急重症護理人員對無效醫療知識與教育需求之探討－以心肺復甦術為例

Evaluation of Critical Care Nurses' Knowledge and Educational Requirements Regarding the Medical Futility of CPR

10.6142/VGHN.33.4.377

魏碧青(Pi-Ching Wei)；王桂芸(Kwun-Yun Wang)；周幸生(Shin-Shang Chou)；王凱微(Kai-Wa Wang)；唐福瑩(Fu-In Tang)

無效醫療 ； 心肺復甦術 ； 教育需求 ； medical futility ； cardiopulmonary resuscitation ； educational requirement

榮總護理

33卷4期（2016 / 12 / 01）

377 - 387

繁體中文

本研究旨在探討急重症護理人員面對執行心肺復甦術時，是否具有相當知識背景了解提供了無效醫療。研究方法乃採橫斷性調查研究，以北部某醫學中心248 位急診與加護單位護理人員為樣本，運用三部分( 基本資料、知識評估、教育需求) 自擬結構式問卷進行評量。結果顯示98% 急重症護理人員表示曾照護過心肺復甦術無效醫療病人，整體答對率67.8%。自覺知識充足者僅50.4%，需要相關教育訓練者卻高達83.0%。知識主要來源為醫院在職教育，遇疑問時會詢問護理同儕，主觀自覺知識程度與客觀知識評量呈正相關。無論如何，急重症護理人員對此相關知識明顯不足，職稱、職級愈高，定期接受相關訓練者有較高知識，可做為新進人員良好諮商對象，且建議增加專門諮詢場所、跨團隊討論及規劃相關在職教育課題等，來提升以知識背景為基礎的溝通，早期停止無效醫療相關照護。

This cross-sectional study investigated the relationship between emergency nurses' knowledge and educational requirements and the medical futility of CPR. In this study (N = 248) the results of the questionnaire developed by the researchers revealed the following: (1) 98.0% of nurses indicated that they had administered medically futile CPR, (2) correct answer rate was 67.8%, (3) only 50.4% reported that they had ＂sufficient＂ knowledge, and 83.0% hoped to undergo further training on this issue, (4) their knowledge had been mainly obtained from in-hospital continuing education and consultation with colleagues, and (5) this subjective evaluation was consistent with objective evaluations. The results suggest that nurses possess insufficient knowledge regarding CPR medical futility, and more fundamentally, that nurses require continual education, increased specialized consulting establishments, and cross-team discussion to ensure precision in decision-making.

