https://scholars.lib.ntu.edu.tw/handle/123456789/156295
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor | 張媚 | en |
dc.contributor | 臺灣大學:護理學研究所 | zh_TW |
dc.contributor.author | 周燕玉 | zh |
dc.contributor.author | Jou, Yann-Yuh | en |
dc.creator | 周燕玉 | zh |
dc.creator | Jou, Yann-Yuh | en |
dc.date | 2006 | en |
dc.date.accessioned | 2007-11-27T01:48:38Z | - |
dc.date.accessioned | 2018-07-07T01:12:34Z | - |
dc.date.available | 2007-11-27T01:48:38Z | - |
dc.date.available | 2018-07-07T01:12:34Z | - |
dc.date.issued | 2006 | - |
dc.identifier | zh-TW | en |
dc.identifier.uri | http://ntur.lib.ntu.edu.tw//handle/246246/55814 | - |
dc.description.abstract | 本研究採前瞻性描述性相關性研究,主要目的在探討為病患簽署「不施行心肺復甦術」同意書的病患家屬對加護病房照護與醫療決策的滿意度。研究採取立意取樣,以台北市某醫學中心外科加護病房爲病患簽署不施行急救同意書的家屬為收案對象。本研究採取結構式量表收集資料,研究工具包括兩個部份:(一)家屬及病患的基本資料;(二)家屬對加護病房照護與醫療決策過程之滿意度量表。於病患死亡或者是辦理自動出院後一個月,先郵寄問卷至個案家,然後再用電話訪談。收案期間從94年2月至94年8月,共收50位個案。研究結果發現:(1)男性佔46%,女性佔54%,平均年齡為44歲,74%家屬的教育程度為高中以上,與病患的關係多為子女或配偶,64%的受訪家屬為替病患作不施行心肺復甦術者。(2)82%家屬在未作決定之前,就已經聽過不施行心肺復甦術,而且持贊成的態度。(3)家屬對加護病房照護最滿意的前三個項目,包括:護理人員的技術與能力、護理人員的溝通、以及加護病房的工作人員對病患的態度;最不滿意的項目,是家屬休息室的氣氛。(4)影響家屬對整體照護滿意度最重要的因素,是對病患的態度以及護理人員的技術與能力;而影響家屬醫療決策過程中對於自我角色的整體滿意度之重要因素,是獲得資訊的容易程度。(5)住進加護病房意識程度不清楚與疾病嚴重度較高之病患的家屬,對加護病房照護的滿意度較高;家屬對不施行心肺復甦術的態度越認同者,對照護的滿意度也較高。(6)家屬對參與醫療決策過程的看法方面72%的受訪者表示參與決策的時機剛剛好,80%的家屬表示獲得恰好的資訊量並且有足夠的時間考慮決策,50%的家屬表示醫護人員讓他們對病患的病情有正確的期待,46%的家屬感受到病患的生命有縮短。 | zh_TW |
dc.description.abstract | This is a prospective, descriptive relationship study. By intention sampling, we recruited the families, who signed the “Do not resuscitate” (DNR) consent for patients in surgical intensive care units (SICU) of a Taipei medical center. The purpose of this study is to investigate the families’ satisfaction with care and decision-making process during the patients’ stay in SICU. The data were collected by structured questionnaires in the study. The study tools included two parts: 1.demographies of the patients and their families. 2. the questionnaires to measure the families’ satisfaction with care and decision-making process in SICU. One month after the patients’ death or discharge to home when impending death, we mailed the questionnaires to the families, then interviewed by telephone to follow up. From February 2005 to August 2005, 50 study cases were recruited in this study. The result were: 1). 46% of the study cases were male, and 54% were female. Their average age was 44 years old. 75% of the study cases had education above high school. The most common relationship of the study cases to the patients were children or spouses. 64% of the study cases were the families, who decided DNR for the patients. 2). 82% of the study cases had known DNR and had positive attitude to it before they decided DNR for the patients. The top 3 items, which the families were most satisfied with the ICU care, were technique and ability of nurses, communication by nurses’, the attitudes of ICU staff to the patients; the most unsatisfied item was the atmosphere of family rest room. 4). The most important factors that influenced the families’ total satisfaction with the ICU care was the attitude to the patients, and skill and competence of the nurses. The most important factor that influenced the families’ satisfaction with their self roles in decision-making process was the ease of getting information 5). The families of the patients, who had unclear consciousness on admission to SICU and had higher diseases severities, were more satisfied with the ICU care. The families who had more positive attitudes to DNR were more satisfied with the ICU care. 6). 72% of the study cases felt that they were involved in decision-making at the right time. 80% of the study cases felt that they got the right amount of information and let them have enough time to consider decision-making. 50% of the study cases felt that medical staff had right expectation of the patients’ diseases progress. 46% of the study cases felt that the patients’ lives were shortened | en |
