题名

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

并列篇名

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

作者

王淑演

关键词

壓力感受 ； 疾病末期醫療處置態度 ； DNR同意書簽署 ； 加護病房 ； perceived stress ； attitude toward end-of-life treatment ； DNR designation ； Intensive care unit (ICU)

期刊名称

長榮大學護理學系(所)學位論文

卷期/出版年月

2017年

学位类别

碩士
导师

吳麗珍
内容语文

繁體中文
中文摘要

本研究採橫斷性設計，探討加護病房家屬的壓力感受與疾病末期醫療處置態度之相關性以及影響家屬對DNR同意書簽署之因素。研究者於2015年3月至2016年6月期間，於南部某醫學中心之成人內科加護病房收案，以方便取樣方式共徵得61位家屬同意參與研究。樣本包括36位男性和25位女性，平均年齡47.67歲。研究工具為「家屬壓力感受量表」及「疾病末期醫療處置態度量表」，家屬是否簽署DNR則以病歷上的記錄為依據。 從「家屬壓力感受量表」之得分，顯示家屬之壓力感受處於輕度壓力至中度壓力之間，各壓力感受面向由高至低，依序為「病人疾病」、「個人」、「環境」及「人際」。家屬壓力感受之「病人疾病」及「環境」會受到家屬年齡的影響(F=4.40, p<.05；F=4.63, p<.05)；家屬壓力感受之「人際」會受到家屬教育程度及是否聽過安寧緩和醫療(F=-2.45, p<.05；F=2.62, p<.05)的影響；家屬壓力感受之「病人疾病」、「個人」、「人際」及「環境」會受到病人進入加護病房原因的影響(F=2.69, p<.01；F=2.19, p<.05；F=2.08, p<.05；F=3.69, p<.01)。在對疾病末期醫療處置態度上，家屬傾向採取緩和性治療，90.2%的家屬同意積極性治療會增加病人身心方面的痛苦，有63.9%的人表示不會鼓勵病人接受積極性治療。 家屬的壓力感受與疾病末期醫療處置態度之相關性分析，結果呈現負相關(γ=-.27, p<.05)，表示家屬在人際方面之壓力感受越高，對病人疾病末期醫療處置態度越傾向採取積極性治療。 以邏輯氏迴歸分析影響家屬對DNR同意書簽署之因素，顯示家屬對DNR同意書之簽署未受到家屬對疾病末期醫療處置經驗、病人年齡、進入加護病房原因、疾病嚴重度、家屬壓力感受及家屬對病人疾病末期醫療處置態度之影響。樣本數太小可能是無法達到統計顯著水準的原因。 研究結果可幫助加護病房醫護人員了解家屬的壓力感受及家屬對病人疾病末期醫療處置態度，以提供醫療團隊面對家屬溝通病人疾病末期醫療處置決策之參考。
英文摘要

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.
主题分类 醫藥衛生 > 社會醫學
健康科學學院 > 護理學系(所)
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  66. 王美惠(2008)．探討二組腦部手術病患主要照顧者在病患住院期間的壓力感受及其因應行為(未發表的碩士論文)．取自華藝線上圖書館。
  67. 林玉如(2002)．成人加護病房病患家屬之壓力感受與因應策略之探討(未發表的碩士論文)．台北：陽明大學臨床護理研究所。
  68. 黃麗續 (2009)．從DNR分析看無效醫療的界線與醫學的極限(未發表的碩士論文)．嘉義：南華大學生死學研究所。
  69. 陳宇菁(2007)．加護病房家屬代理病人的DNR決策 (未發表的碩士論文) ．台北護理學院護理研究所。
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  72. 英文部分
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