接受氣切病人生活品質改變及主要照顧者認知感受之初探

The Change of Quality of Life in Patients with Tracheostomy and their Primary Caregiver’s Cognitive Perception: A Preliminary Study

10.6530/YYN/2015.1.03

賴美玉(Mei-Yu Lai)；陳玉如(Yu-Ju Chen)；游顯妹(Hsien-Mei Yu)

氣切 ； 主要照顧者 ； 感受 ； 生活品質 ； 決策 ； Tracheostomy ； primary caregiver ； perception ； quality of life ； decision-making

源遠護理

9卷3期（2015 / 09 / 01）

27 - 36

繁體中文

背景：長期呼吸器依賴病人的主要照顧者，在病人無法自主時，則必須面臨代替病人接受氣切之決策困境。然而，接受氣切後病人生活品質的改變與否，為主要照顧者的最關鍵感受，但相關的研究卻付之闕如。目的：探討主要照顧者於親人接受氣切後生活品質改變的經驗與感受。方法：本研究為描述性研究以自擬問卷對某醫學中心接受氣切的60位病人之主要照顧者進行調查，研究期間為2013年01月01日至12月31日，調查結果以SPSS17.0 for window套裝軟體進行分析。結果：研究發現主要照顧者感覺親人在接受氣切術後的生活品質改善最多者為「感覺比較舒服或清潔」及「嘴唇乾裂和破皮改善」；而改善較少者為「變得比較與人合作與互動」。在主要照顧者對親人接受氣切後認知感受中，以「同意親人接受氣切手術的決定是對的」及「醫護人員鼓勵我的親人接受氣切手術是對」的同意程度最高；但其對於親人「更不可能離開醫院」、及「家庭經濟負擔會更重」的同意程度最低。另外，病人於接受氣切手術前不曾自拔管者，其主要照顧者對於病人接受氣切後生活品質改變的感覺及其認知感受上，均較曾自拔管者為正向且達統計水準差異（p＜.05）。結論：主要照顧者於病人氣切術後，對於氣切照護及相關決策的認知感受趨於正向。此結果將提供臨床照護人員，在解除家屬對於氣切是否合適自己親人的疑慮時說明之參考。

Background: Tracheostomy is an important treatment option for patients on prolonged mechanical ventilation. The primary caregivers usually make a decision for those patients who are incapable of giving consent for this procedure. Purpose: To explore primary caregivers’ perception and experience on changes in patients’ quality of life post tracheostomy. Methods: This is a descriptive study. This study enrolled sixty primary caregivers of patients who received tracheostomy between January 1 and December 31, 2013. Each caregiver complete three questionnaires developed by the researchers. Data analysis used SPSS 17.0 for Windows. Results: The primary caregivers’ perception on quality of life after patients’ tracheostomy was positive with the highest on “felt more comfortable and cleaner” and “felt relieving chapped or dry lips and mucosal erosion”; and lowest on “getting more cooperation and interaction with others.” Two highest agreements were “it is the right decision to have the tracheostomy for patient” and “the encouragement from healthcare providers for tracheostomy is the right thing.” Two lowest agreements were “discharge the patient from hospital became less possible” and “heavier financial burden for my family.” Primary caregivers of patients without a history of self-extubation before tracheostomy showed significantly positive and improvement on patients’ quality of life than those patients with a history of self-extubation. Conclusion. Primary caregivers perceived and experienced positively on the quality of life after patients received tracheostomy. These results provide evidence for primary caregivers for a decision on tracheostomy for patients requiring long-term ventilator support.

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