護理人員預立醫療決定知識與影響因素之探討

背景與目的︰病人自主權利法於2019年1月6日正式實施，目前缺乏護理人員對於病人自主權利法之預立醫療決定的相關研究。故本研究目的為了解臨床護理人員對於預立醫療決定的知識現況，並探討預立醫療決定知識之相關影響因素。方法︰採橫斷式相關性設計，方便取樣選取144名南部某區域教學醫院護理人員，運用問卷評估護理人員對預立醫療決定的知識，共20題，總分20分，得分越高代表預立醫療決定知識越正確。結果：護理人員預立醫療決定知識平均得分為15.8（SD＝1.75），題項以「依據病人自主權利法，當末期病人，意識昏迷且已簽屬預立醫療決定時，醫護人員執行預立醫療決定的程序為何」最不清楚；小組長以上、護理工作總年資10年以上及教育程度研究所以上之護理人員知識得分顯著較高，經多元迴歸分析後職稱為護理人員預立醫療決定知識之預測因素。結論：護理人員於執行預立醫療決定程序、可接受或拒絕的照護選項及五種臨床條件確診的程序之認知最為不足，小組長以上的護理人員知識得分較高，建議加強臨床基層護理人員臨床案例討論或工作坊此層面的教育，進而落實預立醫療決定之推展。

關鍵字

護理人員；預立醫療決定；預立醫療決定知識

並列摘要

Background and purpose: The Patient Right to Autonomy Act was officially implemented on 6 January 2019 in Taiwan. There is no prior study exploring the current status and factor associated with knowledge of advance decision among nursing staff. The purpose of this study was to identify the relationship between clinical nursing staff and knowledge of Advance Decision, and explore factors influencing knowledge of Advance Decision. Methods: A cross-sectional study was conducted. A convenience sample of 144 nursing staffs was recruited from Southern regional teaching hospital. Self-developed questionnaire were used to examine nursing staff's knowledge of Advance Decision. Total of 20 questions were distributed, giving a total mark of 20 points. Higher score revealed greater accuracy in knowledge of Advance Decision. Results: The average score for nursing staff in Advance Decision was 15.8 (SD=1.75). Majority of the respondents were more unclear about "process of medical staff in carrying out Advance Decision under Patient Right to Autonomy Act when terminal patient had signed Advance Decision and is unconscious", only 14% of the people were correct. Statistically significantly higher scores were found in respondents with position greater than team chief leader, total work seniority over 10 years and educational status higher than research institute. Multiple linear regression indicated that job title was a predictor of Advance Decision among nursing staff. Conclusions: Insufficient knowledge was found in "process of medical staff in carrying out Advance Decision under Patient Right to Autonomy Act when a terminal patient had signed an Advance Decision and is unconscious", "the available acceptance and rejection of care selection options in Advance Decision" and "5 clinical criteria for confirmed diagnosis process". Respondents with a position greater than team chief leader scored better. It is recommended that clinical case discussions or workshops for clinical nursing staff training should be provided in order to further promote the implementation of Advance Decision.

並列關鍵字

nursing staff ； Advance Decision ； knowledge of Advance Decision

參考文獻

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