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

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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

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

蘇雅菁 , Masters　　Advisor：陳玉敏　　

繁體中文

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

Abstract │ Reference (256) │ Times Cited (1) │ Altmetrics

Abstract 〈TOP〉

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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.

Reference ( 256 ) 〈TOP〉

王大昆、王拔群、張燕良、黃鈞鴻、李國森、蔡銘修等（2006）．氣管切開術之併發症
連結：
王拔群、石崇良、林仲志、楊漢、翁惠瑛、李偉強（2007）．台灣病人安全通報系統中
連結：
王玉玲、吳杰亮（2008）．呼吸器依賴患者之死亡率、生活品質、生活功能與醫療資源
連結：
尹裕君、杜異珍（2000）．氣切患者出院準備服務計畫之執行．榮總護理，17 （4），383-391。
連結：
石崇良、侯勝茂、薛亞聖、鍾國彪、蘇喜、廖熏香（2005）．異常事件通報系統與通報
連結：

Times Cited (1) 〈TOP〉

鄭巧玲(2015)。影響主要決策者對呼吸器困難脫離病人氣切決策之相關因素探討。高雄醫學大學護理學系碩士班學位論文。2015。1-99。

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