護理人員對末期患者撤除維生治療行為意向及其相關因素探討

A Correlative Study of the Behavior Intentions of Withdraw Life-Sustaining Treatment in End-of-Life Care Among Nurses

楊幸純(Hsing-Chun Yang)

指導教授 ： 白香菊

中山醫學大學/醫學院/護理學系碩士班/碩士(2018年)

摘要

背景：安寧緩和醫療條例於2013年總統令公布部分條文修正案，重大變革後，僅需一位家屬，可依相關規範步驟進行撤除維生醫療，但末期病人不只是癌症末期，還包括了八大疾病，且臨床上，許多末期病人不只在安寧病房中，加護病房和一般病房也越來越多的末期病人，不施行心肺復甦術及撤除維生治療將是許多護理人員當前及未來常會遇到的議題。
目的：本研究探討影響護理人員對撤除維生治療行為意向及其相關因素。
方法：以橫斷式描述性設計，採方便取樣方式，使用結構式問卷進行資料收集，研究對象以台灣北部某區域醫院護理人員為對象，收案222名個案，研究問卷內容包括「基本資料（人口學特性與個人相關經驗）」、「對不施行心肺復甦術態度量表」、「護理人員對於臨終照護的知覺(障礙與支持)量表」、「撤除維生治療感受態度量表」及「撤除維生治療的行為意向量表」五部分，經由統計軟體SPSS 22進行分析。
結果：護理人員對於不施行心肺復甦術態度較趨於正向，於臨終照護的知覺障礙與支持屬於中立，於撤除維生治療感受態度較趨於正向，而在撤除維生治療的行為意向上，認為實際執行可能性偏高，撤除維生治療的行為意向較趨於正向。人口學特性與個人相關經驗與對不施行心肺復甦術態度、臨終照護的知覺、撤除維生治療感受態度皆有顯著性。護理人員在撤除維生治療行為意向上與臨終照護的知覺支持、撤除維生治療感受態度呈正相關(r = 0.136, p < 0.05；r = 0.157, p < 0.05)，與臨終照護的知覺障礙呈負相關(r = -0.134, p < 0.05)，而與不施行心肺復甦術態度無顯著相關(r = -0.110, p > 0.05)。發現在執行撤除維生治療的行為意向具影響力為「撤除維生治療感受態度」，其解釋力為2.5%，顯示撤除維生治療感受態度越正向時，其撤除維生治療的行為意向動機較強。
結論：整體而言，人口學特性、個人相關經驗、臨終照護的知覺及撤除維生治療感受態度等因素，會影響護理人員對撤除維生治療行為意向。而本研究探討護理人員臨終照護的知覺中，發現面對悲傷情緒及處理醫療糾紛之經驗較為不足，建議可以增加安寧緩和與臨終照護哀傷及法律知識等相關在職教育課程，增加護理人員在面對這些問題時的處理能力；而研究結果發現在撤除維生治療行為意向之重要影響因子為撤除維生治療態度，但解釋力偏低，建議未來研究可以增加知識或認知及行為相關因素一起探討。

關鍵字

撤除維生治療 ； 行為意向 ； 末期患者 ； 安寧緩和

並列摘要

Background：The partial amendment to the Hospice Palliative Care Act was announced by the presidential decree in 2013. After the major reform, only one family member was required to withdraw life-sustaining treatment according to relevant norms and steps. However, terminal patients not only include patients with terminal cancer, but also include patients with eight major diseases. In addition, many terminal patients are not from hospice wards; an increasing number of terminal patients are from the ICU wards and general wards. Not performing cardiopulmonary resuscitation and withdrawing life-sustaining treatment are issues frequently encountered by nursing staff in the present and future.
Objective: This study explored factors affecting behavioral intent of nursing staff in withdrawing life-sustaining treatment and other related factors.
Method: With the cross-sectional descriptive design, the convenience sampling method was adopted, and a structured questionnaire was used to collect data. With nursing staff from a regional hospital in northern Taiwan as research participants, 222 cases were accepted. The questionnaire content includes five parts: “basic information (demographic characteristics and personal experiences)”, “the Do Not Resuscitate Attitude Scale”, “national survey of critical care nurses’ perceptions of end-of-life care (intensity, frequency, and Perceived Intensity Scores (PIS) for obstacles in end-of-life care; and intensity, frequency, and Perceived Supportive Behavior Scores (PSBS) for supportive behaviors in end-of-life care)”, “Attitude Toward Withdrawing Life-Sustaining Treatment Scale” and “Behavioral Intent Toward Withdrawing Life-Sustaining Treatment Scale”. Data analyses were conducted through statistical software SPSS22.
Results: The nursing staff showed more positive attitude toward not performing cardiopulmonary resuscitation, were neutral toward perception disorder and support of hospice care, and had a more positive attitude toward withdrawing life-sustaining treatment. In terms of the behavioral intent toward withdrawing life-sustaining treatment, they believed the feasibility of actual execution was high and had a more positive behavioral intent toward withdrawing life-sustaining treatment. The demographic characteristics and personal experiences, attitude toward not performing cardiopulmonary resuscitation, perceived hospice care, and attitude toward withdrawing life-sustaining treatment showed significance. The nursing staff’s behavioral intent toward withdrawing life-sustaining treatment showed a positive correlation with perceived support of hospice care, and attitude toward withdrawing life-sustaining treatment (r = 0.136, p < 0.05; r = 0.157, p < 0.05), the perception disorder of hospice care showed a negative correlation (r = -0.134, p < 0.05), and attitude toward not performing cardiopulmonary resuscitation showed no significant correlation (r = -0.110, p > 0.05). It was found that the behavioral intent of executing withdrawal of life-sustaining treatment was influenced by “attitude toward withdrawing life-sustaining treatment”, with an explanatory power of 2.5%, indicating that the more positive the attitude toward withdrawing life-sustaining treatment, the stronger the behavioral intent and motivation toward withdrawing life-sustaining treatment.
Conclusion: Overall, the demographic characteristics, personal experience, perceived hospice care, attitude toward withdrawing life-sustaining treatment and other factors affected the nursing staff’s behavioral intent toward withdrawing life-sustaining treatment. From the discussion on perceived hospice care, it was found that there was inadequate experience related to dealing with sad emotions and handling medical disputes. It is recommended that hospice palliative care, hospice care bereavement, legal knowledge, and related in-service education curriculums be added to enhance nursing staff’s ability to deal with these problems. Results show that the important influential factor for behavioral intent toward withdrawing life-sustaining treatment is attitude toward withdrawing life-sustaining treatment, but it has relatively low explanatory power. It is suggested that knowledge, perception and behavior related factors be included in the investigation.

並列關鍵字

behavior intentions ； terminal patients ； hospice palliative care ； withdraw life-sustaining treatment

參考文獻

中文參考文獻

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