知情同意於護理臨床實務之運用

The Use of Informed Consent in Clinical Nursing Practice

10.6224/JN.000013

鄭君婷(Chun-Ting Cheng)；林秋菊(Chiu-Chu Lin)

知情同意 ； 自主權 ； 病人為中心 ； 臨床實務 ； informed consent ； autonomy ； patient-centered ； clinical practice

護理雜誌

64卷1期（2017 / 02 / 01）

98 - 104

繁體中文

社會民主化的提升，以病人為中心的照護模式，是落實知情同意與自主權的主要因素。知情同意是複雜的溝通過程，包括：告知、決定能力、自願三大要素。知情同意是醫病溝通的過程，此過程受到病人因素、病人與醫療互動以及文化議題影響。病人層面與病人理解能力和自主決定意向有關；病人與醫療互動層面，與專業人員溝通技巧有關;文化層面則與病人期待家屬參與醫療決策程度，及家屬參與決策動機有關。醫療人員在評估影響因素，周詳地告知病人利益、可能風險、替代方案後，護理人員應就個別需求，選擇影音視聽、網路資源、附圖的書面資料等多元輔助工具，使病人充分理解訊息內容，以作為同意的基礎。臨床上，護理人員應站在病人的立場，鼓勵提問與討論，主動安排團隊人員進一步說明釐清疑惑以降低焦慮感，讓病人能在完全理解的情況下，不被脅迫地以病人需求為最大考量，尊重他依照自我價值觀做出的最佳健康照護決策。

Obtaining informed consent and ensuring patient autonomy are critical to implementing a patient-centered model of healthcare. Informed consent is a complex process of communication that includes three elements: disclosure, competence in making decisions, and voluntariness. However, individual patient factors, doctor-patient interaction, and cultural issues are known to influence the process of obtaining informed consent. Individual patient factors include the ability of patients to understand and determine their intent; doctor-patient interaction includes communication skills; and cultural issues include the expectations of patients with regard to family involvement in medical decision-making and in decision-making motives. After assessing the relevant influencing factors, healthcare providers typically provide patients with comprehensive information on the benefits and risks of treatment as well as related alternatives. Moreover, healthcare providers typically provide patients with audio/video, Internet, and written information with illustrations based on individual patient needs. In addition to the above, we suggest that healthcare providers proactively adopt the perspective of patients in order to better encourage patients to address questions, to engage with patients in more productive discussions, and to take the initiative to explain and clarify patients' questions in order to minimize anxiety. This approach will help ensure that patients are adequately informed and free from coercion so that they make appropriate healthcare-related decisions. However, even under this optimal situation, healthcare providers must emphasize the needs of their patients and respect their decisions.

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