護理人員與照顧服務員簽署預立醫療指示之差異性探討-以南部某區域教學醫院為例

Difference in Advance Medical Directive Decisions between Nurses and Nurse Aides：A Case of a Southern Regional Teaching Hospital

劉怡伶(Yi-Leng Liu)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2012年)

https://doi.org/10.6833/CJCU.2012.00129

摘要

目的 預立醫療指示之推動，可讓民眾自主掌握生命末期之醫療決策，降低無效醫療及醫療浪費。醫療從業人員對預立醫療指示的知識及態度，會影響預立醫療指示的推動，護理人員與照服員皆是醫療照護團隊中的一員，提供病人最直接的持續性照護，因此，本研究欲探討護理人員與照服員對預立醫療指示之知識及態度是否影響其本身簽署預立醫療指示之行為意向。
方法 本研究採結構式問卷，以南部某區域教學醫院全體護理人員及照服員為研究對象，發出368份問卷，回收有效問卷331份（89.9%），護理人員270份、照服員61份。回收問卷經整理後，以SPSS進行差異性、相關性、多項式邏輯斯迴歸等統計分析。
結果 僅7.4%的護理人員完成預立醫療指示之簽署，沒有意願簽署預立醫療指示之主因為「我還健康，未考慮此事」。在預立醫療指示之知識及態度，護理人員與照服員達顯著差異，且護理人員得分均高於照服員。預立醫療指示之知識與態度（r=0.253, p＜0.01），及態度與行為意向呈顯著正相關（r=0.390, p＜0.01）。透過多項式邏輯斯迴歸分析顯示，預立醫療指示態度之「建立生命優先順序」對行為意向之「有意願/考慮中」之模式具有顯著之正向預測力（β=.041），其勝算比（OR）為1.042倍。
結論 護理人員及照服員之預立醫療指示之簽署率相當低，可能進而影響其推動之意願。研究結果顯示，護理人員與照服員在相同的臨床照護環境中，雖皆能由工作經驗中獲取相關的資訊，但有接受過安寧相關教育訓練的護理人員，其對預立醫療指示之知識及態度得分還是高於照服員，顯示教育訓練的重要性。建議政府能將生死教育融入國人生活及教育中，引領其重視末期照護議題，醫療人員應隨時提供病人及家屬相關資訊，進而落實簽屬預立醫療指示之推動。

關鍵字

預立醫療指示 ； 知識 ； 態度 ； 行為意向

並列摘要

Objectives The promotion of advance medical directives can help people make their own decisions of medical treatment at the end of life, and reduce the futility of medical treatment and medical resources wastage as well. Knowledge and attitude about advance medical directives among health care professionals will affect the promotion of this program. Nurses and nurse aides are members of health care teams, who provide patients direct and continu care. The purpose of this study is to explore that if nurses and nurse aides affect the signing of advance medical directives agreement by their knowledge or attitude.
Methods A structured questionnaire was developed and 368 copies were distributed to nurses and nurse aids in one regional level hospital in southern Taiwan. 331 valid questionnaires (270 from nurses and 61 from nurse aides) were collected with a response rate of 89.9%. With the aid of SPSS package, descriptive analysis, difference analysis, correlation analysis, and multinomial logit model were conducted.
Results Only 7.4% of nurses completed the advance medical directives agreement. The main reason why they didn’t sign the advance medical directives was "I'm still healthy and have not considered it yet". Nurses and nurse aides had significant differences in their knowledge and attitudes regarding advance medical directives issues, and the nurses’ scores were higher than the nurse aides’. The results present significant positive relation between knowledge of advance medical directives program and overall attitudes (r=0.253, p＜0.01) ; and overall attitudes and behavioral intention (r=0.390, p＜0.01), respectively. In the multinomial logit model, "the establishment of life priority" for attitudes of advance medical directives for the behavioral intention of "yes/ consideration", with an odds ratio of 1.042, was a significant positive predictor (β=.041).
Conclusions The percentage signing advance medical directives agreement among nurses and nurse aides was very low, which may affect their willingness to promote this program. The relevant results show that although both the nurses and nurse aides obtained similar relevant information from work experience in the same care environment, the nurses who had received hospice training got higher scores than the nurse aides on their knowledge and attitudes about advance medical directives issue, which confirms the importance of educational training. We recommend that the government should integrate the "life and death" concept into people’s daily life and education, to lead them to place great importance on the issue of terminal care. Besides, health care professionals should also readily provide related information to patients and their families in order to promote the practice of signing this advance medical directives agreement.

並列關鍵字

advance medical directives ； knowledge ； attitudes ； behavioral intention

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