請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55715
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 高碧霞(Bih-Shya Gau) | |
dc.contributor.author | Shu-Ru Uen | en |
dc.contributor.author | 溫淑如 | zh_TW |
dc.date.accessioned | 2021-06-16T04:19:09Z | - |
dc.date.available | 2016-10-09 | |
dc.date.copyright | 2014-10-09 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-08-19 | |
dc.identifier.citation | 中文部份
王靜琳、黃瓊玉、呂桂雲、何美瑤(2007).護理人員工作壓力與社會支持之探討.榮總護理,24(1),59-68。 巫慧芳、蕭淑貞(1995).護理人員面對病患家屬時的工作壓力與因應方式之探討.中華衛誌,14(5),417-425。 李佩珊、鍾佳雯、程小育、郭淑珍(2008).輪班工作對生活品質的影響:深度會談護理人員.健康管理學刊,6(2),147-160。 李淑莉、莊玉仙、陳秀月、林淑媛(2009).高雄某教學醫院新進護理人員的工作壓力敘說.護理暨健康照護研究,5(2),83-90。 邱啟潤、王秀紅(2004).以家庭為中心的照護本質之思辯.護理雜誌,51(3),53-58。doi:10.6224/JN.51.3.53 林知樺(2003).新進護理人員感受臨床護理工作挫折之探討.慈濟護理雜誌,2(4),83-94。 范姜玉玲、楊慧貞(2012).共創同心圓探討護理人員與醫療團隊合作.慈濟護理雜誌,11(2),16-23。 周珞琦、翁新惠、鄭雅慧、馮容莊(2002).醫護人員面對重症早産兒照護之倫理困境與相關因素探討.榮總護理,19(2),186-198。 周登偉、賴芳足、李秋慧、徐華吟、葉淑如、呂錦慧、林佩勳(2013).導入團隊資源管理對加護單位病人安全文化之影響.醫院,46(4),32-41。 柯文哲(2010).葉克膜(ECMO)倫理問題.澄清醫護管理雜誌,6(2),4-7。 胡瑞桃(2000).加護單位護理人員對其工作壓力來源之反應及調適.長庚護理,11(2),20-29。 徐莞雲、陳筱瑀(2008).提升輪班護理人員生活品質之策略.榮總護理,25(4),357-361。 梁淑媛、郭婷婷、梁挋、曾雯琦(2007).護理人員面對困難家屬壓力之初探.中華職業學雜誌,14(2),111-119。 張和美、陳昭惠、藍麗美(2005).新生兒加護病房預期醫護人員流動與工作壓力之研究.榮總護理,22(2),139-148。doi:10.6142/VGHN.22.2.139 張松齡、陳梅麗、王瑋(2003).東部地區精神科護理人員工作壓力、因應行為及其相關因素之探討.慈濟護理雜誌,2(3),59-69。 張育菁、張碧真(2009).對新生兒加護病房執行DNR困境之建議.護理雜誌,56(4),94-99。doi:10.6224/JN.56.4.94 張惠甄、陳佩英、郭素青(2004).醫院設立分院時新進護理人員工作壓力源及其影響因素.健康管理學刊,2(1),37-50。 張曉鳳、林育秀、王素美、饒育華、吳芯霈、梁亞文(2010).醫療服務人員工作壓力源與離職意願之探討.澄清醫護管理雜誌,6(1),21-31。 張靜怡、徐德福、張韻勤、陳品堂、徐月霜、劉秀微、傅玲(2012).某醫學中心護理人員對醫療團隊資源管理現況感受之初探.榮總護理,29(4),405-414。doi:10.6142/VGHN.29.4.405 陳德人、毛家舲(2009).新生兒急救的倫理原則和臨終照護.台灣醫學,13(5),509-512。 黃瑞珍、黃珊、林麗滿(2001).手術室護理人員工作壓力情形及其相關因素之探討.長庚護理,12(1),1-11。 黃璉華(2004).從護生到護士—談新進護理人員的適應.護理雜誌,51(4),33-36。 劉淑娟(2000).嚴謹度.於陳月枝總校閱.質性護理研究方法(21-57頁).台北:護望。 蔡翊新、林亞陵、黃勝堅(2007).重症病患之生命末期照護.安寧療護雜誌,12(3),312-320。 蔡麗雲、李英芬(2003).安寧緩和護理人員的壓力源、壓力反應與調適策略之探討.安寧療護雜誌,8(2),143-160。 鄭麗娟、蔡芸芳、陳月枝(1999).台灣東部某區域醫院加護單位護理人員工作壓力和調適行為之研究.慈濟醫學,11(2),161-169。 邊苗瑛、龍芳、林知穗、楊式興(2010).體外膜氧合治療的臨床使用.呼吸治療,9(1),41-52。 Singer, P. A. (2009) .臨床生命倫理學二版(蔡甫昌編譯).臺北:金名。(原著出版於1998) Stewart, D. W., & Shamdasan, P. N. (2000) .焦點團體:理論與實務(歐素汝譯).臺北:弘智。(原著出版於1996) 英文部份 Aldridge, M. D. (2005). Decreasing parental stress in the pediatric intensive care unit: One unit’s experience. Critical Care Nurse, 25, 40-50. Allan, C. K., Thiagarajan, R. R., Beke, D., Imprescia, A., Kappus, L. J., Med, L. J., …, & Weinstock, P. H. (2010). Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams. Journal of Thoracic and Cardiovascular Surgery, 140 (3), 646-652. doi:10.1016/j.jtcvs.2010.04.027 Barrett, C. S., Bratton, S. L., Salvin, J. W., Laussen, P. C., Rycus, P. T., & Thiagarajan, R. R. (2009). Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitation. Pediatric Critical Care Medicine, 10 (4), 445-451. Brown, K. L., Ichord, R., Marino, B. S., & Thiagarajan, R. R. (2013). Parental symptoms of posttraumatic stress after pediatric extracorporeal membrane oxygenation. Pediatric Critical Care Medicine, 14(5), s73-83. doi:10.1097/PCC.0b013e318292e3fc Callaghan, P., Tak-Ying, S. A. & Wyatt, P. A. (2000). Factors related to stress and coping among Chinese nurse in Hong Kong. Journal of Advanced Nursing, 31 (6), 1518-27. Cavaliere, T. A., Daly, B., Dowling, D. & Montgomery, K. (2010). Moral distress in neonatal intensive care unit RNs. Advances in Neonatal Care, 10 (3), 145-156. Chan, S. Y., Figueroa, M., Spentzas, T., Powell, A., Holloway, R. & Shah, S. (2013). Prospective assessment of novice learners in a simulation-based extracorporeal membrane education program. Pediatric Cardiology, 34 (3), 543-52. doi: 10.1007/s00246-012-0490-6 Chen, Y. Y., Chen, L., Huang, T. S., Ko, W. J., Chu, T. S., & Ni, Y. H. (2014). Significant social events and increasing use of life-sustaining treatment: Trend analysis using extracorporeal membrane oxygenation as an example. BioMed Central Medical Ethics, 15 (21), 1-8. doi: 10.1186/1472-6939-15-21 Colaizzi, P. F. (1978). Psychological research as a phenomenologist views it. In R. S. Valle,& M. King (Eds.), Existential Phenomenological Alternatives for Psychology (pp. 48-71). New York: Oxford University Press. Epstein, E. G., Miles, A., Rovnyak, V., & Baernholdt, M. (2013). Parents’ perceptions of continuity of care in the neonatal intensive care unit. The Journal of Perinatal and Neonatal Nursing, 27 (2), 168-175. doi:10.1097/JPN.0b013e31828eafbb Ferrell, B. R. (2006). Understanding the moral distress of nurses witnessing medically futile care. Oncology Nursing Forum, 33 (5), 922-930. Ferrans, C. E., & Powers, M. J. (1992). Psychometric assessment of the quality of life index. Research in Nursing and Health, 15 (1), 29-38. Ferrans, C. E., & Powers, M. J. (1985). Quality of life index: Development and psychometric properties. Advances in Nursing Science, 8 (1), 15-24. Freeman, R., Nault, C., Mowry, J., & Baldridge, P. (2012). Expanded resources through utilization of a primary care giver extracorporeal membrane oxygenation model. Critical Care Nursing Quarterly, 35(1), 39-49. doi:10.1097/CNQ.0b013e31823b1fa1 Gaies, M. G., Clarke, N. S., Donohue, J. E., Gurney, J. G., Charpie, J. R., & Hirsch, J. C. (2012). Personnel and unit factors impacting outcome after cardiac arrest in a dedicated pediatric cardiac intensive care unit. Pediatric Critical Care Medicine, 13(5), 583-588. doi:10.1097/PCC.0b013e318238b272 Griffin, T. (2013). A family-centered “visitation” policy in the neonatal intensive care unit that welcomes parents as partners. The Journal of Perinatal and Neonatal Nursing, 27 (2), 160-165. doi:10.1097/JPN.0b13e3182907f26 Guerguerian, A. M., Ogino, M. T., Dalton, H.J., & Shekerdemian, L.S. (2013). Setup and maintenance of extracorporeal life