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  • 學位論文

長照機構照護人員善終信念與照護臨終住民態度之相關

Association between Good-Death Belief and Attitude toward Caring Dying Resident of Care-Staff in Long-Term Care Facility

指導教授 : 張李淑女
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摘要


由於長照機構存在需將臨終住民「送醫往生」的窘境,這與安寧療護達成善終的原則違背,因此本研究目的主要有四:(一)了解長期照護機構照護人員之「善終信念」;(二)探討長期照護機構照護人員對「照護臨終住民」的態度及其相關因素;(三)探討長期照護機構照護人員「善終信念」對「照護臨終住民態度」的影響;(四)探討影響長期照護機構照護人員「是否支持住民可選擇在機構內死亡」之相關因素。結構式問卷中之「照護臨終住民態度量表」採Brent ( 1991) 之“ Attitude Scales Toward the Care of Dying Patient”進行翻譯修改及自擬「善終信念量表」,進行橫斷性調查研究。收案的對象是選取中部縣市(台中市、南投縣、彰化縣)長期照護機構之照護人員(包括護理人員及照顧服務員)共372位,共發出420份,回收384 份,有效問卷372 份(有效回收率達96.9%)。所得的資料以SPSS12.0中文版統計軟體為分析工具,主要的統計方法為描述性分析、獨立樣本t 檢定、單變量變異數分析( One-way ANOVA Analysis)、皮爾森相關分析( Pearson’s Correlation Analysis )、卡方檢定( Chi-square)、逐步迴歸分析( Stepwise Regression Analysis) 及 二元邏輯斯迴歸分析( Binary Logistic Regression Analysis) 。研究結果顯示:(一)照護人員對於自己的「善終」,較著重「心理」與「靈性」的構面 ;(二)「善終信念」使得照護人員「個人的滿足」、「專業性挑戰」、「專業性收穫」等三個強調臨終照護成就感、正向情感滿足及專業態度的「臨終住民照護態度」構面更正向;(三)照護人員在臨終照護上,對於死亡仍有較負向的態度及缺乏談論死亡相關議題的能力;(四)使用逐步迴歸分析後,「照護臨終住民態度」之預測因子為:家人談論死亡或喪葬情形、自覺健康狀況、死亡或生命教育課程「時數」大於三天、年齡、曾協助或辦理喪葬儀式、曾瀕臨死亡的經驗,但只能解釋17.3%的變異;(五)照護人員不支持住民可選擇在機構內死亡的佔54.3%,使用邏輯式迴歸分析後,與照護人員「支持住民可選擇在機構內死亡」相關的因素中以「認為『工作的機構』支持『住民可選擇在照護機構內死亡』」(Odds Ratio=48.601)具最大勝算比,其餘為:無宗教信仰、曾「照顧」過臨終病人或臨終住民、曾照顧「臨終病人或住民『人數』大於(含)10人」。本研究針對未來研究、長照機構教育訓練、生命教育課程發展、長期照護政策及臨終照護實務提出建議,以提昇機構中照護人員臨終照護能力及培養正向的臨終照護態度,期望能有助於達成機構中臨終住民的善終。

並列摘要


The phenomenon of “sent dying resident to hospital for expiration” existed in long-term care facility, which against “good-death” principle of hospice. Hence this research mainly has four goals:(1) Understanding “Good-Death Belief” of care-staff in long-term care facility (2) Investigating “ Attitude Toward the Care of Dying residents” and its relevant factors of care-staff in long-term care facility (3)Investigating associations between “ Good-Death Belief ” and “ Attitude Toward the Care of Dying residents” of care-staff in long-term care facility (4) Investigating of relevant factors influencing care-staff’s “whether supporting residents can choose to die in the facility” in long-term care facility. Structured questionnaire include “Attitude Scales toward the Care of Dying Patient” (translated and adjusted from “Attitude Scales toward the Care of Dying Patient” of Brent (1991)) and “Scales toward Good-Death Belief”. Cross-sectional survey was conducted, a total of 372 care-staff in long-term care facility (including nursing-staff and care-attendant) enrolled from middle counties of Taiwan (Taichung City, Nantou County, Changhua County). After a total of 420 copies issued, 384 were recovered and 372 valid questionnaires were acquired (effective recovery rate of 96.9%). The data was analyzed via Chinese version of SPSS12.0 statistical software. The main statistical methods include Descriptive Analysis, Independent Sample t-Test, One-way ANOVA Analysis, Pearson’s Correlation Analysis, Chi-square, Stepwise Regression Analysis, Binary Logistic Regression Analysis. The results show: (1)About “Good-Death Belief” of care-staff, care-staff focus on “psychological” and “spirituality” dimensions; (2) “Good-Death Belief” makes care-staffs’ “Personal satisfaction” , “professional challenge” and “professional harvest” dimensions (emphasizing a sense of achievement, positive emotion and professional attitude of “dying residents care attitude”) more positive ; (3) About End-of-life Care attitude of care-staff, there is still more negative attitudes toward death and care-staff lack of ability to discuss issues related to death ;(4) After stepwise regression analysis, the relevant factors of “Attitude Toward the Care of Dying residents” include: family talk about death or burial, perceived health status, more than three days of death or life education, age, experience for funeral rites, experience of dying, but only 17.3% of the variance could be explained ; (5) Care-staff who do not support “residents can choose to die in the facility” accounted for 54.3%. After logistic regression analysis, “facility supporting residents can choose to die in the facility” own the largest odds ratio (Odds Ratio = 48.601) among the relevant factors for “care-staff supporting residents can choose to die in the facility”. The rest include: no religion, “take-care” of terminally ill or dying residents, number of take-care for dying patients or residents is greater than (with) 10. For improving end-of-life care ability and nurturing positive attitude for end-of-life care, this study provided recommendations for future research, long term care education and training curriculum, development of life education, long-term care policy and end-of-life practice. And researcher wishes to help terminally ill resident achieving “Good-Death” in the long term care facility.

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