以照顧者觀點探討介入模式對預立醫囑之影響

預立醫囑（advance directive, AD）是顯示先進國家對病人「善終」自主權的尊重，是一項前瞻性的全球政策。本研究旨在探討介入模式對非安寧居家照顧者在預立醫囑意向五大構面的影響力及預測力。採橫斷式描述性研究，問卷調查花蓮縣南區接受非安寧居家護理服務之照顧者共計125位，以「介入模式」與「預立醫囑意向」量表進行資料收集。運用SPSS 21.0，採用描述性統計、t檢定、單因子變異數分析及線性迴歸進行統計分析。研究結果顯示在預立醫囑意向五大構面皆呈顯著解釋力，介入模式中「是否曾與醫護人員談論安寧緩和醫療」方面雖無顯著影響，仍突顯醫護人員在宣導預立醫囑過程中是重要的推手。建立本土化預立醫囑推動模式，是未來從急性醫療延伸至長期照護中不可或缺的一塊，期望能激起更多醫護人員的熱誠與投入，共同承擔推動預立醫囑的社會責任。

關鍵字

居家照顧者；預立醫囑

並列摘要

Advance directive (AD) is a global trend in a developed country that respects a person's right and wishes regarding medical treatment should the person be unable to communicate them to a doctor. The aim of this study was to explore the influence and the prediction of interventional models on the five intentions dimensions of AD of non-hospice home caregivers. Cross-sectional and descriptive analysis was used. The questionnaire comprised two subscales of interventional models and intentions of AD to the non-hospice caregivers living in southern Hualien. A total of 125 valid copies were analyzed using descriptive statistics, t-test, one-way ANOVA and hierarchical regression. SPSS 21.0 was used for the analysis. The results showed that the complete models of five intentions dimensions of AD have a significant explanatory power. The interventional model of ＂whether discussed hospice with medical staff＂ showed no significant impact on the five intentions dimensions of AD; however, the findings highlight that the medical staff should initiate a discussion on AD with the caregivers, and design a dialogue platform as an intervention program. To establish a cultural sensitive model to promote AD is an indispensable part from acute to long-term care facilities in the future. The author hopes that this study may ignite the enthusiasm of more medical staff to share the social responsibility and to join the promotion of AD.

並列關鍵字

caregivers ； advance directive

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以照顧者觀點探討介入模式對預立醫囑之影響

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