dc.description.tableofcontents | 誌謝…………………………………………………………………I 論文摘要……………………………………………………………………II 論文目錄……………………………………………………………V 圖表目錄……………………………………………………………………Ⅶ 第壹章 序論………………………………………………………1 第一節 研究動機…………………………………………………1 第二節 研究目的…………………………………………………5 第三節 研究假設…………………………………………………6 第四節 研究架構…………………………………………………7 第五節 名詞解釋…………………………………………………8 第貳章 文獻查證…………………………………………………11 第一節 不施行心肺復甦術 ……………………………………11 第二節 加護病房的環境與特性 ………………………………15 第三節 加護病房生命末期的照護……………………………18 第四節 家屬對加護病房照護滿意度…………………………21 第五節 影響家屬對加護病照護滿意度的因素………………23 第六節 影響家屬醫療決策過程滿意度的因素………………26 第參章 研究方法…………………………………………………31 第一節 研究對象及場所…………………………………………31 第二節 研究工具…………………………………………………32 第三節 研究工具信效度之檢定…………………………………37 第四節 資料收集步驟………………………………………………39 第五節 倫理關注……………………………………………………40 第六節 資料處理與分析……………………………………………42 第肆章 研究結果……………………………………………………44 第一節 加護病房末期病患的基本資料……………………………44 第二節 加護病房末期病患家屬的基本資料………………………48 第三節 家屬對加護病房照護滿意度之現況..……………………52 第四節 影響家屬對加護病房照護滿意度的因素…………………56 第五節 家屬對醫療決策過程的滿意度之現況………………63 第六節 影響家屬對醫療決策過程滿意度的因素………………67 第伍章 討論………………………………………………………73 第一節 加護病房末期病患的基本資料分析………………………73 第二節 加護病房末期病患家屬的基本資料分析…………………74 第三節 家屬對加護病房照護滿意度之現況分析…………………77 第四節 影響家屬對加護病房照護滿意度的因素…………………81 第五節 家屬對參與醫療決策過程滿意度之現況分析……………83 第六節 影響家屬對醫療決策過程滿意度的因素…………………88 第陸章 結論、建議與限制……………………………………90 第一節 結論………………………………………………90 第二節 護理的應用與建議………………………………93 第三節 研究限制與未來研究之建議………………………………94 參考文獻……………………………………………………………97 中文部份………………………………………………………………97 英文部分……………………………………………………………100 附錄………………………………………………………………104 附錄一:原作者問卷授權同意書……………………………………104 附錄二:內容效度專家名單 ………………………………………105 附錄三:病患家屬問卷同意書與問卷………………………………106 圖表目錄 表一、加護病房末期病患的人口學資料……………………………46 表二、加護病房末期病患的臨床狀況………………………………47 表三、加護病房末期病患家屬的人口學資料………………………49 表四、加護病房末期病患家屬對不施行心肺復甦術的態度 ……51 表五、家屬對加護病房照護的滿意度………………………………54 表六、病患住進加護病房時的意識狀態與家屬對加護病房照護滿意 度之關係……………………………………………………58 表七、病患疾病的嚴重度(APACHE Ⅱ)與家屬對加護病房照護滿意度之關係………………………………………58 表八、家屬對加護病房照護滿意度之各變項相關情形……………59 表九、家屬對加護病房照護滿意度支付回歸分析…………………59 表十、自變項之共線性診斷…………………………………………60表十一、家屬對不施行心肺復甦術的態度與家屬對加護病房照護滿意度之關係…………………………………………62 表十二、家屬對醫療決策過程中對資訊需求的滿意度……………63 表十三、家屬參與病患生命末期照護醫療決策過程的經驗……65 表十四、病患住進加護病房的意識狀態與家屬參於照護策過程中對自我角色的滿意度之關係……69 表十五、資訊需求與家屬於照護決策過程中對自我角色滿意度之關係……………………………………………………………70 表十六、家屬於照護決策過程中對自我角色的整體滿意度影響因素之複回歸分析……………………70 表十七、自變項之共線性問題………………………………………70 表十八、家屬與病患同住與否對家屬參與病患生命末期照護醫療決策過程經驗中病患受到照護的程度或量之滿意度………72 圖一、研究架構…………………………………………………7 圖二、殘差值常態機率分佈圖………………………………………60 圖三、殘差值與預測圖交叉分佈圖…………………………………61 圖四、殘差值常態機率分佈圖………………………………………71 圖五、殘差值與預測圖交叉分佈圖…………………………………71 | zh_TW |
dc.format.extent | 541355 bytes | - |
dc.format.mimetype | application/pdf | - |
dc.language | zh-TW | en |
dc.language.iso | en_US | - |
dc.subject | 不施行心肺復甦術 | en |
dc.subject | 家屬 | en |
dc.subject | 加護病房 | en |
dc.subject | 滿意度 | en |
dc.subject | DNR | en |
dc.subject | family | en |
dc.subject | intensive care units | en |
dc.subject | satisfaction | en |
dc.title | 簽署不施行心肺復甦術同意書病患家屬對加護病房照護與醫療決策過程滿意度之初探 | zh_TW |
dc.title | The preliminary investigation of satisfaction with intensive care and decision making process in patients ’ families who signed " Do not resuscitate " consent for the patients. | en |
dc.type | other | en |
dc.identifier.uri.fulltext | http://ntur.lib.ntu.edu.tw/bitstream/246246/55814/1/ntu-95-R91426030-1.pdf | - |
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Most critically ill patients are perceived to die in comfort during withdrawal of life support: a Canadian multicentre study. Canadian Journal of Anesthesia, 51(6), 623-630. Rothchild, E. (1994). Family dynamics in end-of-life treatment decisions. General Hospital Psychiatry,16, 251-258. Singer, P. A., & MacDonald, N. (1998). Bioethics for clinicians: 15. quality end-of-life care. Canadian Medical Association Journal, 159(2), 159-162. Singer, P. A., Martin, D. K., & Kelner, M. (1999). Quality end-of-life care: Patients’ perspective. JAMA, 281(2), 163-168. Tilden, V. P., Tolle, S. W., Garland, M. J., & Nelson, C. A. (1995). Decisions about life-sustaining treatment impact of physicians’ behaviors on the Family. Archives of Internal Medicine, 155, 633-638. Tschann, J. M., Kaufman, S. R., & Micco, G. P. (2003). Family involvement in end-of-life hospital Care. Journal of American Geriatrics Society, 51(6), 835-840. | zh_TW |
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