臺灣博碩士論文加值系統

本研究旨在探討加護病房家屬對疾病末期病人醫療決策行為意向及其影響因素，採立意取樣，使用結構式問卷。訪談60位北部某醫學中心內外科加護病房之疾病末期病患家屬。將所收集之資料，以SPSS11.0版進行統計分析。重要結果為：（1）85％家屬同意讓疾病末期病人在加護病房內接受緩和性治療。（2）僅25％家屬聽過安寧緩和醫療條例。（3）91.7％家屬認為醫師第一個應告知家屬疾病末期病人之病情。（4）加護病房家屬對疾病末期病人之「真相告知態度」、「末期醫療處置態度」及「末期醫療決策行為意向」均較正向。（5）加護病房家屬認為病人之生活品質為4.58分，且五成認為病人未達善終。（6）「家屬對病人生活品質看法」之重要預測因子為「簽署DNR同意書」及「有看過他人CPR且有被影響」。（7）「末期醫療決策行為意向」之重要預測因子為「真相告知態度」及「末期醫療處置態度」。（8）「家屬對適切性醫療滿意度」之重要預測因子為「病人住ICU起始日至家屬受訪日」及「病人存活時間」。（9）「病人善終與否」之重要預測因子為「家屬對適切性醫療滿意度」及「病人存活時間」。（10）「有無簽屬DNR同意書」之重要預測因子為「家屬與病人關係」及「醫療決策行為意向」。研究結果讓醫護人員瞭解加護病房家屬，在做末期醫療決策行為時之重要預測因子。以利提供適當之護理措施、減少醫療資源之浪費，並藉著病情真相告知，間接促進病人善終之達成。

The aim of this study was to investigate the factors influenced the behavior intention of medical decision and targeting on the families with terminal patients at intensive care units(ICU).A purposive sampling method was used in.60 families.This data was analyzed by the software of SPSS11.0 version.
The important findings are: (1) When the patients are at the terminal stage of their diseases, 85% of their families are willing to have hospice care at ICU. (2) The Regulations of Hospice Care are known by only 25% of the families. (3) When the patients are at the terminal stage of their diseases,91.7% of their families consider themselves as the first ones to be informed by the doctors. (4) The family of the patients at ICU have a positive attitude toward “truth telling”, “the treatment for terminal stage”, and “terminal medical decision making”. (5) The family of the patients at ICU think the patients’ life quality score was 4.58 in average, and half of them feel that the patients do not have good dying. (6) “DNR agreement” and “having seen CPR to others and having been influenced” are significant predictors to “how the patients’ family think about patients’ life quality”. (7) Regarding to the attitudes of patients’ families, “attitudes toward truth telling” and “the treatment for terminal stage” are significant predictors to “attitudes towards terminal decision making”. (8) “The time interval from the first day of ICU admission to the day of interview” and “patients’ survival time” are significant predictors to “the family’s satisfaction of appropriate medical care”. (9) “The family’s satisfaction of appropriate medical care” and “patients’ survival time” are significant predictors to “ the familiy’s opinion of the patient’s good dying”. (10) “The family - patient relationship” and “attitudes toward terminal decision making” are significant predictors to “DNR agreement”.The results of this study can help medical professionals understand the factors and significant predictors of the terminal decision making by the family of the patients at ICU. It may facilitate us to implement appropriate nursing strategies for terminal patients at ICU and to reduce the medical cost. “Truth telling” is helpful for patients’ good dying.

中文摘要 III
Abstract V
目錄 VII
圖表目錄 X
第壹章 緒論 1
第一節 研究動機 1
第二節 研究目的 4
第三節 研究架構 5
第四節 名詞界定 7
第貳章 文獻查證 10
第一節 疾病末期及心肺復甦術的定義 10
第二節 加護病房家屬與醫護人員末期照護之倫理困境 13
第三節 醫療決策之概念 20
第四節 加護病房病患家屬對疾病末期病人醫療處置之影響因素 24
第五節 末期病人之生活品質及善終 29
第六節 適切性醫療滿意度 32
第參章 研究方法 34
第一節 研究設計 34
第二節 研究對象及場所 34
第三節 研究工具 35
第四節 研究工具信效度檢定 38
第五節 資料收集步驟 44
第六節 倫理關注 46
第七節 資料分析方法 47
第肆章 研究結果 49
第一節 基本資料 49
第二節 真相告知態度、末期醫療處置態度及末期醫療決策行為之意向 57
第三節 疾病末期病人之生活品質 72
第四節 家屬對適切性醫療與病人善終的滿意度 74
第五節 生活品質及簽署DNR同意書與其影響因素之關係 76
第六節 滿意度及善終與其影響因素之關係 83
第七節 簽署DNR同意書及善終之重要預測因子 90
第伍章 討論 92
第一節 國內外真相告知態度之比較 92
第二節 簽署DNR同意書及其影響因素之比較 93
第三節 加護病房病人生活品質及存活時間之比較 95
第四節 適切性醫療滿意度及善終之影響因素比較 96
第陸章 結論與未來研究之建議 98
第一節 結論 98
第二節 護理應用及建議 101
第三節 研究限制 103
中文部分 104
英文部分 107

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