探討加護護理人員照護「不予心肺甦醒術」病人之態度及倫理困境

The Factors of Critical Care Nurse's Attitudes toward DNR and Ethic Dilemmas

莊紫雲(Tzu-Yun Chuang) ； 楊易宏(Yi-Hung Yang) ； 熊道芬(Tao-Fen Hsiung) ； 謝佑珊(Yeu-Shan Hsieh)

《榮總護理》 28卷4期 (2011/12) Pp. 378-386

https://doi.org/10.6142/VGHN.28.4.378

摘要

本研究之目的係探討各科加護護理人員照顧DNR病人之態度與其倫理困境之相關因素。採橫斷式描述性設計，以立意取樣方式，選取對象為北部某醫學中心加護中心護理人員，以結構式問卷量表調查385位加護單位護理人員，平均年齡為33.81歲。平均臨床年資為129.52個月，級階以N2最多有250人（64.9%）。結果顯示：加護病房科別屬性及護理人員年資會影響其對DNR與對照顧DNR病人之態度；級階越低及年齡越輕者在對DNR之態度方面反而越好；年齡越輕者其痛苦程度與發生倫理困境的頻率越高。本研究可用來瞭解並確立加護護理人員之基本資料屬性，其對DNR的態度、照顧DNR病人的態度與倫理困境的分佈、相關性及差異性，期能藉由建立標準化之照護指引，提供加護單位護理人員在面對DNR病人時能提升臨床照護DNR病人之品質。

關鍵字

加護護理人員 ； 不予心肺甦醒術 ； 倫理困境

並列摘要

Making a decision of ”do no resuscitation” (DNR) is an ethical dilemma commonly encountered in everyday nursing care practices. However, this issue has never been fully explored in an intensive care setting. Therefore, we conducted this cross-sectional descriptive study with an aim to identify the attitude of intensive care nursing staff in making DNR decision, caring for patients with DNR and associated factors. The study population was selected from a single medical center in northern Taiwan via purposeful sampling and questionnaires consisting of general background survey, scale on taking patient with DNR and ethical dilemma delivered to each study object. The study enrolled 385 nursing staffs with an average age of 33.81 years. The average clinical practice period was 159.52 months and most of them were clinically rank as N2 (64.9%). The results showed that the difference in attitude on DNR and taking patients with DNR were associated with clinical field and different clinical practice periods. Participants with a younger age and a lower clinical rank had better attitude toward issues associated with DNR. Frequency in encountering ethical dilemma and suffering from the issuance of DNR increased in younger age group. Results of this study help us to understand the general attitude on DNR, the care of DNR patients among intensive care nursing staff and factors associated with the issue. We wish that the result could be applied in the establishing of standardized practice guideline which would promote the quality of care for DNR patients in the future.

並列關鍵字

intensive care nursing staff ； do no resuscitation ； ethical dilemma