加護病房護理人員的無效醫療經驗

Intensive care nurses' experience of medical futility

江蓮瑩(Lien-Ying Chiang)

指導教授 ： 徐明儀

中山醫學大學/護理學院/護理研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00028

摘要

醫療科技的進步使重症患者得以延長壽命，然而，醫療終究有其極限。在某些情況下，臨床上任憑再努力對重症病人施予醫療處置，其結果是徒勞無功的無效醫療仍是時有所見。我國政策上欲對重症末期無效醫療制定評估與照護標準，但國內對於何謂無效醫療尚無一致性的定論與共識，有關台灣重症患者的無效醫療現況了解也很有限，故本研究經由現象學研究法，由加護病房護理人員的觀點，瞭解我國的無效醫療經驗。
本研究以台灣中部一家醫學中心、一家區域醫院為研究場域，立意取樣及滾雪球取樣方式選擇在成人加護病房工作資歷一年以上之護理人員，進行一對一的半結構式深度訪談並錄音，共有8位護理人員參與，研究過程以Lincoln與Guba(1985) 提出的可信賴性(trustworthiness)作為嚴謹度之控制，採Colaizzi(1978)所提出的步驟進行資料分析，研究結果共涵蓋五個主題：一、護理人員對無效醫療的定義；二、演變成無效醫療的病人；三、無效醫療的考量；四、無效醫療的發生；五、護理人員面對無效醫療。此研究結果能幫助台灣重症患者無效醫療情況上的瞭解，並作為臨床照護、教育與相關政策擬定之參考。

關鍵字

重症病人 ； 無效醫療

並列摘要

Advanced medical technology could extend life of critical patients, but it has its limitations. Medical interventions that prolong life without effect that someone can appreciate as a benefit. It is imperative to develop a policy of medical futility for critical patients. However, medical futility of critical patients not only lacks of knowing but also has no consensus about its definition in Taiwan. The purpose of this phenomenological study was to explore the ICU nurses' medical futility experience on taking care of critical patients.
Snowball sampling and purposeful sampling were used to recruit nurses at one medical center and a regional hospital located in central Taiwan. Researcher collected data using in-depth, semi-structured and tape-recorded interviews. Eight participants participated in this study. The trustworthiness of the study was examined using Lincoln and Guba (1985) principles. Data were analyzed using the Colaizzi (1978) method. Five major themes emerged, including ICU nurse’s definition of futility; the patients evolved into medical futility; consideration of medical futility; reasons for providing futilely care; and facing futile care. The study findings could help understand medical futility in critical patients, and provide clinical care, education and medical policy development.

並列關鍵字

medical futility ； critically ill

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