support programs. Pediatric Critical Care Medicine, 14(5), s84-93. doi: 10.1097/PCC.0b013e318292e528 Hartog, C. S. & Jensen, H. I. (2013). Family-centered ICU care may be good for everyone. Intensive Care Medicine, 39, 1650-1652. doi:10.1007/s00134-013-2996-7 Kean, S. (2014). A framework for a physician-parent follow-up meeting after a child’s death in a PICU and why this family-centered care approach should interest us all. Critical Care Medicine, 42(1), 214-216. doi:10.1097/01.ccm.0000435687.85468.de Kopala, B. & Burkhart, L. (2005). Ethical dilemma and moral distress: Proposed new NANDA diagnoses. International Journal of Nursing Terminologies and Classification, 16 (1), 3-13. Kreuger, R. A. (1988). Focus groups: A practical guide for applied research. London: Sage. Krueger, R. A., & Casy, M. A. (2000). Focus group: A practical guide for applied research. California: Sage. Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Mosby. Lewis, A. R., Wray, J., O’Callaghan, M., & Wroe, A. L., (2014). Parental symptoms of posttraumatic stress after pediatric extracorporeal membrane oxygenation. Pediatric Critical Care Medicine, 15(2), e80-88. doi:10.1097/PCC.0000000000000036 Lincoln, Y. S. & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage. Lynn, M. R. (1985). Determination and quantification of content validity. Nursing Research, 34 (6), 382-385. Meert, K. L., Eggly, S., Pollack, M., Anand, K. J. S., Zimmerman, J., Carcillo, J., Newth, C. J. L., Dean, J. M., Willson, D. F., & Nicholson, C. (2008). Parent’s perspectives on physician-parent communication near the time of a child’s death in the pediatric intensive care unit. Pediatric Critical Care Medicine, 9(2), 2-7. doi:10.1097/01.PCC.0000298644.13882.88 Meyer, E. C., Ritholz, M. D., Burns, J. P., & Truog, R. D. (2006). Improving the quality of end-of-life care in the pediatric intensive care unit: Parents’ priorities and recommendations. Pediatrics, 117, 649-657. doi:10.1542/peds.2005-0144 Michael, F. F., & Charlotte, F. (1992). The most important needs of parents of critically ill children: Parents’ perceptions. Intensive and Critical Care Nursing, 8, 130-139. October, T. W., Fisher, K.R., Feudtner, C., & Hinds, P. S. (2014). The parent perspective: “Being a good parent” when making critical decisions in the PICU. Pediatric Critical Care Medicine, 15(4), 291-298. doi:10.1097/PCC.0000000000000076 Patrick, D. L. & Erickson, P. (1993). Health status and health policy: Quality of life in health care and resource allocation. New York: Oxford University Press. Schleien, C., Brandwein, A., & Stasiuk, L.(2013). Do families play a role in deciding on their own involvement in family centered rounds. Pediatric Critical Care Medicine, 14(2), 235-236. doi:10.1097/01.PCC.0b13e31827451d8 Schumann, J. H. & Alfandre, D. (2008). Clinical ethical decision making: The four topics approach. Seminars in Medical Practice, 11, 36-42. Sharman, M., Meert, K. L., & Sarnaik, A. P. (2005). What influences parents’ decisions to limit or withdraw life support. Pediatric Critical Care Medicine, 6(5), 513-518. doi:10.1097/01.PCC.0000170616.28175.D9 Tiedje, L. B. (2000). Moral distress in perinatal nursing. The Journal of Perinatal and Neonatal Nursing, 14 (2), 36-43. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55715 | - |
