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  • 學位論文

家屬對病人入住安寧病房的決策經驗

Family Experience of Decision-Making for Hospice Admission

指導教授 : 林俐伶助理教授

摘要


本研究旨在探討癌末病患家屬對安寧病房的決策經驗,研究方法採紮根理論研究法,研究對象為入住安寧病房之癌末病患的家屬,且同時為決策過程的主要決策者,以立意取樣方式自南部某醫學中心之安寧病房選擇收案對象,收案對象為入住安寧病房滿72小時之癌末病患,其決策過程的主要決策者,資料收集時間為民國96年3月起到96年12月止總計12人符合收案條件,期間有3人照顧者為看護,家屬因為忙碌而婉拒訪談,1人為外籍人士故排除收案,另外有2人在訪談期間因悲傷而中斷訪談,研究者在轉介心理師之後決定不再約訪排除收案,總計收案6人。以深度訪談方法收集資料,研究結果發現家屬對安寧病房的決策經驗共有三個範疇、七個主題及十四個次主題,分別為決策前期、決策中期及決策後期三個範疇。「決策前期:在不捨中擺渡」,包含「覺知生命消逝」、「困頓感」及「社會資源網絡」等三個主題及「生命遲暮」、「受苦的存在」、「疲憊」、「無助」、「不捨」、「經濟因素」、「照顧的責任」、「醫病互動經驗」等八個次主題,呈現研究對象在面對醫療措施無法有效緩解病人的痛苦與追求善終的希望產生衝突,且照顧的壓力及安頓家庭的過程讓研究對象身心俱疲,引發研究對象思考安寧療護的可能性;「決策中期:必須承受的難」,包含「自我反思」與「決策的阻力」二個主題,及「病人意願的探詢」、「決定放下」、「安寧=等死」、「行政規範的限制」等四個次主題,此階段是指研究對象從病人在門診或病房照會安寧療護,舉行家庭會議到決定進入安寧病房的決策經驗,在此階段研究對象在「等死」的社會氛圍中進行自我療癒決定放下,並具體內化進入安寧病房決策的合理性;進入「決策後期:告別與安頓」,有「告別時刻」與「身心安頓」二個主題,是對此決策的再評價,研究對象在經歷了不同的照護經驗之後,對於進入安寧病房的決定給予正向的意義。 研究結果提供護理人員對癌末病患家屬之入住安寧病房的經驗感受有進一步的認識,建議加強醫護人員的安寧療護教育,能早期覺察病患及家屬的安寧照護需求,期望能協助病人及家屬在病人的生命末期能獲得身心紓解。在行政體制方面,住院日數的限制是家屬另一個遷移的開始,更是安寧療護四全照護目標的限制,未來應思考符合全程、全隊照護的執行模式。 關鍵詞:安寧病房、決策經驗

關鍵字

安寧病房 決策經驗

並列摘要


The purpose of this study was to explore the experience of decision-making for hospice admission among end stage cancer patients’ families. A grounded theory design using in-depth interviews was applied in the study. Using purposed smpling processure, a total of 6 participants were recruited from a hospice ward in a medical center in south Taiwan. The recruit criteria were that the patient had admitted the hospice ward over 72 hours, and the participant should be the primary decision maker. Three categories, seven themes, and twelve sub-themes were found from data analysis. The first category is the pre-decision-making stage which includes three themes: “aware it is time to go”, “exhausted”, and “social network”, and eight sub-themes: “the life died away”, “suffer being”, “fatigue”, “helplessness”, “reluctant to let go ”, “economic resources”, “responsibility of care”, and “the interaction between healthcare team and patient”. Families at this stage experienced conflicts between the end stage care stresses and their hopes in keeping patients’ lives. It is the initial motivation to think about palliative care. The second category is the middle stage of decision-making. There are two themes included in this category: “reflection”, and “the resistance of decision- making”. Under these two themes, four subthemes were presented, namely, “explore patient’s preference”, “decide to let go”, “waited for died”, “administrative restriction”. Finally, post stage of decision- making, is a evaluate process for the decision-making. Two major themes are “settle down” and “time to say goodbye”. From the result of the study, nurses will have a better understanding of the experience of decision-making for hospice admission among end stage cancer patients’ families. Further suggestion for clinical practice is to enhance nurses’ education about hospice care in order to aware patients and families’ needs in advance and offer help as necessary. For administrative pratice, control the LOS in hospice ward makes the family suffer afer all settle down. Healthcare system need to find a more humanistic care model in considering the holistic care.

參考文獻


安寧共同照護模式試辦經驗•安寧療護雜誌,10(3),234-242。
末病人與其照顧者之影響•安寧療護雜誌,9(2),124-131。
安寧病房深度參訪成效之初探•安寧療護雜誌,8(4),381-392。
癌末病人善終之評估•安寧療護雜誌,10(1),13-23。
照護型態對住院醫療費用與住院天數之影響•台灣衛誌,26

被引用紀錄


何雪綾(2015)。社區醫療照護模式中末期患者家屬參與患者之「預立醫療計劃討論」的心理歷程特徵〔博士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2015.00199
吳梓卉(2012)。高齡者臨終意象之探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.00009
陶韻然(2010)。大學應屆畢業生個人背景因素、校園經驗與生涯成熟態度研究--以北部地區大學為例〔碩士論文,國立臺灣師範大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0021-1610201315214799
王素鴻(2010)。某醫學中心安寧療護轉介時機之探討〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0003-1002201016223300
劉曉恬(2014)。家屬照顧者運用安寧療護經驗探討〔碩士論文,朝陽科技大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0078-2502201617123144

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