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  • 學位論文

末期重症病人之緩和鎮靜治療:家屬顧慮及對家屬哀傷程度的影響

Palliative Sedation for Terminal Critically ill Patients : Family Concerns and Levels of Grief

指導教授 : 林佳靜

摘要


緩和鎮靜治療在現代加護病房幾乎已經為一項常見且例行的醫療處置 。重症病人因疾病需求必須進入加護病房照護,甚至需要醫療儀器以及呼吸器的輔助使用,同時予以鎮靜治療來緩解疼痛及控制呼吸。然而,病情不斷變化進展,病人家屬在面對因鎮靜治療而喪失意識、無法言語表達的至親病人時,心中不免擔心病人是否會因此而一覺不醒直到死亡,或是無法再與病人溝通,甚至會影響其日後喪親之調適,然而過去這方面的研究相當少。故此研究目的是探討末期重症病人在加護病房治療過程中使用緩和鎮靜治療,家屬之顧慮及對家屬悲傷程度之影響。本研究採描述性相關性研究設計,以立意取樣於台北某醫學中心之加護病房進行,主要研究對象選取為:加護病房之末期重症病人及其家屬,以結構式問卷進行訪談,針對病人部份:於加護病房中所有死亡病人完成病人基本資料表,若病人在加護病房中有使用緩和鎮靜治療者,則完成緩和鎮靜治療使用情形問卷;針對病人家屬部份:除了完成家屬基本資料表外,若病人在加護病房中有使用緩和鎮靜治療者,則完成家屬對於緩和鎮靜治療之顧慮問卷、家屬決策過程問卷,並於喪親後一個月以電話訪談方式,完成所有家屬之哀傷程度量表。為保護個案隱私,研究者取得之資料係以匿名及編號方式處理 ,以SPSS 18.0版套裝統計軟體進行資料分析。結果發現:全部有406位加護病房中的死亡病人。62位受試者病人家屬接受訪談,有使用緩和鎮靜治療的病人有31位、無使用緩和鎮靜治療者有31位,在加護病房中末期重症病人是否有使用緩和鎮靜治療,其家屬之喪親後哀傷反應程度並沒有顯著影響,僅有在連續性緩和鎮靜使用情形的部分發現 ,當緩和鎮靜治療開始至死亡之天數越久則家屬的哀傷程度就越低, 國內加護病房中緩和鎮靜治療使用率為44.8%、使用緩和鎮靜治療至死亡平均天數為11.43天,多以持續性、常規性使用為主,與國外研究相似;雖然如此,研究中發現家屬對於末期重症病人之緩和鎮靜治療仍有些顧慮,認為我希望能有機會與全體家屬及醫療團隊一起討論 、我因無法與他/她交談而感到不安、我覺得他/她能有尊嚴的睡著及我對於他/她病況的改變尚未準備好等之顧慮。期望藉由此結果能協助加護病房中的醫護人員了解重症病人家屬之感受,適時並提早與家屬溝通,讓家屬及病人能有更多時間考慮、溝通,以期讓病人能在加護病房照護過程中達到最佳的症狀控制以及高品質的照護。

並列摘要


Using palliative sedation in the modern intensive care unit (ICU) is a common and routine medical procedure. Due to their illness, terminal patients must enter the ICU care. They even need to use medical equipment and ventilator to maintain lives. At the same time, they may need to receive sedation treatment to relieve pain and to control breath. But it may cause profound family distress, even effect their grief. The purpose of this study is to determine the family concerns and levels of grief in palliative sedation. The survey of the families of cancer patients who received palliative sedation at ICU in one of the medical center in Taipei. The questionnaire survey assessed 406 death patients in the ICU and 62 bereaved families participated. There were 31 participants whose families used palliative sedation therapy; the other 31 participants’ families in the ICU did not use palliative sedation therapy. According to the result, the terminal patients whether used palliative sedation therapy or not, the levels of their families’ grief did not show significant influence. Only when the palliative sedation therapy was given continuously, we could find the longer the therapy was applied, the lower the level of the bereaved families’ grief would achieve. In Taiwan, 44.8% of patients in the ICU used palliative sedation therapy. The average duration of using palliative sedation therapy until to death was 11.43 days. Most of these patients continually and routinely used palliative sedation therapy. It was similar with other foreign research. However, this study found that families of these terminal patients still had some concerns about using palliative sedation therapy. For example, they think that They always urge to discuss with the attending physicians and the whole staves. They are always uneasy about inability to talk to the patients. They hope the patients can pass away peacefully and with dignity. The families are anxious that the patients themselves are not well prepared to face their destined death. It expects that knowing this result can help health professionals to understand the feelings of families of terminal patients in the ICU and to communicate with these families timely and early. It will allow patients and their families to have more time to consider the situations and to communicate each other, in order to help patients in the ICU care process to achieve optimal symptom control and high-quality care.

參考文獻


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