成人加護病房家屬壓力感受與疾病末期醫療處置態度對DNR同意書簽署之探討

王淑演

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成人加护病房家属压力感受与疾病末期医疗处置态度对DNR同意书签署之探讨

Influence of Perceived Stress and Attitude toward End-of-life Treatment on DNR Designation in Family of Intensive Care Unit Patients

王淑演 , 硕士　　导师：吴丽珍　　

繁体中文

压力感受；疾病末期医疗处置态度； DNR同意书签署；加护病房； perceived stress ； attitude toward end-of-life treatment ； DNR designation ； Intensive care unit (ICU)

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摘要 │ 参考文献 (80) │ 国际计量

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This cross-sectional study investigates the correlation between perceived stress and attitude toward end-of-life treatment, and explores the factors that influence DNR designation in family members of ICU patients. A convenience sample of 36 male and 25 female family members was recruited from intensive care units of a medical center in Tainan from March 2015 to October 2016.  The average age was 46.67. The instruments used were "Questionnaires of Stress Perception of Patients’ Families" and "Questionnaires of Attitude toward End-Of-Life Treatment". The patient’s chart was used for designation of DNR.
  "Questionnaires of Stress Perception of Patients’ Families" scores showed families perceiving mild to moderate stress. The highest subscale score was "patients’ condition", followed by "personal", "environment" and "interpersonal relationship". The "patients’ condition" and "environment" of perceived stress correlated with family member’s age (F=4.40, p<.05; F=4.63, p<.05). The "interpersonal relationship" of perceived stress correlated with family member’s education and whether to hear about hospice-palliative care (F=-2.45, p<.05; F=2.62, p<.05). The "patients’ condition", "personal", "interpersonal relationship" and "environment" of perceived stress correlated with the causes of disease (F=2.69, p<.01; F=2.19, p<.05; F=2.08, p<.05; F=3.69, p<.01). Regarding “Attitudes toward End-of-Life Treatment", family members generally favored palliative treatment at the end-of-life: 90.2% of family members agreed that aggressive treatment would increase the patient's physical and mental pain and 63.9% would not want patients to receive aggressive treatment. 
  There was a negative correlation between the perceived stress and attitude toward end-of-life treatment (γ = -.27, p<.05). It meant that the higher the interpersonal relationship stress experienced by family members, the more likely they were to ask for aggressive treatment for patients. 
  Logistic regression was used to examine factors that influenced DNR designation. The independent variables were the family experience of end-of-life treatment, patient age, the causes of disease, the severity of ill, perceived stress and attitude toward end-of-life treatment. The results showed that none of the factors in this study influenced the designation of signing DNR by family members. The small sample size in this study may be one of reasons that none of these variables were statistically significant.
  However, the study can help medical providers understand the stress experienced by family members and their attitude toward end-of-life treatment. When medical providers speak with family members about end-of-life treatment for the patient, they can be more empathetic and understanding.

参考文献 ( 80 ) 〈TOP〉

向雅玲、彭台朱、杨福麟、苏泉发、李茹萍(2011)．卫教介入对头部外伤病人主要照顾者焦虑与疾病知识之影响．新台北护理期刊，13(1)，33-42。doi：10.6540/ntjn.2011.1.004
连结：
吕如分(2005)．中风病患主要照顾者生活品质及其相关因素之探讨．长期理照护杂志，9(2)，152-170。doi：10.6317/LTC
连结：
吴宜芳(2005)．探讨加护病房家属对疾病末期病人医疗决策行为意向及其影响因素(硕士论文)．取自华艺线上图书馆。。
连结：
吴春桂、林宏茂、林芳如、林亚陵、蔡纹苓、廖婉伶、…黄胜坚(2011)．重症生命末期照护之新趋势．台湾医学，15(1)，37-47。doi： 10.6320/FJM.2011.15(1).07
连结：
吴美幸(2009)．家属对病人入住安宁病房的决策经验(硕士论文)．取自华艺线上图书馆。
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引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。