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研究生:林美伶
研究生(外文):Mei-LingLin
論文名稱:受限之選擇:選擇性手術病患決定手術經驗
論文名稱(外文):Choices within restrictions: Exploring Taiwanese elective surgery patients’ decision-making experiences
指導教授:陳清惠陳清惠引用關係
指導教授(外文):Ching-Huey Chen
學位類別:博士
校院名稱:國立成功大學
系所名稱:健康照護科學研究所
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:2012
畢業學年度:100
語文別:中文
論文頁數:155
中文關鍵詞:選擇性手術尊重病人自主權知情同意手術決定
外文關鍵詞:elective surgeryrespect for patients’ autonomyinformed consentsurgical decision-making
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尊重病人自主權乃是健康照護專業人員的義務與責任,在病人作治療決定前確保病人知情同意的權利;若是專業人員不清楚病人作手術決定時的處境,知情同意恐流於程序,而無法提供病人展現自主性的機會。本研究期望探討病人手術決定過程,由病痛開始尋求醫療的過程,進而理解其決定的處境及自主決定的經驗。採用現象學研究法,以深度訪談方式,收集南部某醫學中心17位手術後病人之手術決定經驗,所獲得資料以Colaizzi方法進行分析。研究結果發現病人決定手術經驗包括二個主題:手術是身不由己的決定及無法改變決定中的選擇。從研究結果呈現病人乃是經歷身不由己的病痛,迫使其必須選擇手術,而在受限制的選擇下,病人僅能選擇各種溝通方式,維持與手術醫師和諧的人際關係下,爭取手術的安全。因此,若能理解病人作決定過程中身不由己的情境、交託醫療專業的無奈以及在維持自身醫療安全之努力,健康照護專業人員更應主動關注病人了可能的疑慮,護理人員更能在此過程扮演代言人的角色,以增進醫病互信關係的建立,如此才能落實知情同意在尊重自主之真正意涵。
To respect patients’ autonomy, health care professionals are obligated to protect and ensure patients’ rights by obtaining informed consent before a treatment starts. Nevertheless, informed consent is only a treatment procedure; it cannot ensure a patient’s autonomy if health care professionals fail to understand the context of the patient’s surgery decision-making. This study explored 17 elective surgery patients’ experiences during their decision-making processes. The research was conducted with a phenomenology method and Colaizzi's method was adopted for the data analysis. The participants were recruited from a teaching hospital in southern Taiwan. Two themes emerged from the data analysis, i.e., “An involuntary yet necessary alternative--a surgery” and “Alternatives constrained by the unalterable decision--the surgery”. Under such constraints, patients are forced to maintain harmony with their physicians in their interactions to ensure their safety during surgery. Therefore, it was asserted that medical professionals’ disregard to their patients’ vulnerability in their decision-making, and their lack of caring attitude toward their patients would render informed consent a mere medical routine. Hence medical professionals should empathize with their patients while they are dealing with their distress, and take the initiative to address their patients’ doubts. In a medical context, nurses can be the best advocators for such a concept and practice, and with their efforts trustful doctor-patient relationships can be facilitated to make the respecting patients' autonomy credence truly meaningful.
中文摘要 I
致謝 III
目錄 V
表目錄 VII
圖目錄 VII
第一章 緒 論 1
第一節 研究動機 1
第二節 研究重要性 4
第三節 研究目的 6
第四節 名詞說明 7
第二章 文獻查證 8
第一節 尊重病人自主發展過程 8
第二節 疾病對個體的威脅 18
第三節 醫病遭逢之情境 21
第四節 醫療處置的交付與決定 33
第五節 文獻小結 36
第三章 研究方法 37
第一節 研究方法之選擇 37
第二節 研究準備階段 51
第三節 研究執行階段 56
第四節 研究完成階段 66
第四章 結 果 67
第一節 參與者基本資料 67
第二節 整體描述 68
第三節 結果內容 69
第五章 討 論 93
第一節 研究結果之反思 93
第二節 與先前文獻之對話 95
第三節 對尊重自主原則之反思 106
第六章 結 論 119
第一節 摘要研究結果 119
第二節 研究限制 121
第三節 研究建議與應用 123
參考資料128
附錄 訪談稿 144



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