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  • 學位論文

家屬面對呼吸器依賴病人遷移過程之經驗

The Experience of Family Members Facing a Ventilator Dependent Patient’s Transference

指導教授 : 吳麗珍

摘要


使用呼吸器治療在加護病房救活很多呼吸衰竭的病人,但是急性期之後,仍有許多病人無法脫離呼吸器而必須轉入亞急性呼吸病房接受呼吸訓練。呼吸訓練30天後仍然無法自行呼吸或呼吸訓練沒有進展者,可能成為呼吸器依賴患者。為有效運用醫療資源,依健保局規定,這些在亞急性呼吸病房呼吸訓練42天沒有成功的病人就必須轉至自費的慢性長期呼吸照護病房。在從原醫療機構遷移至長期照護機構的過程,醫療人員經常未注意到家屬所承受之壓力。因此,本研究主要是探討家屬面對呼吸器依賴病人遷移過程之經驗和感受,期望透過病人家屬經驗感受的敘說,醫療人員能夠更深層的瞭解他們的心路歷程。此質性研究,以南部某醫學中心呼吸器依賴病人之家屬為對象,採立意取樣共訪談六位符合收案條件的家屬,研究者以一對一訪談方式收集資料。錄音之訪談內容轉騰成逐字稿後,依內容分析法進行資料分析。家屬在呼吸器依賴病人遷移過程之經驗呈現四個主題:「決策過程的掙扎」、「病情理解的轉變」、「轉出的衝突」、「自我生命價值的理解」。本研究結果所提供的資料能夠協助醫療人員了解家屬在病人遷移過程的感受和困難,及早提供家屬在面臨此問題時之準備及規劃,有效的協助家屬將病人遷移至長期呼吸照護機構。本研究結果亦可提供給醫療機構作為其他類型病人遷移或出院準備服務之參考。

並列摘要


In the intensive care unit, respirator treatments have saved many patients from respiratory failure. After the acute phase, however, many still depend on the respirators and have to be transferred to a respiratory care center, subacute care center, for respiratory training. If patients still can not breathe on their own or if their breathing condition has not improved significantly, they are likely to become respirator-dependent. In order to use health care resources more effectively, the Taiwan National Health Care rules stipulate that patients who are not successfully trained after 42 days have to be discharged to a self-pay chronic long-term respiratory care institution. This transfer process is often very stressful for patients and their family members, who may not receive much support from health care providers. Thus, this study seeks to explore the experiences of the family members of respiratory-dependent patients during the transfer process. It is hoped that through the descriptions of the families’ experiences, healthcare providers might gain deeper insight of the family members’ perspective during the transfer. This qualitative study used purposive sampling to recruit family members who met the inclusion criteria. Six family members of respiratory-dependent patients in a medical center in southern Taiwan were included in the study. Data was collected through one-on-one face-to-face interviews by the researcher. The six interviews were recorded and transcribed verbatim for content analysis. Four themes emerged: struggle to make health decisions, changing interpretation of the patients’ condition, family conflict regarding transfer, and insight into one’s own life and value. The results of this study will help health care providers understand the difficulty and feelings of the families of respirator-dependent patients during transfer from a hospital to a long-term care institution. This will allow health care providers to prepare family members in advance and to manage the patient transfer process more effectively. The results of this study may also aid other types of patient transfer preparation and patient discharge planning.

並列關鍵字

ventilator-dependent family members transfer

參考文獻


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