簽署不施行心肺復甦術同意書病患家屬對加護病房照護與醫療決策過程滿意度之初探

The preliminary investigation of satisfaction with intensive care and decision making process in patients ’ families who signed " Do not resuscitate " consent for the patients.

周燕玉(Yann-Yuh Jou)

指導教授 ： 張媚

國立臺灣大學/醫學院/護理學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.00309

摘要

本研究採前瞻性描述性相關性研究，主要目的在探討為病患簽署「不施行心肺復甦術」同意書的病患家屬對加護病房照護與醫療決策的滿意度。研究採取立意取樣，以台北市某醫學中心外科加護病房爲病患簽署不施行急救同意書的家屬為收案對象。本研究採取結構式量表收集資料，研究工具包括兩個部份：(一)家屬及病患的基本資料；(二)家屬對加護病房照護與醫療決策過程之滿意度量表。於病患死亡或者是辦理自動出院後一個月，先郵寄問卷至個案家，然後再用電話訪談。收案期間從94年2月至94年8月，共收50位個案。研究結果發現：（1）男性佔46%，女性佔54%，平均年齡為44歲，74%家屬的教育程度為高中以上，與病患的關係多為子女或配偶，64%的受訪家屬為替病患作不施行心肺復甦術者。（2）82%家屬在未作決定之前，就已經聽過不施行心肺復甦術，而且持贊成的態度。（3）家屬對加護病房照護最滿意的前三個項目，包括：護理人員的技術與能力、護理人員的溝通、以及加護病房的工作人員對病患的態度；最不滿意的項目，是家屬休息室的氣氛。（4）影響家屬對整體照護滿意度最重要的因素，是對病患的態度以及護理人員的技術與能力；而影響家屬醫療決策過程中對於自我角色的整體滿意度之重要因素，是獲得資訊的容易程度。（5）住進加護病房意識程度不清楚與疾病嚴重度較高之病患的家屬，對加護病房照護的滿意度較高；家屬對不施行心肺復甦術的態度越認同者，對照護的滿意度也較高。（6）家屬對參與醫療決策過程的看法方面72%的受訪者表示參與決策的時機剛剛好，80%的家屬表示獲得恰好的資訊量並且有足夠的時間考慮決策，50%的家屬表示醫護人員讓他們對病患的病情有正確的期待，46%的家屬感受到病患的生命有縮短。

關鍵字

不施行心肺復甦術 ； 家屬 ； 加護病房 ； 滿意度

並列摘要

This is a prospective, descriptive relationship study. By intention sampling, we recruited the families, who signed the “Do not resuscitate” (DNR) consent for patients in surgical intensive care units (SICU) of a Taipei medical center. The purpose of this study is to investigate the families’ satisfaction with care and decision-making process during the patients’ stay in SICU. The data were collected by structured questionnaires in the study. The study tools included two parts: 1.demographies of the patients and their families. 2. the questionnaires to measure the families’ satisfaction with care and decision-making process in SICU. One month after the patients’ death or discharge to home when impending death, we mailed the questionnaires to the families, then interviewed by telephone to follow up. From February 2005 to August 2005, 50 study cases were recruited in this study. The result were: 1). 46% of the study cases were male, and 54% were female. Their average age was 44 years old. 75% of the study cases had education above high school. The most common relationship of the study cases to the patients were children or spouses. 64% of the study cases were the families, who decided DNR for the patients. 2). 82% of the study cases had known DNR and had positive attitude to it before they decided DNR for the patients. The top 3 items, which the families were most satisfied with the ICU care, were technique and ability of nurses, communication by nurses’, the attitudes of ICU staff to the patients; the most unsatisfied item was the atmosphere of family rest room. 4). The most important factors that influenced the families’ total satisfaction with the ICU care was the attitude to the patients, and skill and competence of the nurses. The most important factor that influenced the families’ satisfaction with their self roles in decision-making process was the ease of getting information 5). The families of the patients, who had unclear consciousness on admission to SICU and had higher diseases severities, were more satisfied with the ICU care. The families who had more positive attitudes to DNR were more satisfied with the ICU care. 6). 72% of the study cases felt that they were involved in decision-making at the right time. 80% of the study cases felt that they got the right amount of information and let them have enough time to consider decision-making. 50% of the study cases felt that medical staff had right expectation of the patients’ diseases progress. 46% of the study cases felt that the patients’ lives were shortened

並列關鍵字

DNR ； family ； intensive care units ； satisfaction

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