生命末期醫療決策概念分析

Concept Analysis of Decision Making in End of Life

孫婉娜(Wan-Na Sun) ； 蘇靖幃(Jing-Wei Su) ； 李淑琄(Shu-Xuan Li) ； 何孟修(Mang-Shiu He) ； 林嘉雯(Chia-Wen Lin) ； 林怡初(Yi-Chu Lin) ； 許心恬(Hsin-Tien Hsu)

《高雄護理雜誌》 34卷3期 (2017/12) Pp. 59-68

https://doi.org/10.6692/KJN.201712_34(3).0006

摘要

生命末期醫療決策是一個動態且複雜的過程，身為臨床醫療工作者，特別是在病人生命末期階段，應理解一個好的醫療決策，會牽涉到病人是否能善終、家屬是否徒留遺憾、是否耗費珍貴醫療及社會資源。過去文獻對此“生命末期醫療決策”概念並無清楚的定義，有鑑於此，本文使用Walker & Avant(2010)方式，歸納出生命末期醫療決策之概念定義性特徵有以下四點：一、病人六個月內，面臨疾病病程為不可逆，且進行至死亡已不可避免時所做選擇；二、醫療團隊與病人及家屬間透過雙向溝通、知識傳達及病況分析之動態過程；三、病人具自主權，決定治療措施與方向；四、尊重病人意願，並透過列舉典型、邊緣及相反案例，來協助釐清概念。確定前因與後果，統整臨床常用的實證性工具。期許本文資料的統整能提供醫療人員對生命末期醫療決策概念的瞭解及引導研究進行，並提升此概念於臨床之實務應用。

關鍵字

生命末期 ； 醫療決策 ； 概念分析

並列摘要

End-of-life decision making is a dynamic and complex process. Health professionals should understand a good end-of-life decision making will affect whether to provide patient die in a peaceful and dignified way, to allow family numbers have no regret in their life, to minimize waste in health care facilities. Because the concept of end-of-life decision making is not clearly defined in the literature, four defining attributes of the concept were identified by using Walker and Avant's (2010) concept analysis.: first, a decision is needed to make for a patient with irreversible disease expected to cause death within six months; second, there is a dynamic process between medical team and patients /family numbers through two-way communication, transmission of knowledge and analysis of disease conditions; third, respect for patient autonomy regarding desired treatment; fourth, respect for the wishes of the patient. A model case, a borderline case, a contrary case are presented to differentiate the concepts from other concepts. Antecedents and the possible consequences of the concept were addressed. Empirical referents demonstrate the current perspective of the concept of end-of-life decision making. The results of this study are expected not only to guide future research but also to enhance end-of-life decision making in nursing practice.

並列關鍵字

end-of-life ； decision making ； concept analysis

參考文獻

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