Title

重症末期病患家屬簽署DNR心路歷程之敘事分析

Translated Titles

Narrative analysis of families’ experience in giving DNR consent for the critically ill patients

DOI

10.6830/CMU.2010.00080

Authors

蔡淑華

Key Words

重症末期病患 ; 家屬 ; 不予心肺復甦術 ; 敘事文本 ; critical-ill patient ; families ; Do-Not Resuscitation(DNR) ; Narratives

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

2010年

Academic Degree Category

碩士

Advisor

辛幸珍

Content Language

繁體中文

Chinese Abstract

研究目的:我國通過「安寧緩和醫療條例」至今已有十年,在癌末病人的末期照護上已達相當的成效,然對於需要透過不予心肺復甦術(Do Not Resuscitation: DNR)來達到善終的重症末期病患,到目前為止實施上卻仍無共識。重症末期病患大多無法表達其意願,必須由家屬簽署DNR同意書才能免除臨死前無謂的急救。為理解家屬面對此項重大抉擇時內心的掙扎與衝擊,本研究以質性訪談揭露重症病患家屬簽署過程中的心路歷程。 研究方法:採質性研究,選擇中部某醫學中心之七個加護病房簽署DNR同意書之重症末期病患家屬,經過多次探訪建立關係並進行田野觀察,於病人逝世後約2-6個月,以電話追蹤了解其哀傷狀態並表達關心,最後徵得其同意後列為受訪對象,將訪談過程予以錄音並謄打為逐字稿,以質性內容分析法進行分析。 結果:共訪談了十位重症末期簽署DNR之病患家屬,訪談資料分析後選擇其中四個故事撰寫成敘事文本,這些敘事文本內容呈現出深刻的倫理議題,進一步剖析及討論出重症末期醫療抉擇的情境與脈絡,其結果歸納為以下三項主題:1.重症末期病患家屬簽署DNR考量因素之林林總總。2.醫護運用同理、透過溝通促成末期醫療決策。3.以末期關懷與正確認知協助生死兩相安。 結論:經由家屬回溯,以故事呈現出DNR決策過程是充滿衝擊與無奈,分析結果讓我們再確定醫護人員在家屬面臨到重症末期醫療抉擇時,具有極大之影響力,在促成DNR圓滿的過程中亦能成為家屬強而有力的後盾,協助家屬不悔其決定並確定能達病患善終的目的。

English Abstract

Objective: Natural Death Act has been legislated in Taiwan for more than ten years. Do-Not-Resuscitation (DNR) was approved to improve the end-of-life care(EOL)for terminal cancer patient. However, for the non-cancer critically ill patients there are still no consensus in the management of their end-of-life. For most critically ill patients who are unable to express their wishes, their DNR consent should be signed by the families to prevent futile CPR before they die. For us understand the difficulties of families facing EOL decision, we conduct this study to explore families’ experience in giving DNR consent on behalf of the critically ill patients. Research methods: This study is based on qualitative research. A purposive sample of families who signed DNR for their critically ill families in their terminal stage were adopted from seven intensive care units in a mid-Taiwan hospital. To attempt to establish close relationships with those participants, researcher visited the families for several times since the patients were admitted in ICU and kept on taking field notes. If families’ emotion status were evaluated to be stable by phone, an indepth interview was conducted in approximately 2-6 months after the patient’s death. The interviews were audiotaped, transcribedt(verbatim) and were subject to qualitative content analysis. Results: A total of ten interviews data were analyzed , choosing four of ten stories writing into narrative text. These narrative texts combine in-deep ethical issues and the contexture of families’ struggling in the process of EOL decision-making. Three major theme were emerged from families’ subjective narratives : 1. multiple factors considered during making DNR consent for the critically ill patient. 2. Health care providers with compassionate and communication skills can improve the process of EOL decision-making. 3. EOL care and sufficient EOL cognition would help families and patients remain peaceful. Conclusion: Through the retrospective interviews, most of the families expressed their experience of EOL decision as shocking and conflicting. According to those participants narratives, it also imply that health care providers play an important role in families of EOL decision-making. Our study create an opportunities for a reflection upon health care providers’ role in terminal DNR in critical-ill patient to improve the patient peaceful death and to facilitate families won’t regret the EOL decision-making.

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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