Title

長期呼吸器依賴老年病患家屬行氣切決策衝突預測因子之探討

Translated Titles

Predictors of Tracheotomy Decision-Conflict among the Family of Ventilator-Dependent Elders

Authors

蘇雅菁

Key Words

長期呼吸器依賴老年病患 ; 氣切 ; 決策衝突 ; Ventilator-dependent elders ; tracheotomy ; decision conflict

PublicationName

中國醫藥大學護理學系碩士班學位論文

Volume or Term/Year and Month of Publication

2013年

Academic Degree Category

碩士

Advisor

陳玉敏

Content Language

繁體中文

Chinese Abstract

本研究目的為探討長期呼吸器依賴老年病患家屬行氣切決策衝突預測因子。採相關 性研究設計,以立意取樣於中部某醫學中心選取長期呼吸器依賴老年病患家屬100位為研究對象,進行結構式問卷及開放性問題資料收集資料。研究工具包括:老年病患基本資料、家屬基本資料、決策衝突量表、開放式問題等四部分。以SPSS/PC 18.0套裝軟體進行統計分析,而開放式問題以內容分析法進行資料分析。 本研究結果顯示:(1)就整體而言,長期呼吸器依賴老年病患家屬決策衝突總平均得分為2.47分,顯示氣切決策衝突不高。但依有無選擇氣切兩組來看,在選擇不行氣切組方面,決策衝突總平均得分為2.59分,則顯示有氣切決策衝突。兩組在決策衝突次量表得分高低,依序均為「不確定感」、「感覺未獲支持」、「決定滿意度」、「個人價值觀不明確」、「感覺未獲相關資訊」。(2)平日主要照顧長期呼吸器依賴老年病患為媳婦者,其「個人價值觀不明確」次量表得分較高。而長期呼吸器依賴老年病患住加護病房至行氣切的天數,和「感覺未獲相關資訊」次量表呈負相關。並且長期呼吸器依賴老年病患行計畫性的移除氣管插管次數,和決策衝突總量表呈負相關。(3)長期呼吸器依賴老年病患家屬在「不確定感」次量表和氣切決策衝突總量表得分,會因「經濟狀況」、「決策是否後悔」等變項,於各組間呈顯著的差異。(4)逐步複回歸分析結果顯示,決策衝突量表中之「不確定感」次量表的預測因子為「家屬年齡」、「家屬經濟狀況」及「分擔照顧成員」,共可解釋6%的變異量,決策衝突總量表的預測因子為「家屬經濟狀況」,共可解釋5%的變異量。(5)長期呼吸器依賴老年病患家屬行氣切決策之開放性問題訪談結果,分別依決策考量、因應方法及專業協助需求等三個主題呈現。在決策考量方面,分別有生理、心理、家庭及醫療等四個層面。而家屬所採取的因應方法則有:尋求相關訊息及支持、因循社會倫理及接受專業評估等。最後,在專業協助需求方面則分別有:給予充分考慮時間、提供實際案例、完整且具體的氣切手術及預後說明、氣切後續照護計畫說明及加強醫護病溝通等。 期本研究結果能提供護理人員在臨床照護長期呼吸器依賴老年病患及其家屬之參考。

English Abstract

The purpose of this study was to explore the predictors of tracheotomy decision-conflict among the families of ventilator-dependent elders. The purposive sampling method was to recruit 100 families of ventilator-dependent elders from a medical center in Taichung city. Research instruments include the background data sheets of geriatric patients and their families, decisional conflict scale and three open questions. Datas were analyzed by using SPSS / PC 18.0 for Windows. The open questions were analyzed by content analysis. The results indicated: (1) The decisional conflict scale average score was 2.47 points, showed no too high decision-conflict among the families of ventilator-dependent elders. But according to chose or chose not to tracheostomy groups, the group of chose not to tracheostomy has higher decisional conflict score. The sequence of two groups in the decisional conflict subscores was ‘uncertainty subscale’,‘support subscale’,‘effective decision subscale’,‘values clarity subscale’,‘informed subscale’. (2) The primary caregiver of ventilator-dependent elders were daughter-in-law who has the higher score in the values clarity subscale. And the days of ventilator-dependent elders from admitted ICU to tracheostomy were negatively correlated with informed subscale. In addition, the numbers of ventilator-dependent elders planned extubation were negatively correlated with decisional conflict scale. (3) Ventilator-dependent families of elders significant differences in uncertainty subscale and decisional conflict scale due to ‘economic conditions’ and ‘ decision whether to regret ‘. (4) Stepwise regressions showed that the uncertainty subscale predictors were ‘age of families‘, ’ family economic conditions‘ and ’ take care of the members’, explain 6% of the variance.And the family of enconomic situation was the predictor of decisional conflict scale, explained 5% of the variance. (5) According to the open interviews, the tracheotomy decisions among the families of ventilator-dependent elders had to present by the three themes : decision-making considerations, coping methods and professional assistance needs. The decision-making considerations had four dimensions of physiological, psychological, family and medical; coping methods include seeking relevant information and support, following social ethics, and receiving professional assessment; professional assistance needs were to give time to consider, provide actual case, explain the tracheostomy and prognosis completely, descrip the care plan after tracheostomy and strengthen communication in doctor-nursing-patient. The result of this study could be a reference for clinical nurses in providing care to ventilator-dependent elders and their families.

Topic Category 醫藥衛生 > 社會醫學
健康照護學院 > 護理學系碩士班
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