公私立醫院加護病房護理人員對死亡態度、社會支持與關懷照護行為之研究

The Study of the Relationship among Intensive Care Unit Nurses’ Death Attitude, Social Support, and Caring Behavior in Public and Private Hospitals.

周佳慧(CHIA-HUI CHOU)

指導教授 ： 張馨云

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2017年)

摘要

目的：在醫療體系直接面對瀕死病人的情緒起伏是護理人員，研究指出80%的病人在死亡前會轉入加護病房，20%的病人會在加護病房死亡。這讓加護病房護理人員承受搶救生命和協助善終的壓力衝擊，故本研究探討公私立醫院加護病房護理人員的死亡態度、社會支持與關懷照護行為間的影響並提出建議。

方法：採自填式結構問卷，以台灣中部某公、私立醫院加護病房護理人員為研究對象，共收案101位，人口學特徵、死亡態度、社會支持為自變項，關懷照護行為依變項，所得資料以描述統計、t考驗、單因子變異數分析、標準迴歸分析等統計方法，運用SPSS 17.0進行資料分析。

結果：本研究護理人員平均年齡34.9歲，年資13年以上居多，多數為專科學歷和信奉佛道教，死亡態度為正向「中性死亡接受」，自覺社會支持度80.4分，以「情感性支持」為主，關懷照護行為多表現在「了解病人的需求」，不同人口學特徵對死亡態度、社會支持和關懷照護行為有顯著影響（P＜.05），而「中性死亡接受」與「趨近導向死亡接受」、「情感支持」與「肯定支持」對關懷照護行為均呈現正相關和預測力。

結論：子曰：之死而致死之，不仁而不可為也，之死而致生之，不知而不可為也(禮記，檀弓上)。意思是，為死者設計一個能讓他安息的環境，以安頓生者不忍之心。正如研究結果呈現加護病房護理人員有正向死亡態度和高社會支持能增加瀕死病人的關懷照護行為。結果期望提供醫院教育單位對推動重症安寧的參考。

關鍵字

加護病房護理人員 ； 死亡態度 ； 社會支持 ； 關懷照護行為

並列摘要

Purpose: Nurses are frequently exposed to dying patients and death in the course of their work. This experience makes individuals conscious of their own mortality, often giving rise to anxiety and unease. Nurses who have a strong anxiety about death may be less comfortable providing nursing care for patients at the end of their life. From the study indicated that 80% of patients were transferred to intensive care units before they died, 20% of patients will die in the intensive care unit. This paper explores the literature on intensive care units nurses’ attitudes and social support to determine the impacts of nurses’ caring behavior for dying patients.

Method: Quantitative data were collected from 101 the intensive care unit nurses of public and private hospital in middle Taiwan. The resulting data were analyzed by calculating simple descriptive statistics, t-tests, one-way ANOVA, and regression analysis; used of SPSS 17.0 for data analysis.

Result: Based on quantitative surveys using valid instruments, results showed younger nurses consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care. Nurses need to be aware of their own beliefs. The average age of nurses in this study was 34.9 years old, working years more than 13 years of the majority. Most of them are Junior college graduates, and believe in Buddhism and Taoism. The social support scale is 80.4%; “Neutral Acceptance” and “Approach Acceptance”, “Esteem Support” and “Certain Support” are a positive correlation and predictive power for caring behavior (P <.05).

Conclusion: Confucius said: in dealing with the dead, if we treat them as if they were entirely dead; that would show a want of affection. As the results are presented intensive care unit nurses have positive death attitude and good social support can increase the care of dying patients care behavior. Nursing care of the dying is a particularly demanding role that requires nursing skill and also necessitates nurses to have insight into their personal beliefs about death and dying. Nurses who had a more positive attitude towards death were more likely to have a positive attitude towards providing end of life care for patients. Nurses need to consider their own race and spiritual beliefs (as well as those of the dying patient) because these may affect their objectivity in caring for a patient and the end of their life. Regardless of the cultural settings in which nurses work (or their continent) younger nurses under age 30, with less ability to cope with negative attitudes and the demands of emotional work would benefit from death education in the workplace.

並列關鍵字

Intensive Care Unit Nurses ； Death Attitude ； Social Support ； Caring Behavior

參考文獻

王郁智、章淑娟、朱正一（2006）。升遷機會、社會支持、工作滿意度與留任意願之相關性研究。志為護理，5(4)，90-101。

李選、白香菊、顏文娟(2008)。台灣地區護理人員執業環境之現況調查。護理雜誌，55(4)，30-40。

黃寶園（2010）。社會支持在壓力反應歷程中的中介效果。中華心理衛生學刊，23(3)，401-436。

鄧素文（2014）。臺灣護理人力概況與解決策略。護理雜誌，61（2），5-12。

中文部分