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  • 學位論文

加護病房護理人員照顧瀕死病人家屬哀傷反應的意願及其相關因素之初探

Willingness to Care for Family's Grief Reactions of Dying Patients and Related Factors among ICU Nurses

指導教授 : 許雅娟

摘要


加護病房是一個時常面對死亡衝擊的急性單位。臨床常見護理人員採取逃避方式面對家屬的哀傷反應。當護理人員無法察覺或逃避照護家屬的哀傷反應時,護理人員可能會出現自我否定的角色挫折(陳,2004),家屬也會在不良的哀傷調適過程,轉變成問題症狀,如憂鬱症(Burke et al., 2010)。過去有關加護病房瀕死病人研究大多為探討醫療決策過程及影響因素,安寧療護的認知與態度,護理人員死亡態度和照護瀕死病人認知、行為、和影響因素的探討,較缺乏護理人員照顧瀕死病人家屬哀傷的相關研究。故本研究目的旨在探討加護病房護理人員照護瀕死病人家屬哀傷反應之意願及相關因素。 採橫斷式相關性研究設計,方便取樣於南部某醫學中心進行問卷調查。加護病房護理人員選樣條件為:1.年齡滿20歲以上者;2.領有護士或護理師證書;以及3.於加護病房工作滿六個月以上者。護理人員排除條件為:擔任護理行政主管者,包括護理長、副護理長。問卷包括四部分:一、護理人員人口特性、二、護理人員接觸病人死亡經驗、三、護理人員死亡態度量表、四、護理人員照顧瀕死病人家屬哀傷反應之意願。研究問卷調查期間為101年7月至9月,共發出145份問卷,回收135份問卷,回收率達93%,無效問卷0份。 研究資料使用SPSS18.0統計套裝軟體進行t檢定、Pearson's correlation統計分析。結果顯示本研究樣本平均年齡30.37歲,以26-30歲居多,平均工作年資以6年內居多,超過半數樣本有宗教信仰,且超過九成有意願照顧瀕死病人家屬的哀傷反應。加護病房護理人員的年齡、工作年資及宗教信仰與照顧瀕死病人家屬之哀傷反應無相關性。加護病房護理人員半年內「常常」接觸病人死亡經驗者比「不常」接觸病人死亡經驗者,呈現顯著較高的意願照顧瀕死病人家屬之哀傷反應。此外,加護病房護理人員之「死亡逃避」、「逃離導向的死亡接受」死亡態度次量表與照顧瀕死病人家屬之哀傷反應意願呈顯著負相關。 本研究結果可提供護理主管安排末期照顧議題在職教育課程方向及課程設計之參考。建議可使用死亡態度量表來作為醫院招聘加護病房護理人員初步篩選之參考,也可以作為護理主管了解加護病房護理人員死亡態度傾向。

關鍵字

哀傷 照顧意願

並列摘要


Nurses in Intensive Care Units are frequently faced with the occurrence of patient death. While being faced with patient death, nurses may adopt a passive attitude when encountering family grief reactions. When nurses cannot realize and attempt to escape from such grief reactions, they may demonstrate feelings of self-denial and frustrations related to nursing roles (Chen, 2004). In addition, problematic symptoms such as depression may result from poor adjustment to grief (Burke et al, 2010). In past years, studies of nurses caring for dying patients have mostly explored the process of decision making and its factors, cognition and attitude toward hospice care, and the relationship between death attitude and factors associated with cognition and behavior. However, little is known about the association of caring for family’s grief reactions in dying patients among ICU nurses. The purpose of this study was to examine the degree of willingness of ICU nurses to address the families of dying patients' grief reactions and it’s associated factors. This study was a cross-sectional, correlational design that was conducted in ICUs in a medical center in southern Taiwan. Inclusion criteria for subjects included nurses who were aged at least 20 years old, those licensed as either a practical nurse or registered nurse, and those who had worked in the ICU for a minimum of six months. Nursing administrators, including head nurses and vice head nurses, were excluded. Questionnaires included four parts: nurses demographic characteristics, past experiences in caring for dying patients and receiving courses related to terminal care, nurses' Death Attitude Scale, and one question related to the degree of willingness to address the family grief reactions of dying patients. A total of 145 questionnaires were distributed, with 135 questionnaires returned. Invalid questionnaires were 0. Data were analyzed using the SPSS 18.0 statistical software package. Statistical methods included descriptive statistics, t-test and Pearson's correlations. The average age of the study sample was 30.37 years old. Most participants were aged between 26 and 30 years, with a mean of six working years. More than 50% of participants had religious beliefs. Over ninety percent of participants reported their willingness to address dying patients' family grief reactions. There were no significant relationships between age, working years, religious beliefs, and the degree of willingness to address dying patients' family grief reactions. Participants who reported frequent contact with patient death within the last six months at the time of sampling had a higher willingness address dying patients' family grief reactions than those who had infrequent contact with patient death. Regarding death attitudes, the subscales of "death to escape" and "escape-oriented death acceptance" revealed significant negative correlation with the degree of willingness address the dying patients' family grief reactions. The findings of this study provide a reference for nursing administrators for the design of continuing education programs. Findings also suggest that the Death Attitude Scale can be used to evaluate the tendency of ICU nurses’ death attitude during recruitment.

並列關鍵字

grief Willingness to Care

參考文獻


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