dc.description.abstract | 近年來醫療資訊的發達及媒體的渲染,讓病人和家屬對於體外維生系統(Extracorporeal Life Support, ECLS)存有過度的期望,在兒科加護病房中體外維生系統的使用也越來越普遍,常會面對什麼樣的病人才適合使用、由誰來決定、病人的預後和未來的生活品質、使用後的合併症,誰來撤除或永無止盡地使用,從中衍生了許多的倫理議題,讓加護病房的護理人員除了面對高張力的醫療環境,因為每個人的價值觀的不同在照護病人的理念上也會産生衝突,而出現了許多的挫折、適應不良的問題。因此想要去探討兒科加護病房護理師在照顧使用體外維生系統病童時,遭遇的工作壓力,及決策過程中該如何去處理及應對。
本研究為描述性調查研究,於2014年01月27日至2014年3月26日止,採焦點團體方式會談15位兒科加護病房護理師,會談時間約60-100分鐘。利用半結構式的會談大綱進行資料收集,藉由護理人員主觀感受的敍說與描述照顧體外維生系統維生系統病童及家屬的護理經驗。資料分析將會談記錄所得的資料加以歸納、分析及整理,將其隱含的意義完整呈現,以找出兒童加護病房護理人員在照顧此類病童時所面對的壓力源。 依據Colaizzi(1978)所提出的現象學研究步驟進行資料分析,研究結果歸納出四個範疇:病童及家屬照護的挑戰、護理人員照護能力的自我準備度、跨團隊的協調溝通及合作、臨床決策的倫理困境。 一、病童及家屬照護的挑戰,此範疇包含兩個主題:(1)病童屬性複雜多變,其次主題為:疾病種類複雜,無法專精及病況多變,生命驟然喪失;(2)家屬面對病童病情的不確定感,其次主題為:決定治療前的掙扎、等待體外維生系統手術過程中的焦慮、不捨與不確定感的未來、不符實際的期待與現實的落差及面對生命末期不輕言放棄。 二、護理人員照護能力的自我準備度,此範疇包含三個主題:(1)體外維生系統照護,其次主題為:手術用物及儀器操作不熟悉、手術用物準備流程過於急迫、害怕操作機器及警告聲、害怕體外維生系統管路的操作;(2)新手上路摸索學習,其次主題為:初次照顧的莫名壓力、自我摸索忐忑不安、懵懵懂懂手足無措;(3)緊急狀況變化判斷及應變,其次主題為:照護經驗少致判斷評估能力不足、照護標準不一難以判斷突發狀況、異常狀況之緊急處置、合併症發生後的心靈創傷。 三、跨團隊的協調溝通及合作,此範疇包含二個主題:(1)團隊合作默契的磨合,其次主題為:放置維生系統時的急迫氛圍、緊急狀況處置的立即支援、跨團隊成員的照護能力;(2)不同醫療處置時的抉擇,其次主題為:醫療處置意見的多面向、醫療處置的整合。 四、臨床決策的倫理困境,此範疇包含三個主題:(1)維生系統放置的抉擇,其次主題為:客觀中立說明、尊重家屬選擇及讓家屬有時間撫平心理的衝擊;(2)維生系統與病童照護的考量,其次主題為:科學證據與人性照護的掙扎、置放原則標準化與醫療公平性的平衡;(3)維生系統撤除的選擇,其次主題為:生命延長與生活品質的考量、疾病合併症的自然過程。 本研究結果發現兒科加護病房護理師在照護體外維生系統病童的過程中,所要面對的壓力包含許多,尤其是在病童家屬方面、照護團隊的合作及溝通、臨床實境的抉擇,以及自我專業能力的學習成長,藉此提供醫療人員在照護類似個案時的方向以及自我壓力的調適,並協助護理師在學習新的高科技醫療的照護方式時,能夠有適當的訓練,跨團隊的協調及合作,並能增加急重症的安寧照護以提供更人性化的照護品質。 | zh_TW |
dc.description.abstract | Background and purposes: In recent years, owing to the medical development and media spreading, patients and families are over expectations to the Extracorporeal Life Support (ECLS). The use of ECLS also becomes prevalent in Pediatric Intensive Care Unit (PICU). The problems which the medical staff faces are as follows: what kinds of patients are suitable for use, who is able make the decision, the influences of the prognoses and the complications of the patients, the future life quality of the patient, who will be in charge of removing the ECLS or keeping it without unknown ending. It is wonder that this is to extend the patient’s life or death. For this, the ethical issue makes the nursing staff has to face not only high tension but also frustration and maladaptation of the medical environment. The purpose of this research was to explore the stressors that nurses of PICU may encounter when tending children using ECLS, and it also discusses the decision making process.
