某離島醫護人員對末期病人撤除維生醫療行為意向及其相關因素探討

Behavior Intention and its Associated Factors of Healthcare Professionals to Withdrawal of Life-Sustaining Treatment in Terminal Ill Patients in an Outlying Island Hospital

陳婉君(Wan-Chun Chen) ； 潘雪幸(Hsueh-Hsing Pan) ； 劉淑皎(Shu-Chiao Liu) ； 陳佳宏(Jia-Hong Chen) ； 洪東源(Dueng-Yuan Hueng) ； 張芳維(Fung-Wei Chang) ； 歐淑華(Shu-Hua Ou)

《安寧療護雜誌》 24卷2期 (2020/06) Pp. 112-126

https://doi.org/10.6537/TJHPC.202006_24(2).02

摘要

研究目的：探討醫護人員對生命末期病人撤除維生醫療之行為意向及其相關因素。材料方法：本研究採橫斷式研究設計、立意取樣及結構式問卷收集資料，以澎湖離島某地區教學醫院照顧末期病人的醫護人員為研究對象，問卷內容包含基本資料、態度量表、行為意向量表等，回收有效問卷共150份，包含醫師25人及護理師125人，回收率達98.7%。結果：醫護人員對撤除維生醫療態度及行為意向呈顯著正相關，醫護人員在態度、有參與撤除維生醫療經驗及醫師為執行撤除維生醫療行為意向重要預測因子，總解釋變異量達20.3%，其中以態度為最佳相關。73.6%的人具正向的態度，81%的人能配合執行撤除維生醫療行為，家屬之間對無效醫療或撤除維生醫療行為無共識是影響撤除維生醫療意願重要因素。結論：本研究建議醫護人員應持續末期病人照護訓練，強化臨床照護技能，增強護理人員對撤除維生醫療的行為，運用家庭會議與家屬達成共識，以維護末期病人善終權益，提升更高品質之生命末期病人照護。

關鍵字

撤除維生醫療 ； 安寧緩和醫療 ； 末期病人 ； 行為意向

並列摘要

Purpose: To explore the behavioral intentions and related factors of healthcare professionals on the withdrawal of life-sustaining treatment from terminally ill patients. Material and Methods: This study used cross-sectional research design, purposive sampling, and a structured questionnaire to collect data. The participants were healthcare professionals who cared for terminally ill patients in a teaching hospital in an outlying island (Penghu). The questionnaire contained basic attributes, the attitude scales, and the behavioral intention scales. A total of 150 valid questionnaires were returned, including 25 physicians and 125 nurses, with a completion rate of 98.7%. Results: Healthcare professionals had a significant positive correlation with attitudes and behavioral intentions for the withdrawal of life-sustaining treatment. Important predictors were factors in attitudes, experience in participating in execution of withdrawal of life-sustaining medical treatments, and physicians' intentions for performing withdrawal of life-sustaining treatment behaviors, explaining 20.3% of the total variance. Among them, attitude showed the highest correlation. 73.6% of the participants expressed a positive attitude, and 81% of them could cooperate in the implementation of the withdrawal of life-sustaining treatment behavior. An important factor affecting the withdrawal of life-sustaining treatment was that there was no consensus among the family members on invalid medical treatment or withdrawal of medical treatment. Conclusions: This study recommends that healthcare professionals should continue training in caring patients at the end of life, strengthen clinical care skills, enhance nurses' positive behaviors regarding in withdrawal of life-sustaining treatment. Using family meetings to reach consensus with family members, these efforts may promote patients' right to peaceful dying and improve the quality of care for terminally-ill patients.

並列關鍵字

Withdrawal of life-sustaining treatment ； Palliative care ； Terminally ill patients ； Behavioral intention

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