫療知識相關性探討之研究架構
...............................................27
圖3-2研究量表編制建構流程..............................35
圖4-1急重症護理人員心肺復甦術時,無效醫療知識得分分佈.......41
表目錄
表目次
表4-1急重症護理人員之基本資料............................39
表4-2急重症護理人員心肺復甦術時,無效醫療知識分項正確率排序...43
表4-3急重症護理人員心肺復甦術時,無效醫療自覺知識程度........44
表4-4急重症護理人員心肺復甦術時,無效醫療知識教育需求........44
表4-5急重症護理人員心肺復甦術時,無效醫療知識來源...........45
表4-6急重症護理人員心肺復甦術時,無效醫療知識疑問時如何解決....45
表4-7急重症護理人員基本屬性與心肺復甦術時,無效醫療知識之
單變項分析......................................47
表4-8急重症護理人員基本屬性與心肺復甦術時,無效醫療知識自
覺程度、教育需求之單變項分析.......................49
表4-9心肺復甦術時,無效醫療知識、自覺知識程度與教育需求之相關性..50
表4-10心肺復甦術時,無效醫療知識與自覺知識程度、教育需求之單變項分
析..51
表4-11急重症護理人員心肺復甦術時,無效醫療知識量表鑑別度檢測..53







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