護理人員對末期病人不施予人工營養與水分的認知與態度調查

The Investigation of Nursing Staff's Knowledge and Attitude towards ＂Artificial Nutrition and Hydration＂ Among Terminally-Ill Patients

張雅玲(Ya-Ling Chang) ； 張元玫(Yuanmay Chang) ； 劉介宇(Chieh-Yu Liu)

《安寧療護雜誌》 25卷2期 (2021/03) Pp. 110-123

https://doi.org/10.6537/TJHPC.202103_25(2).02

摘要

背景：善終是照護上困難的課題，末期病人身體衰弱已無法吸收時，是否還需大量供給人工營養與水分，是末期照護領域中重要議題。目的：探討護理人員對身體衰弱的末期病人供給人工營養與水分的觀點。方法：橫斷性研究，針對北部某醫學中心129位護理人員為研究對象，收案時間自2018年4至12月。採結構性自擬問卷，以SPSS 22.0統計軟體進行獨立樣本t檢定、單因子變異數及雪費事後比較分析。結果：1.臨床護理人員接受「不施予人工營養與水分」認知與態度的得分為中上程度（74.4％）。2.臨床護理人員在「年齡」上，與「末期病人照護觀念」、「補充人工營養與水分的時機與決策」、「不施予人工營養與水分」的認知與態度呈現正相關。3.臨床護理人員年齡與身體功能及消化功能認知與態度上呈現顯著差異，「末期病人照護觀念」及「補充人工營養與水分的時機與決策」認知越瞭解時，臨床護理人員對接受「不施予人工營養與水分」態度也越正向。結論：末期病人照護提供實施人工營養與水分宜謹慎，照護者應更致力於增進對末期病人身體衰弱之臨終照護技能、面對末期生死的正向觀念與提供舒適護理，有助於提供末期病人人工營養與水分的處置及抉擇參考。

關鍵字

末期病人 ； 人工營養與水分

並列摘要

Background: Achieving a good death is one of the most difficult issues in care. The nurses' knowledge affects the quality of life of terminally-ill patients which is an important issue in the field of terminal care. Purposes: To explore relationship between knowledge and attitudes of nursing staff towards providing artificial nutrition and hydration (ANH) for terminally-ill patients. Methods: We conducted a cross-sectional study, with a convenience sample of 129 nurses working in a medical center in northern Taiwan as research subjects. We used a demographic data questionnaire, and a self-developed artificial nutrition and hydration structured questionnaire. Data were collected from April to December 2018 and analyzed using SPSS version 22.0, included mean ± SD, independent t test, one-way ANOVA, and Scheffe's test. Results: 1. Acceptance of ANH rated above average (74.4%). 2. Positive correlation was found between ＂Age of nurses＂, ＂Terminally-ill patients care concept＂, ＂ANH decision-making＂ and the perception and attitude of ANH. 3. There were significant differences between clinical nurses in knowledge and attitudes about age, physical function and digestive function with providing ANH for patients with end-stage. The more they understood the concept of ＂Terminally-ill patient care＂ and ＂Timing and decision-making of ANH＂, clinical nurses were more positive on ＂ANH＂ attitude. Conclusions: Careful attention should be paid to providing ANH in the nursing care of terminally-ill patients. Caregivers should be more committed to improving the skills of terminal care to terminally-ill patients with physical function decline; to think positively when facing end-of-life situation; and to provide comfortable care. This will contribute to the handling and decision making of ANH treatment for terminally-ill patients.

並列關鍵字

terminally-ill patients ； artificial nutrition and hydration (ANH)

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