- 學位論文
加護病房生命末期病人緩和照護之品質:醫師與護理師觀點之比較
The Quality of Palliative Care at the End-of-Life in the Intensive Care Unit：A Comparison Between Physiciansˈ and Nursesˈ Perceptions
摘要
本研究目的為瞭解醫師與護理師對於預立醫囑的知識和態度以及護理師參與末期醫療決策現況、加護病房末期病人緩和照護品質，採橫斷性研究。研究對象為加護病房醫師與護理師，給予自評式問卷填寫，研究自2013 年11月至2013 年12 月以北部某醫學中心一年內工作於加護病房領有執業執照的醫師和護理師為研究對象，收案醫師56位，護理師120位。 研究結果發現：1.預立醫囑知識程度，醫師的分數4.39（SD = 1.49）分比護理師3.89(SD = 1.30)分高( p<0.05）。2.醫師與護理師對於末期醫療決策呈現正面的態度。3.多數的醫護人員認為醫師會和護理師討論末期醫療決策，且護理師目前有參與討論末期醫療決策，九成五以上的醫護人員認為護理師應該參與末期醫療決策。當末期醫療決策決定後，約八成的醫師和六成的護理師認為醫師和護理師有取得共識。4.緩和照護品質中，表現較佳的領域為症狀處理和舒適的照護，較不足的前三項為醫院對於醫護人員情感面和教育的支持、病人和家屬的靈性支持、持續性照護。5.醫師自評末期病人緩和照護品質與性別、加護病房屬性、教育程度、預立醫囑的知識、末期醫療策的態度無顯著關聯性；護理師自評末期病人照護品質重要預測因子為性別、末期醫療策的態度、護理師是否參與末期醫療決策；末期病人照護品質重要預測因子為職稱、預立醫囑的態度。 本篇研究可以作為加護病房緩和照護品質評估工具之參考及指引。此外，本篇研究建議護理師應更積極參與末期醫療決策，以有效提升末期病人緩和照護品質。
並列摘要
The purpose of the study is to assess the knowledge and attitudes regarding advance directives from doctors and nurses. Another aim is to find out the nurses’ involvement in end-of-life decisions making and the quality of palliative care in the intensive care unit. This study adopted a cross-sectional design, using self-assessment questionnaire to 56 doctors and 120 nurses working in Northern Taiwan ICU during November 2013 and December 2013. The survey concluded: (a) Doctors have more knowledge regarding advance directives than nurses. (b) Both doctors and nurses keep positive attitudes of end-of-life decision making (c) Most clinicians consider doctors will discuss with nurses about end-of-life decision making. 95% nurses think they should participate in end-of-life decision making, whereas around 80% doctors and 60% nurses agreed to get consensus when end-of-life decision was made. (d) During palliative care, the quality of symptom management and comfort care was considered performed well. However, emotional and organizational support for ICU clinicians, spiritual support of patients and families, continuity of care were considered to be insufficient. (e) From nurses’ self-assessment result, the predicting factors of the quality of palliative care were significantly related to nurses’ gender, participation, as well as the attitude toward advance directives in end of life care. The results of this study can be applied as a reference for effective guideline and assessment tools for quality of palliative care in the intensive care unit. In addition, this study suggest that it’s important to get nurses more involved in end-of-life decision making so as to improve the quality of palliative care in the future.
參考文獻
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