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研究生:王淑演
研究生(外文):WANG, SHU-YEN
論文名稱:成人加護病房家屬壓力感受與疾病末期醫療處置態度對DNR同意書簽署之探討
論文名稱(外文):Influence of Perceived Stress and Attitude toward End-of-life Treatment on DNR Designation in Family of Intensive Care Unit Patients
指導教授:吳麗珍吳麗珍引用關係
口試委員:黃惠子許雅娟
口試日期:2017-05-19
學位類別:碩士
校院名稱:長榮大學
系所名稱:護理學系碩士班
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:2017
畢業學年度:105
語文別:中文
論文頁數:74
中文關鍵詞:壓力感受疾病末期醫療處置態度DNR同意書簽署加護病房
外文關鍵詞:perceived stressattitude toward end-of-life treatmentDNR designationIntensive care unit (ICU)
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本研究採橫斷性設計,探討加護病房家屬的壓力感受與疾病末期醫療處置態度之相關性以及影響家屬對DNR同意書簽署之因素。研究者於2015年3月至2016年6月期間,於南部某醫學中心之成人內科加護病房收案,以方便取樣方式共徵得61位家屬同意參與研究。樣本包括36位男性和25位女性,平均年齡47.67歲。研究工具為「家屬壓力感受量表」及「疾病末期醫療處置態度量表」,家屬是否簽署DNR則以病歷上的記錄為依據。
從「家屬壓力感受量表」之得分,顯示家屬之壓力感受處於輕度壓力至中度壓力之間,各壓力感受面向由高至低,依序為「病人疾病」、「個人」、「環境」及「人際」。家屬壓力感受之「病人疾病」及「環境」會受到家屬年齡的影響(F=4.40, p<.05;F=4.63, p<.05);家屬壓力感受之「人際」會受到家屬教育程度及是否聽過安寧緩和醫療(F=-2.45, p<.05;F=2.62, p<.05)的影響;家屬壓力感受之「病人疾病」、「個人」、「人際」及「環境」會受到病人進入加護病房原因的影響(F=2.69, p<.01;F=2.19, p<.05;F=2.08, p<.05;F=3.69, p<.01)。在對疾病末期醫療處置態度上,家屬傾向採取緩和性治療,90.2%的家屬同意積極性治療會增加病人身心方面的痛苦,有63.9%的人表示不會鼓勵病人接受積極性治療。
家屬的壓力感受與疾病末期醫療處置態度之相關性分析,結果呈現負相關(γ=-.27, p<.05),表示家屬在人際方面之壓力感受越高,對病人疾病末期醫療處置態度越傾向採取積極性治療。
以邏輯氏迴歸分析影響家屬對DNR同意書簽署之因素,顯示家屬對DNR同意書之簽署未受到家屬對疾病末期醫療處置經驗、病人年齡、進入加護病房原因、疾病嚴重度、家屬壓力感受及家屬對病人疾病末期醫療處置態度之影響。樣本數太小可能是無法達到統計顯著水準的原因。
研究結果可幫助加護病房醫護人員了解家屬的壓力感受及家屬對病人疾病末期醫療處置態度,以提供醫療團隊面對家屬溝通病人疾病末期醫療處置決策之參考。
This cross-sectional study investigates the correlation between perceived stress and attitude toward end-of-life treatment, and explores the factors that influence DNR designation in family members of ICU patients. A convenience sample of 36 male and 25 female family members was recruited from intensive care units of a medical center in Tainan from March 2015 to October 2016. The average age was 46.67. The instruments used were "Questionnaires of Stress Perception of Patients’ Families" and "Questionnaires of Attitude toward End-Of-Life Treatment". The patient’s chart was used for designation of DNR.
"Questionnaires of Stress Perception of Patients’ Families" scores showed families perceiving mild to moderate stress. The highest subscale score was "patients’ condition", followed by "personal", "environment" and "interpersonal relationship". The "patients’ condition" and "environment" of perceived stress correlated with family member’s age (F=4.40, p<.05; F=4.63, p<.05). The "interpersonal relationship" of perceived stress correlated with family member’s education and whether to hear about hospice-palliative care (F=-2.45, p<.05; F=2.62, p<.05). The "patients’ condition", "personal", "interpersonal relationship" and "environment" of perceived stress correlated with the causes of disease (F=2.69, p<.01; F=2.19, p<.05; F=2.08, p<.05; F=3.69, p<.01). Regarding “Attitudes toward End-of-Life Treatment", family members generally favored palliative treatment at the end-of-life: 90.2% of family members agreed that aggressive treatment would increase the patient's physical and mental pain and 63.9% would not want patients to receive aggressive treatment.
