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台北市某社區型醫院醫病溝通會議之成效

Exploring the Effectiveness of Physician-Family Communication Meeting in a Community Hospital in Taipei

摘要


目的:台灣104 年新制醫院評鑑於「病人及家屬權責」章節中,增訂需與住院病人或家屬溝通、適當說明住院之必要性及治療計畫,並推動病人、家屬參與醫療決策之過程(share decision making)。台北市某社區型醫院經明訂家庭會議作業流程與規範,促使醫療照護成員參與家庭會議,並探討實施狀況、了解參與會議成員、追蹤主治醫師與單位護理長參與的配合度與貢獻度並評核會議成效。方法:建置家庭會議作業流程與作業規範,經「家庭會議登錄系統」收集會議召開狀況,以2015 年4 月至12 月該資料庫資料進行描述性統計分析。結果:在2015 年4-12 月共累計召開13925 次會議。主治醫師實際參與為365 位,約佔全院主治醫師60%,平均每年每一位參與主治醫師約分擔38.15 場次的家庭會議。護理長實際參與為79 位,約佔全院護理長81%,平均每年每一位參與護理長約分擔176 場次的家庭會議。家庭會議的成效顯示,「無論是否撤除維生設備團隊絕不放棄」得分最高為95.2 分,「確知病人能夠得到舒適照護」得95.1 分為次之; 統計評核結果顯示「提供正確訊息」得分比率為93.2%,「為決策解釋」得分比率為90.4%,「開放交流」得分比率為92.2%。結論:醫病之間可透過醫護巡房、床邊交接、家庭溝通會議等達到溝通的效果,然家庭會議的召開能使醫療團隊對病人及家屬提供正確訊息,決策的選擇與說明,並給予支持以及建立醫護病間的互信氛圍。

並列摘要


Objective: The Taiwan Hospital Accreditation amended additional contents in the section of "patient and family rights and responsibilities" amended that healthcare provider should communicate with patients and families, explain the necessity of hospitalization and treatment plans, and promote the participation of patients, families, medical staffs in decision making process (shared decision making). A community hospital in Taipei City had established an operation protocol and the regulations for Physician-Family Communication Meeting that urge medical care members to join the Physician-Family Communication Meeting, investigate the actual implementation status, comprehend members of the meeting, follow-up the coordination and contribution of the attending physicians and head nurse of the unit, and assess the efficacy of the meeting/conference. The purpose of this study was to explore the implementation of Physician-Family Communication Meeting in clinical situations, understand the participation of family members, follow-up physicians and head nurses involvement, cooperation and contribution of the meetings, and audit the contribution and assessment results of Physician-Family Communication Meeting. Methods: We established an operation protocol and the regulations for Physician-Family Communication Meeting. Data of the meetings were recorded in a Physician-Family Communication Meeting record system from April to December 2015, and descriptive statistics were reported. Results: A total of 13925 Physician-Family Communication Meeting were held between April to December 2015. Around 60% of our attending physicians participated in 365 Physician-Family Communication Meeting, sharing 38.15 Physician-Family Communication Meeting per physician. 79 (81%) head nurses participated in the Physician-Family Communication Meeting, and in average each head nurse was involved 176 Physician-Family Communication Meeting. Analysis of effectiveness showed that "Whether withdrawing life-support equipment or not, the medical team will never give up" got the highest score of 95.2, followed by "Assure patients can get comfort care" with the second highest score of 95.1. The score for "provide correct message", "explain the decision" and "open for exchange" were 93.2%, 90.4%, and 92.2%, respectively. Conclusion: Physician-Family Communication Meeting enable medical team members to provide the correct information to patients and families, as well as the establishment of mutual trust relationship.

被引用紀錄


賴佾楦、蔣立琦(2023)。照顧一位壓力性損傷病人及家庭照顧者負荷過程之護理故事源遠護理17(1),44-52。https://doi.org/10.6530%2fYYN.202303_17(1).0006
宋聖芬、陳煌麒、楊婉萍(2022)。末期醫療抉擇的家庭會議溝通模式之回溯性分析台灣公共衛生雜誌41(2),226-233。https://doi.org/10.6288%2fTJPH.202204_41(2).110147

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