護理人員對於預立醫療決定知識、態度、經驗及自信之探討

本研究目的在探討護理人員對於預立醫療決定知識、態度、經驗與自信之現況，方法採橫斷式相關性研究設計，選取北部某區域醫院護理人員為研究對象，共收案300位。研究工具包含社會人口學特性及預立醫療決定知識、態度、經驗與自信之問卷。所得資料以SPSS25.0軟體建檔，並以描述性及推論性統計如獨立樣本t檢定、無母數檢定、單因子變異數分析、皮爾森積差相關及多元迴歸作為分析。研究結果發現：1.本研究對象在預立醫療決定知識方面平均得分為9.63分（總分為16分），對於病人自主權利法相關程序的了解，最為缺乏；預立醫療決定態度方面平均得分為32.06分（總分40分），傾向正向；約8成的護理人員有照顧預立醫療決定病人的經驗，6-7成的人曾看過或親自提供過已有預立醫療決定的病人與其意願相左的CPR或只能延長瀕死過程的維生醫療；預立醫療決定自信程度總得分為34.77分（總分為55分），護理人員對於預立醫療決定相關法律條文最沒有自信。2.教育程度為碩士以上、工作職稱為專科護理師及進階層級N4者知識得分較高；而本研究中人口學特性在態度方面，皆未達顯著差異；年紀長、專科護理師、急診室服務、年資深、進階層級N2及參與病主法ACP未簽AD者有較多的經驗；年紀長、碩士以上、專科護理師和護理長及督導長含以上、年資深、有接受安寧及病主法相關教育訓練、有簽署病主法AD者及參與病主法ACP未簽AD者有較多的自信。3.護理人員對於預立醫療決定的態度與經驗、自信呈現正相關（r＝0.152、r＝0.248），經驗與自信程度亦呈現正相關（r＝0.447）。4.工作職稱與進階層級為知識影響因素；工作職稱、服務科別及進階層級為經驗影響因素；而進階層級為自信影響因素。結論：預立醫療決定為善終的前置因素，本研究結果顯示護理人員對於預立醫療決定態度雖然偏正向，但對於預立醫療決定法律相關知識最為不足及缺乏自信，超過8成的研究對象有照護預立醫療決定病人的經驗，但實務上仍然不夠尊重病人的自主意願。建議能夠依照不足之處規劃教育內容，加強護理人員對於相關倫理及法律議題的知識，建立其正確認知，進而有效落實預立醫療決定的推動。

關鍵字

預立醫療決定；知識；態度；經驗；自信；病人自主權利法

並列摘要

This study aimed to understand nurses’ knowledge, attitude, experience, and confidence regarding advance directives. A cross-sectional correlation research design was used to target nurses working in a regional hospital in northern Taiwan. Three hundred nurses were enrolled and asked to complete a questionnaire including demographic characteristics, knowledge, attitude, experience, and confidence on advance directives. The results were as follows: (1) The average score for the participants’ knowledge of advance directives was 9.63 out of 16, with most lacking knowledge on relevant procedures of the Patient Right to Autonomy Act. The participants obtained an average score of 23.06 out of 40 on their attitude toward advance directives, indicating a positive attitude. About 80% of the participants had the experience of taking care of patients with advance directives, with 60–70% of the participants had witnessed or personally provided CPR or life-sustaining treatments that prolonged the dying process against the will of the patients who had made advance directives. The average score for the confidence on advance directives was 34.77 out of 55, indicating that the nurses had little confidence on the legal provisions concerning advance directives. (2) Participants with a master’s degree or above, nurse practitioner, and at the advanced level of N4 obtained higher scores for their knowledge of advance directives. There was no significant difference regarding the attitude toward advance directives between participants with different demographic characteristics. Older, nurse practitioners, worked in emergency rooms, senior, at the advanced level of N2, and had participated in advance care planning stated but did not sign the advance directives had more experience of taking care of patients with advance directives. Moreover, older, had a master’s degree or above, nurse practitioner, head nurse, nursing supervisor or above, senior, had received educational training regarding hospice care, had signed advance directives stated, and had participated in advance care planning stated but did not sign the advance directives were more confident on advance directives. (3) The participants’ attitude, experience, and confidence on advance directives were positively correlated (r = 0.152, r = 0.248), and their experience and confidence were also positively correlated (r = 0.447). (4) Nurse practitioner and the advanced levels of N2 and N4 were factors influencing their knowledge of advance directives. Multiple regression results revealed that nurse practitioner, working in emergency rooms, and the advanced levels of N1 and N2 influenced the participants’ experience, while nurse practitioner, head nurse, nursing supervisor or above influenced their level of confidence. Conclusion: Advance directives was the predisposing factor that influenced patients’ good death. This study showed that although the nurses held a positive attitude toward advance directives, they often lacked the knowledge related to the laws of advance directives, and had insufficient confidence regarding advance directives. More than 80% of the participants had the experience of taking care of patients with advance directives, but in practice, they still failed to respect the patients’ will. This study suggested that educational training should be designed and provided to enhance nurses’ knowledge of the ethical and legal issues related to advance directives for a more appropriate understanding to effectively implement advance directives.