There was a negative correlation between the perceived stress and attitude toward end-of-life treatment (γ = -.27, p<.05). It meant that the higher the interpersonal relationship stress experienced by family members, the more likely they were to ask for aggressive treatment for patients.
Logistic regression was used to examine factors that influenced DNR designation. The independent variables were the family experience of end-of-life treatment, patient age, the causes of disease, the severity of ill, perceived stress and attitude toward end-of-life treatment. The results showed that none of the factors in this study influenced the designation of signing DNR by family members. The small sample size in this study may be one of reasons that none of these variables were statistically significant.
However, the study can help medical providers understand the stress experienced by family members and their attitude toward end-of-life treatment. When medical providers speak with family members about end-of-life treatment for the patient, they can be more empathetic and understanding.
第壹章 緒論 1
第一節 研究背景、動機與重要性 1
第二節 研究目的 4
第三節 研究架構 5
第貳章 文獻探討 7
第一節 加護病房家屬的壓力感受及其相關因素 7
第二節 加護病房家屬疾病末期醫療處置態度及其相關因素 10
第三節 家屬簽署DNR同意書之相關因素 13
第參章 研究方法 16
第一節 研究設計 16
第二節 研究對象及場所 16
第三節 研究工具及信效度檢測 16
第四節 資料收集步驟 19
第五節 倫理考量 19
第六節 資料分析方法 20
第肆章 研究結果 21
第一節 成人加護病房家屬及病人之基本資料 21
第二節 成人加護病房家屬壓力感受與家屬及病人的基本屬性之關係 24
第三節 成人加護病房病人疾病末期醫療處置態度與家屬及病人的基本屬性之關係 31
第四節 家屬對疾病末期醫療處置態度與壓力感受之相關性 37
第五節 成人加護病房家屬簽署DNR同意書之影響因素 38
第伍章 討論 41
第一節 成人加護病房家屬壓力感受與家屬及病人基本屬性之相關因素 41
第二節 成人加護病房病人疾病末期醫療處置態度與家屬及病人基本屬性之相關因素 43
第三節 成人加護病房家屬壓力感受與家屬對病人疾病末期醫療處置態度之相關性 44
第四節 成人加護病房家屬簽署DNR同意書之影響因素 44
第陸章 結論與未來研究之建議 46
第一節 結論 46
第二節 建議 47
第三節 研究限制 48
參考文獻 49
中文部分 49
英文部分 53
附錄 59
附錄一 IRB證書 59
附錄二 參與研究同意書 61
附錄三 家屬及病人基本資料 65
附錄四 家屬壓力感受量表 68
附錄五 疾病末期醫療處置態度量表 71
附錄六 家屬壓力感受量表使用同意書 73
附錄七 疾病末期醫療處置態度量表使用同意書 74

圖表目錄
圖2-1 成人加護病房家屬對DNR同意書簽署之概念架構圖 5
表4-1 成人加護病房家屬之基本資料 23
表4-2 成人加護病房病人之基本資料 23
表4-3 成人加護病房家屬壓力感受四項分量表分數 28
表4-4 家屬基本屬性對家屬壓力感受之t檢定分析 29
表4-5 病人基本屬性對家屬壓力感受之t檢定及變異數分析 30
表4-6 成人加護病房家屬對病人疾病末期醫療處置態度二項分量表分數 33
表4-7家屬對病人疾病末期醫療處置態度開放性問題統計 34
表4-8 家屬基本屬性對病人疾病末期醫療處置態度之t檢定及變異數分析 35
表4-9 病人基本屬性對病人疾病末期醫療處置態度之t檢定及變異數分析 36
表4-10 家屬壓力感受與家屬對病人疾病末期醫療處置態度之皮爾森積差相關 37
表4-11 家屬及病人之基本屬性對DNR同意書簽署之卡方檢定及t檢定分析 39
表4-12 影響家屬對DNR同意書簽署之羅吉斯迴歸分析 40
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