探討病人家屬簽署不施行心肺復甦術之認知與態度相關研究

目的：探討病人家屬簽署不施行心肺復甦術之認知與態度相關研究。希望透過此研究，了解家屬對簽署不施行心肺復甦術之相關因素，做為未來政策宣導時之參考。方法：本研究為橫斷式，以中部評鑑等級地區醫院之住院病人家屬為研究對象採用李素貞(2015)編制之「病人家屬對簽署DNR的認知與態度問卷」，取得原作者授權使用同意書，經專家進行效度分析，使量表更具可信度後，發出300份問卷，回收有效問卷280份。採用結構式問卷，包括病人家屬基本資料、家屬對簽署DNR的認知與態度，運用SPSS 17.0進行資料分析，探討各變項間的相關因素。結果:發現多數病人家屬簽署DNR在認知與態度方面都是正向的，總平均分別為3.57±0.38與3.63±0.31；簽署DNR同意書時，病人的意識狀態以昏迷佔41.8%，無法口語表達35.3%；家屬簽屬DNR者以子女為最多佔6.8%；以認知結構、認知歷程、情感反應、主觀意見、客觀判斷、訊息、本身關聯性、親身經驗等均達顯著差異性(p <0.05*;p<0.01** )。與認知結構關聯性最高為「訊息」(r=0.443)；與「認知歷程」關聯性最高者為「主觀意見」(r=0.256)，達顯著水準。結論：多數病人家屬簽署DNR在認知與態度方面都是正向的，然簽屬是家屬而非病人自己。建議臨床醫護人員應積極落實執行病人生命末期醫療的意願，鼓勵病人在意識清醒時預立醫囑「簽署DNR」，讓病人、家屬有機會參與末期醫療決策，可實質保障病人自己善終的權利，並減少無效醫療資源的耗費。關鍵字：病人家屬、不施行心肺復甦術、預立醫囑

關鍵字

病人家屬；不施行心肺復甦術；預立醫囑

並列摘要

Objective: To investigate the relationship between the patients ' family members ' cognition and attitude about signing the document of not to to execute cardiopulmonary resuscitation. It is hoped that through this study, we will understand the relative factors of the family members who sign the documtnt about not to execute cardiopulmonary resuscitation, as a reference for future policy advocacy. Methods: This study was a cross-sectional study of the patients ' family members of the hospital hospitalized patients in the central evaluation area, using Li Su (2015) as the "Questionnaire on the cognition and attitude of the patient's family to sign DNR", obtaining the original author authorized to use the consent, after the validity of the analysis by the experts, so that the scale more credible, issued 300 questionnaires, the recovery of 280 effective questionnaires. Using the structural questionnaire, including the basic data of the patient's family members, the family members ' cognition and attitude to sign DNR, using SPSS 17.0 to analyze the related factors of the variables. Results: It was found that most of the patients ' families signed DNR in both cognition and attitude was positive. The total average was 3.57 ± 0.38 and 3.63 ± 0.31 respectively. When signing the DNR consent document, the patient's state of consciousness is 41.8% in coma and cannot be spoken in 35.3% , the signature DNR of family members is the children accounted for 6.8%. The cognitive structure, cognitive process, emotional response, subjective opinion, objective judgment, message, relevance, and personal experience were significantly different (p <0.05*;p<0.01** ). The highest correlation with cognitive structure is "message" (r = 0.443),and the highest relevance of "cognitive process" is "subjective opinion" (r=0.256),reaching a significant level. Conclusion: Most patients ' family sign DNR is positive in cognition and attitude, but the signature is family rather than patient. It is suggested that clinicians should actively implement the will of patients ' end-of-life medical care, and encourage patients to sign DNR when they are conscious, so that patients and their families will have the opportunity to participate in the final medical decision, which can guarantee the patients ' right to make a good ending, and reduce the cost of invalid medical resources. Key words: Patient family, do not implement cardiopulmonary resuscitation, pre-prescribed medical advice.