家屬對長期使用呼吸器患者氣切之決定過程

Decision Making Regarding Tracheotomy in Patients With Prolonged Ventilator Use

蘇鈺雯(Yu-Wen Su)

指導教授 ： 吳麗珍

長榮大學/健康科學學院/護理學研究所/碩士(2008年)

https://doi.org/10.6833/CJCU.2008.00014

摘要

中文摘要
本研究主要在探討呼吸器依賴患者之家屬對氣切的印象及家屬對患者被建議氣切
時的決定過程。研究地點為南部某區域教學醫院，以參與觀察及深度訪談方式收
集會談資料。共彙整八個家屬的訪談稿與照護摘要進行編碼。其中的個案有3個
不同意氣切，有5個同意氣切，其中一位剛開始不同意氣切，在2個月後同意氣
切者後出院。在癒後方面，氣切後成功脫離呼吸器者有6位，1位成功移除氣切
管者，1位不同意氣切至今仍插氣管內管已2年以上者，2位成功拔除氣管內管
者。
研究結果發現家屬對氣切造口的印象有生命的長短、受苦、生活品質、身體完整
性、看法、照顧負荷、病情嚴重、及試驗品等八項核心類屬。在呼吸器依賴患者
之氣切決定過程方面，感受、自主權、年齡、兩難、資訊來源、經驗、決定方式、
對氣切的期望等八項核心類屬。
家屬對病人使用氣切或使用呼吸器之經驗多視為受苦、折磨的經歷，面對患者不
確定的生命長度與沒希望之希望的期待中，我們除了在護理的過程中應儘可能滿
足病人需求，避免或降低身體部分的不適感受外，同時應主動關心病人與家屬，
以緩解病人或家屬的負向情緒反應。

關鍵字

氣切術 ； 決定過程 ； 家屬

並列摘要

Background: In Taiwan, tracheotomy has become a routine procedure for
patients with respiratory failure who have been depending on an endotracheal
tube for ventilation for over two weeks. After tracheotomy, elderly patients either
die shortly or depend on mechanical ventilation for years until they die.
Furthermore, for some Taiwanese, dying with the body whole, that is, without
a hole in the throat, is important. Thus, whether to receive a tracheotomy is
a very difficult decision, compounded by the fact that most patients are unable
to communicate. As a result, family members are the ones to decide and
conflicts between family members over this issue are very common.
In the acute care setting, matters are made worse by busy health care
providers who often give technical explanations that are difficult to comprehend.
Objective: The purpose of this qualitative study is to explore the meaning
of tracheotomy to the patent’s family, the family decision making process,
and how they have come to accept or reject a tracheotomy for their loved one.
Methods: The investigator is recruiting potential participants from a respiration
care unit in a medical center. Family members whose loved ones have been
on the respirator for more than 21 days are being recruited for this study.
Semi-structured, open-ended questions are used in the in-depth interviews.
The interviews are recorded on tape and transcribed verbatim. Eight interviews
have been conducted thus far, with five families accepting and the other five
rejecting tracheotomy.
Results: Eight themes have emerged from the data analysis with impressions
in tracheotomy: life length, suffers, quality of life, body whole, faith, caregiver
burden, seriously ill, and test piece. Ten themes have emerged from
the data analysis of decision making in tracheotomy: perceptions, autonony,
age, struggle and dilemma, experience, decision pattern and hope. Many factors
influence the family’s decision regarding tracheotomy and the family members
require time to think it through. The results suggest that health care providers
must allow family members sufficient time to make the decision and provide
information to meet each individual family’s needs during this difficult time.

KEYWORDS: tracheotomy, decision making, family members

並列關鍵字

tracheotomy ； decision making ； family members

參考文獻

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