- 期刊
探討急重症護理人員參與病患末期決策之經驗
Experiences Regarding End of Life Decision-Making by Nurses in Emergency and Critical Care Wards
摘要
目的：探討急重症護理人員參與病患生命末期決策經驗並比較異同。方法：為橫斷性研究，採立意取樣選取239位南台灣某區域醫院急診與加護單位之護理人員。研究工具包含基本屬性及護理人員對病患生命末期決策之經驗量表。並以描述性統計及卡方檢定分析。結果：回顧過去照護經驗，90%護理人員同意「醫護人員與病人及家屬在溝通上的困難，會阻礙生命末期照護的決策過程」；86.1%護理人員表示「有些病人因被不當判斷為缺乏決定能力，使其無法參與照護決策」。在參與病患末期決策經驗之差異性部分，急診護理人員有較高比例同意自己「時常沒有足夠時間與病人討論預立醫囑」，而「醫護人員能回答病人有關預立醫囑問題」及「健康照護的費用會影響生命末期決定」方面，則以重症護理人員同意的比例高於急診護理人員。結論：醫病及家屬間的溝通困難、病人被誤判為無決策能力者或誤解預立醫囑意義實為臨床普遍存在的現象，因此，照護末期病人過程，醫療人員首先須建立預立醫囑正確觀念，並透過醫病之間有效溝通協助病人及家屬做出最適切的末期決策及澄清預立醫囑的誤解。
並列摘要
Purpose: To explore and compare the differences in the experiences regarding end of life decision-making by nurses in emergency and critical care wards.Methods: This was a cross-sectional study that collected 239 nurses working on emergency and critical care wards from a regional hospital in south Taiwan. Structural questionnaires were included basic demographic and experiences regarding end of life decision-making. Data were analysed by descriptive statistics and chi-square test.Results: Findings showed that 90% nurses agree 'an impediment to making good decisions about end-of-life care is difficulty communicating with patients and their families'. 86.1% nurses think that 'some patients are excluded from making decisions about their care because they are inappropriately judged to lack capacity to make decisions'. To compare the differences in the experiences, 'there is not enough time to discuss advance directives with patients' received agreement by emergency nurses were significantly higher than critical care nurses. 'Nurses can answer patients' questions about advance directives' and 'the cost of health care affects end of life decisionmaking' received agreement by critical care nurses were significantly higher than emergency nurses.Conclusion: Difficulty communicating with patients, families and medical professionals, patients inappropriately judged to lack capacity to make decisions and misunderstand the meaning of advance directives are common phenomenon. Therefore, medical professionals must knowledgeable with advance directive and effective communication between patients, families and medical professionals to assist patients and families make appropriate decision and clear the misunderstanding of advance directives.