探討加護病房護理人員對簽署DNR認知與照顧DNR病人態度

Knowledge and Attitudes Among Intensive Care Unit Nurses Toward Patients With a Do-Not-Resuscitate Request

陳惠姿(Hui-Tzu Chen) ； 林佳蓉(Chia-Jung Lin)

《榮總護理》 38卷3期 (2021/09) Pp. 302-311

https://doi.org/10.6142/VGHN.202109_38(3).0009

摘要

加護病房護理人員常需面臨生命末期病人死亡前，病人是否仍需接受心肺復甦術等無效醫療之決擇，使得簽署不施行心肺復甦術（Do not resuscitate, DNR）成為重要且值得討論之議題。雖然重症緩和療護已推動多年，但臨床仍發現有護理人員認為簽署DNR的病人就不需要住加護病房或積極照護的觀念，可能影響對生命末期病人的照護品質。故本研究目的為探討加護病房護理人員對簽署DNR認知與照顧DNR病人的態度，採橫斷式研究設計，於2020年3月15日至4月15日，以方便取樣於南部某區域醫院135位加護病房護理人員參與研究。研究工具包括「加護病房護理人員對簽署DNR認知量表」、「加護病房護理人員照護DNR病人之態度量表」及「基本屬性問卷」。研究結果顯示：加護病房護理人員基本屬性與簽署DNR認知無顯著差異；加護病房護理人員簽署DNR認知與照顧DNR病人態度之間具顯著正相關（r=.2, p＜.05）；曾參加DNR相關在職教育者對照護DNR病人態度有顯著的影響（p＜.05）。建議將此研究發現，作為發展台灣加護病房末期病人照護政策的參考，應定期舉辦加護病房DNR相關在職教育，以提升照護品質。

關鍵字

加護病房護理人員 ； 不施行心肺復甦術 ； 認知 ； 態度

並列摘要

The intensive care unit (ICU) provides critical care, and do-not-resuscitate (DNR) requests should be a serious concern in the ICU, especially in patients with a terminal condition. Clinical nurses may wrongly understand DNR to mean no aggressive treatment or no need for ICU admission, which may affect the quality of life among patients with a terminal condition. This study aims to investigate the understanding of DNR requests among ICU nurses and their attitude when caring for patients with a DNR request. This cross-sectional study administered a structured questionnaire. This study examined the (1) level of DNR-related knowledge among ICU nurses; (2) attitude toward caring for DNR patients among ICU nurses; (3) demographic characteristics of ICU nurses. A total of 135 ICU nurses were recruited in a teaching hospital in Southern Taiwan. The results of the study indicated the following. First, ICU nurses who had received DNR education within a year had a positive attitude (p ＜ .05) toward caring for DNR patients. Demographic characteristics were also not correlated with level of DNR-related knowledge. Second, DNR-related knowledge was correlated, but weakly so, with attitude in caring for DNR patients (r = .2, p ＜ .05). Third, this correlation was stronger among nurses who ever received DNR-associated education (p ＜ .05). This study was conducted in an adult ICU in a hospital in south Taiwan. In conclusion, providing clinical DNR-related on-the-job education courses for clinical nursing staff is necessary to improve the quality of care for patients at the end of life.

並列關鍵字

intensive care unit (ICU) nurse ； do-not-resuscitate (DNR) ； knowledge ； attitude

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