1. 陳殷正、劉郁孚、蔡蕙珊、林玉書、范建得(2016)。安寧緩和醫療條例回顧與探討。醫學與健康期刊，5(1)，25-34。
   連結：
2. Kelly, T. L. (1939). The selection of upper and lower groups for the validation of test items. Jounal of Educational Psychology, 30(1), 17-24. doi: 10.1037/h0057123
3. Aghabarari, M.,Nayeri, N. D.(2015).Futile care: Challenges of applying futility concept in caring domain.Tehran University of Medical Sciences,21(1),1-5.
4. Bekkema, N.,De Veer, A. J.,Albers, G.,Hertogh, C. M.,Onwuteaka-Philipsen, B. D.,Francke, A. L.(2014).Training needs of nurses and social national survey.Nurse Education Today,34(4),494-500.
5. Botha, J.,Tiruvoipati, R.,Goldberg, D.(2013).Futility of medical treatment in current medical practice.The New Zealand Medical Journal,126(1383),58-71.
6. Day, L.(2009).Medical futility, personal goods, and social responsibility.American Journal of Critical Care,18(3),279-282.
7. Griffith, R.(2013).'Do not attempt resuscitation' orders: A review of the law.British Journal of Cardiac Nursing,8(8),404-406.
8. Heland, M.(2006).Fruitful or futile: Intensive care nurses' experiences and perceptions of medical futility.Australian Critical Care,19(1),25-31.
9. Lo, B.(2009).Resolving ethical dilemmas: A guide for clinicians.Philadelphia, PA:Lippincott Williams & Wilkins.
10. Nelson, J. E.,Angus, D. C.,Weissfeld, L. A.,Puntillo, K. A.,Danis, M.,Deal, D.,Cook, D. J.(2006).End-of-life care for the critically ill: A national intensive care unit survey.Critical Care Medicine,34(10),2547-2553.
11. O'Connor, A. E.,Winch, S.,Lukin, W.,Paker, M.(2011).Emergency medicine and futile care: Taking the road less travelled.Emergency Medicine Australasia,23(5),640-643.
12. Özden, D.,Karagözoğlu, Ş.,Yıldırım, G.(2013).Intensive care nurses' perception of futility: Job satisfaction and burnout dimensions.Nursing Ethics,20(4),436-447.
13. Paris, J. J.,Angelos, P.,Schreiber, M. D.(2010).Dose compassion for a family justify providing futile CPR?.Journal of Perinatology,30,770-772.
14. Peterson, R. A.,Kim, Y.(2013).On the relationship between coefficient alpha and composite reliability.Journal of Applied Psychology,98(1),194-198.
15. Salvucci , A(2008).Literature review: Terminating resuscitation.Emergency Medical System,12,26.
16. Schneiderman, L. J.,Jecker, N. S.,Jonsen, A. R.(1990).Medical futility: Its meaning and ethical implications.Annals of Internal Medicine,112(12),946-954.
17. Sibbald, R.,Downar, J.,Hawryluck, L.(2007).Perceptions of" futile care" among caregivers intensive care units.Canadian Medical Association Journal,177(10),1201-1208.
18. 吳春桂、林宏茂、林芳如、林亞陵、蔡紋苓、廖婉伶、黃勝堅(2011)。重症生命末期照護之新趨勢。臺灣醫學，15(1)，37-47。
19. 吳讚美、林惠賢、賈佩芳、蔡玉梅、施丞貴、謝志松(2012)。護理人員執行不施予心肺復甦術之現況及相關因素之探討。安寧療護，17(2)，141-161。
20. 林芳如、黃勝堅、吳春桂、黃美玲、林亞陵、蘇玲華、林宏茂(2010)。重症生命末期無效醫療之探討。中華民國急救加護醫學會雜誌，21(5)，1-8。
21. 徐明儀、江蓮瑩(2014)。無效醫療議題之探討。護理雜誌，61(1)，99-104。
22. 翁益強(2012)。對急重症病人生命末期照護。榮總護理，29(3)，220-223。
23. 張惠敏、李鳳屏、胡文郁、謝秀芳(2013)。中文版護理人員生命末期照護之障礙及促進因素表信效度測試。護理暨健康照護研究，9(3)，218-227。
24. 陳美碧、蔣欣欣(2008)。安寧緩和療護的困頓與成長．護理人員的經驗。實證護理，4(3)，191-199。
25. 陳榮基(2013)。醫師應有主動拒絕實施心肺復甦術以維護病人善終的勇氣。安寧療護雜誌，18(1)，51-61。
26. 黃馨葆、蔡兆勳、陳慶餘、邱泰源(2011)。生命末期照顧如何達到好的成本效益。安寧療護雜誌，16(2)，205-216。
27. 鄭淑芬、丁肇慈、郭彩雲(2013)。提升癌症末病人不施行心肺復甦術簽署率。榮總護理，30(1)，29- 37。
28. 羅玉岱、潘輝民、張士琨、劉立凡(2008)。能不能救命？心肺復甦術對老年病患之成效與相關因素探討。台灣老年醫學暨老年學雜誌，3(4)，10-23。
29. 蘇玲華、黃美玲、林亞陵、吳春桂、林芳如、林宏茂、黃勝堅(2008)。護理人員對生命末期照護的知識與態度─ 以中部某區域教學醫院為例。安寧療護雜誌，13(4)，431-446。

1. 蔡姿玲(2016)。社區慢性病老人對無效醫療看法之探討。長榮大學護理學系(所)學位論文。2016。1-107。