知情同意於護理臨床實務之運用

The Use of Informed Consent in Clinical Nursing Practice

鄭君婷(Chun-Ting Cheng) ； 林秋菊(Chiu-Chu Lin)

《護理雜誌》 64卷1期 (2017/02) Pp. 98-104

https://doi.org/10.6224/JN.000013

摘要

社會民主化的提升，以病人為中心的照護模式，是落實知情同意與自主權的主要因素。知情同意是複雜的溝通過程，包括：告知、決定能力、自願三大要素。知情同意是醫病溝通的過程，此過程受到病人因素、病人與醫療互動以及文化議題影響。病人層面與病人理解能力和自主決定意向有關；病人與醫療互動層面，與專業人員溝通技巧有關;文化層面則與病人期待家屬參與醫療決策程度，及家屬參與決策動機有關。醫療人員在評估影響因素，周詳地告知病人利益、可能風險、替代方案後，護理人員應就個別需求，選擇影音視聽、網路資源、附圖的書面資料等多元輔助工具，使病人充分理解訊息內容，以作為同意的基礎。臨床上，護理人員應站在病人的立場，鼓勵提問與討論，主動安排團隊人員進一步說明釐清疑惑以降低焦慮感，讓病人能在完全理解的情況下，不被脅迫地以病人需求為最大考量，尊重他依照自我價值觀做出的最佳健康照護決策。

關鍵字

知情同意 ； 自主權 ； 病人為中心 ； 臨床實務

並列摘要

Obtaining informed consent and ensuring patient autonomy are critical to implementing a patient-centered model of healthcare. Informed consent is a complex process of communication that includes three elements: disclosure, competence in making decisions, and voluntariness. However, individual patient factors, doctor-patient interaction, and cultural issues are known to influence the process of obtaining informed consent. Individual patient factors include the ability of patients to understand and determine their intent; doctor-patient interaction includes communication skills; and cultural issues include the expectations of patients with regard to family involvement in medical decision-making and in decision-making motives. After assessing the relevant influencing factors, healthcare providers typically provide patients with comprehensive information on the benefits and risks of treatment as well as related alternatives. Moreover, healthcare providers typically provide patients with audio/video, Internet, and written information with illustrations based on individual patient needs. In addition to the above, we suggest that healthcare providers proactively adopt the perspective of patients in order to better encourage patients to address questions, to engage with patients in more productive discussions, and to take the initiative to explain and clarify patients' questions in order to minimize anxiety. This approach will help ensure that patients are adequately informed and free from coercion so that they make appropriate healthcare-related decisions. However, even under this optimal situation, healthcare providers must emphasize the needs of their patients and respect their decisions.

並列關鍵字

informed consent ； autonomy ； patient-centered ； clinical practice

參考文獻

伍碧琦、吳麗珍、林梅香、趙善如（2011）．護理人員的護理經驗與其對病人自主態度的探討．護理暨健康照護研究，7（3），233–242。[Wu, P. C., Suen Wu, L. J., Lin, M. H., & Chao, S. R. (2011). A study of nursing experience and attitudes toward patient autonomy. Journal of Nursing and Healthcare Research, 7(3), 233–242.] doi:10.6225/JNHR.7.3.233

伍碧琦、吳麗珍、陳彩鳳、蔡來蔭（2011）．南部某醫學中心住院病人對病人自主態度與其相關因素之探討．長庚護理，22（4），451–462。[Wu, P. C., Suen Wu, L. J., Chen, T. F., & Tsai, L. Y. (2011b). Correlates of inpatient autonomy attitudes at a medical center in southern Taiwan. Chang Gung Nursing, 22(4), 451–462.]

林美伶、吳詠葳、黃美智（2008）．由手術知情同意過程談華人社會文化對自主的意涵．護理雜誌，55（5），69–72。[Lin, M. L., Wu, J. Y. W., & Huang, M. C. (2008). The meaning of autonomy in Chinese culture: Obtaining informed consent for operation. The Journal of Nursing, 55(5), 69–72.] doi:10.6224/JN.55.5.69

張菊惠、胡幼慧、張　珏（1998）．子宮切除術前醫師告知內容之研究．婦女與兩性學刊，9，115–144。[Chang, C. H., Hu, Y. H., & Chang, C. (1998). Physician's inform on hysterectomy. Journal of Women and Gender Studies, 9, 115–144.] doi:10.6255/JWGS.1998.9.115

陳亮汝、劉美玉、吳珈旻、馮兆康（2014）．醫院顧客知情同意認知與實際感受之橫斷性研究．管理實務與理論研究，8（3），79–90。[Chen, L. J., Liu, M. Y., Wu, C. M., & Feng, C. K. (2014). A cross-sectional study of cognition and perception of informed consent among hospital consumers. Journal of Management Practices and Principles, 8(3), 79–90.]