透過您的圖書館登入
IP:3.209.56.116
  • 學位論文

影響加護病房老年重症病人面臨疾病末期時期成年子女簽署DNR同意書意願因素

Factors that Influence the Adult Children to Sign on the DNR Consent Forms for Their Elderly Terminal Ill Parents in the ICU

指導教授 : 許雅娟

摘要


老年人器官退化遇到感染時,會導致病情的嚴重度與死亡之威脅性增加,在無法執行自主決策情況下,成年子女可能成為老年病人之代理醫療決策者。本研究目的旨在探討影響加護病房老年重症病人陎臨疾病末期時,其成年子女簽署DNR同意書意願傾向之相關因素。 研究設計方法以橫斷式、相關性研究設計,研究地點於南部某醫學中心內、外科加護病房為收案地點,採立意取樣,收案對象為入住內科或外科加護病房滿24小時後,年滿65歲(含)以上老年病人,其成年子女為研究母群體,成年子女收案條件包括:1.年滿二十歲(含)以上,為老年病人一等親之直系血親子女;2.具完全行為能力,無明顯精神疾患者;3.可清楚用國、台語溝通者。成年子女排除條件為口頭拒絕問卷調查者。 採結構式問卷收集資料,共計發出133份問卷,回收133份,均為有效問卷,問卷包含兩大部分,第一部份為成年子女基本屬性(年齡、性別、教育程度、家中排序)、醫療照護角色(主要照顧者、主要經濟者及主要決策者)及有無簽署DNR同意書意願題項;第二部份為中文版Mishel家屬疾病不確定感量表。資料以SPSS18.0套裝統計軟體進行描述性統計、t檢定、邏輯式二元迴歸分析等方法做資料處理。 結果發現:88%(117位)成年子女於父母親若被診斷疾病末期不可治癒,至死亡已將無法避免時,有意願簽屬DNR同意書。成年子女的年齡、性別、教育程度、家中排序和與醫療照護角色,皆與簽署DNR同意書意願傾向無顯著差異。成年子女對父母親疾病不確定感受程度屬於中高程度,僅有「不可預測性」之次量表與成年子女簽署DNR同意書意願具統計顯著差異。此研究結果可提供加護病房醫療照護團隊於老年重症病人,對其成年子女解釋簽署DNR同意書意願時之參考。

並列摘要


Infection in the deteriorated organs of elderly may intensify severity of the illness and threat of death. Under the situation the elderly are not able to decide by themselves, their adult children may become the substitutes of their medical decision makers. The aims of this study was to explore relevant factors influencing willingness of the adult children’s signing of DNR consent form when their terminally ill elderly parents were cared in Intensive Care Units. As research design methods, this study adopted cross-sectional and correlational research design. The research was conducted in a medical center in the South of Taiwan. The data were collected in medical and surgery ICUs by the way of purposive sampling; the subjects were 65-year-old or above elderly staying in the medical or surgery ICUs for at least 24 hours. Eligible adult children of the elderly patients with the following properties were enrolled as research population: (1) ones who were ≧20 years old and lineal (first-level) relatives of the elderly patients; (2) ones who had full legal capacity without obvious mental disorders; and (3) ones who could communicate with either Mandarins or Taiwanese dialect. Adult children who refused to participate the study were excluded. Structural questionnaires were used to collect data. Total 133 questionnaires were distributed and were all valid. The questionnaire involved two parts. The first part includes questions regarding basic attributes of the adult children (such as age, gender, education, age ranking in the family), roles of medical care (such as major caregiver , economic resource, and decision maker), and willing of signing DNR consent form. The second part is Chinese Version of Parent Perception of Uncertainty Scale for family member. The data were processed for descriptive statistics, t-tests, and logistic binary regression analysis with SPSS18.0 statistical package. Results showed that 88% (117) of adult children had the willingness to sign the DNR consent form when their parents were diagnosed terminal ill phase without any possibility of being cured and death was unavoidable. Age, gender, education, age ranking in the family, roles of medical care of the adult children were no significantly different with the willing of signing the DNR consent form. Adult children perceiving moderate uncertainty on parents’ diseases showed significantly statistical difference only in subscale of “unpredictability” and signing DNR consent form. Findings provide reference for caring team when they explain the DNR consent form to the adult children of elderly parents with terminally ill in the ICUs.

參考文獻


Lo, Y. T. (2010). Making end-of-life decisions: Revisit Chinese cultural perspectives. Taiwan journal of hospice palliative care, 15(2), 187-195.
安寧緩和醫療條例(民國100年1月26日修正)。
張慧玉(2009)‧探討終末病患照護中有關預立醫囑、生前預囑之現況及倫理法律問題‧(碩士論文),臺北醫學大學護理學研究所。取自華藝線上圖書館。
莊令吏(2005)‧成人加護病房家屬不確定感及需求重要性之探討‧(碩士論文),中山醫學大學。取自華藝線上圖書館。
陳奇祥(2009)‧外科病患及老年病患重返加護病房之臨床特性及結果之研究‧(博士論文),中山醫學大學。取自華藝線上圖書館。

延伸閱讀