長期照顧機構住民家屬之決策性疲憊探討

我國於2018 年邁入高齡社會，2026 年邁入超高齡社會，社會變遷、少子化、老年照顧為當前首要議題，其中家庭式照顧已成為一個難以突破的困境；當病人送進長期照顧機構，種種決策將隨之而來。本研究主要目的為探討影響長期照顧機構住民家屬之決策性疲憊之相關因素；以問卷調查法中部某區域教學醫院之長期照顧機構住民家屬共132 人，研究工具為：1.個人背景屬性資料變項調查表2.照顧者反應量表3.決策疲憊量表。樣本以女性家庭照顧者及住民成年子女為主。卡方檢定「與病人關係」及「主要決策者」結果顯示孫子女的期望值最高；隔代教養之孫子女的照顧壓力或許需要被考量。階層迴歸統計顯示，照顧者反應量表可解釋決策性疲憊約30% 的變異量，其中以「日常作息被干擾」為最強預測因子, p< 0.05。家庭照顧者進行代理醫療決策時，受其背景屬性、下決定的時機點、家庭角色、與病人關係等的影響。因此，應考慮如何及早發現長期照顧機構家屬的疲憊程度，避免在非預期情況時，臨時做出決策，造成難以挽回的局面。當主要決策者出現決策疑慮，便凸顯了護理人員的角色功能，可透過跨團隊的討論、醫病共享決策、主要決策者能理解的用語，給予適當的資訊，以協助其作出通盤考慮後的決策。

關鍵字

決策性疲憊；照顧者反應；主要決策者

並列摘要

Taiwan has entered an aging society in 2018 and will become a superaged society in 2026. Social changes, declining birthrates, and elderly care have considered as the primary issues, such as familybased care becoming a dilemma. When patients admitted to a long-term Care facility, many decisions need to be made. The aim of this study is to explore the relevant factors that affect the decision fatigue in family caregivers of the residents of long-term care facilities. Validated survey questionnaires had administered to a total of 132 family caregivers of long-term care facility from a regional teaching hospital in Taichung. Questionnaires include: Demographic questionnaire, Caregiver Reaction Assessment (CRA), and Decisional Fatigue Scale (DFS). Sample of this study mainly were female and residents’ adult children. The Chi-square test on "relationship with patients" and "primary decision-makers" indicated that the adult grandchildren is the highest contribution to the value of chi-square. Hence, the stress of the medical decision in those who were raised from grand parenting may need further addressed. Hierarchical Regression analysis showed that the caregiver reaction scale can explain about 30% of total variance of the decision fatigue. The " disrupted schedule " is the strongest and significant predictor, p<0.05. The stress from making medical decision for love ones may associate with personal characteristics, timing of decision being made, family role, and relation with resident. Thus, to avoid making perturbation decisions in unexpected situations, resulting in an irreversible situation, it is critical as being able to detect the stress from decision making in family caregivers of resident in longterm care facility. The role and function of the nurse should be highlight when the surrogate decision required further clarification and assist. Nurses may provide the appropriate information through interprofessional discussions for share decision making (SDM); yet further investigation is needed.