Methods: It is a qualitative descriptive study. From January 1st to March 26th 2014, focus groups are being held with 15 nurses from Pediatrics ICU as participants, each meeting lasts 60 - 100 minutes. Semi-structured interviews are adopted to collect data, making the participants subjectively narrating and describing their experiences in taking care of children using ECLS, and their interactions with patients’ families. The interviews are recorded, processed and analyzed in hope to unveil its thorough picture beneath the data and to find nurses’ possible pressure sources when tending children with ECLS. Result: The data was analyzed according to the phenomenology methods suggested by Cloaizzi(1978) and categorized in four domains: the challenges of caring patient and his family, the medical care of ECLS, the self-preparedness of nurse competence, the ethical dilemma of clinical decision making. First, the challenges of caring patient and his family includes two themes: 1. The complexity of patient’s condition, the subthemes is includes the complexity and variety of the disease course, and the sudden loss of patient’s life. 2. The family’s uncertainty in illness among patients, the subthemes includes the struggle before they decide to receive treatment, the reluctance and anxiety when they wait for the operation of setting ECLS, the uncertain of future, the unrealistic expectation and the discrepancy in reality and perseverance during the end of life. Second, the self-preparedness of nursing competence, includes three themes: 1. Medical care of ECLS, the subthemes includes the unfamiliarity with the medical supply and equipment, the rush of preparation, the fear to operate the medical devices and their alarms, the fear to operate the circuit of ECLS. 2. The learning curve of the newbie, the subthemes includes the pressure when they firstly face the patients with ECLS, the upset and helpless feeling of self-learning. 3. The judgment and reaction during emergency, the subthemes includes lack of experience of caring ECLS patients, the inconsistence of the standard of medical care, the emergent management in abnormal situation, the psychological trauma after compilation occurs in patients. Third, the communication and co-operation between medical teams, includes two themes: 1. The adjustment of team work, the subthemes includes the urgent atmosphere during the placement of ECLS, the immediate support of emergent medical management, the capacity of cross-team members. 2. The decision making between different medical management, the subthemes includes multiple perspectives of medical management, the integration of medical management. Fourth, the ethical dilemma of clinical decision making, includes three themes: 1. The decision to place ECLS, the subthemes includes objective explanation, the respect for the choice of the family and the rest period of family for their psychological shock. 2. The consideration of ECLS and medical care of patients, the subthemes includes the struggle between scientific evidence and humanity, the balance between the standardization of the criteria of ECLS placement and the equality of medical care. 3. The decision making of the withdrawal of ECLS, the subthemes includes the consideration of life prolongation and life quality, the nature course of disease complications. Conclusion: This research suggests that the nurses are under several kinds of pressure in treating children with ECLS, among which the most dominant ones come from the families of the patients, the collaboration and communication required in inter-professional practice, the decision-making needed in clinical context, as well as their demand in ameliorating proficiency of nursing. This research hopes to provide a direction and guidance to medical staff who works in similar background to their better adaptation to the pressure, and to assist them in getting proper training in terms of learning new nursing skills with cutting-edge technology, and the ability to collaborate with others in inter-professional practice, as well as to increase hospice care for better nursing quality. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T04:19:09Z (GMT). No. of bitstreams: 1 ntu-103-R95426007-1.pdf: 2777658 bytes, checksum: a310b158406d4ffc0ac31b25231867e0 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii Abstract v 第一章 緒論 1 第一節 研究動機及重要性 1 第二節 研究目的 4 第三節 研究問題 4 第四節 名詞界定 5 第二章 文獻查證 6 第一節 加護病房護理人員之工作壓力及因應行為 6 第二節 使用體外維生系統病人的照護與倫理困境 9 第三節 兒童加護病房家屬面臨生命末期病童的臨床決策與照護需求 11 第三章 研究方法 13 第一節 研究設計 13 第二節 研究對象及場所 15 第三節 研究步驟 17 第四節 研究工具 20 第五節 資料處理及分析 22 第六節 研究嚴謹度 23 第七節 倫理考量 25 第四章 研究結果 26 第一節 病童及家屬照護的挑戰 27 第二節 護理人員照護能力的自我準備度 32 第三節 跨團隊的協調溝通及合作 40 第四節 臨床決策的倫理困境 45 第五節 研究結果總結 50 第五章 討論 53 第一節 以病童家庭為中心的體外維生系統照護模式 53 第二節 護理人員照護體外維生系統能力的訓練 56 第三節 跨團隊的協調溝通及合作 58 第四節 臨床決策的倫理困境因素 60 第六章 結論與建議 62 第一節 結論 62 第二節 建議 65 參考文獻 68 中文部份 68 英文部份 71 附錄一、個案基本資料 76 附錄二、受訪者同意書 77 附錄三、焦點座談邀請書 81 附錄四、研究倫理委員會審查同意書 82 附錄五、醫學倫理相關課程訓練資格書 84 | |
dc.language.iso | zh-TW | |
dc.title | 探討兒科護理師面對病童使用體外維生系統加護護理的壓力源 | zh_TW |
dc.title | Stressors of Pediatric Intensive Care Unit Nurses Caring for Children with Extracorporeal Life Support | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 李雅玲(Ya-Ling Lee),呂立(Leigh Lu) | |
dc.subject.keyword | 兒童加護病房,體外維生系統,壓力源, | zh_TW |
dc.subject.keyword | pediatric intensive care unit,extracorporeal life support,stressor, | en |
dc.relation.page | 84 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-08-20 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 護理學研究所 | zh_TW |
顯示於系所單位: | 護理學系所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-103-1.pdf 目前未授權公開取用 | 2.71 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。