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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 胡文郁(Wen-Yu Hu) | |
dc.contributor.author | Chiung-Yin Chang | en |
dc.contributor.author | 張瓊尹 | zh_TW |
dc.date.accessioned | 2021-06-16T10:13:38Z | - |
dc.date.available | 2016-09-24 | |
dc.date.copyright | 2013-09-24 | |
dc.date.issued | 2013 | |
dc.date.submitted | 2013-08-19 | |
dc.identifier.citation | 參考文獻
方俊凱、賴明亮、呂欣芹、李佩怡、林明慧、曾煥棠(2007)•照顧末期病患醫師之困境與轉變•安寧療護,12,369-384。 李國箴、方慧芬、邱艷芬(2009)•緩和醫療之研究法討論及省思•護理雜誌,56 (6), 81~86。 林美伶、葉莉莉、陳清惠•影響病人參與醫療決策之論述•護理雜誌,56(3)。 吳整昌(2009)•末期病人使用鎮靜治療的倫理議題•澄清醫護管理雜誌,52, 4-9。 柯雅婷、楊美賞(2007)•重症加護病房病患之倫理決策模式•安寧療護,12,198-206。 楊婉萍、賴維淑、趙可式(2008)•協助一位末期病人面對整體苦難之全人照護經驗•護理雜誌,55,101-105。 蔡甫昌、方震中、陳麗光、王榮德(2012)•長期呼吸器依賴病患撤除維生治療之倫理法律議題•台灣醫學,16,156-173。 蔡翊新、林亞陵、黃勝堅(2007)•重症病人生命末期的照護•安寧療護雜誌,12(3),312-319。 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。 周燕玉(2006)。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。未出版碩士論文,國立臺灣大學護理研究所,臺北市。 陳宇菁(2007)。加護病房家屬代理病人的DNR決策。未出版碩士論文,國立臺北護理學院護理研究所,臺北市。 陳信如、盧映潔(2012)•撤除心肺復甦術與病人生命權保障之爭議•台灣醫界,55(3),39-45。 陳嘉妤(2002)。現代醫療對臨終關懷的衝擊與省思。未出版碩士論文,國立政治大學社會學系,臺北市。 馮雅芳(2003)。加護病房醫護人員對疾病末期病人醫療決策行為意向及其影響因素之研究。未出版碩士論文,國立臺灣大學護理學研究所,臺北市。 黃錦鳳(2007)。加護病房重症病人簽署不予急救同意書對醫療處置之影響。未出版碩士論文,臺北醫學大學護理研究,臺北市。 黃勝堅(2007)。生命末期常見倫理困境。嘉義基督教醫院,未出版手稿。 黃勝堅(2007)。急重症生命末期照護。彰化基督教醫院,未出版手稿。 衛生署安寧緩和醫療條例(http://www.tho.org.tw/xms/toc/list.php?courseID=14)。 American Thoracic Society: Withholding and withdrawing life-sustaining therapy. Am Rev Respir Dis 1991; 144: 726-31. BMA: Withholding and withdrawing life-prolong medical treatment: guidance for decision making BMJ Books, third edition, 2007. Truog RD, et al: Recommendation for end-of –life care in the intensive care unit: the ethics committee of the society of critical care medicine. Crit Care Med 2001;29: 2332-48 Truog RD, Margaret L. Campbell ML, et al: Recommendations for end-of-life care in the intensive care unit : A consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008;36:953-63 Diehr P. Lafferty WE. Patrick DL.et al.: Quality of life at the end of life. Health Qual Life Outcomes. 2007:5:51。 Danis, M. (1998). Improving end-of-life care in the intensive care unit: what's to be learned from outcomes research. New Horiz 6 (1),8-110. Chan GK: End-of-life and palliative care in the emergency department: a call for research, education, policy and improved practice in this frontier area. J Emerg Nurs 2006:32:101-3 Clarke EB. Curtis JR. Luce JM. et al: Quality indicators for end-of-life care in the intensive care unit. Crit Care Med 2003:31:2255-62. Thomay AA. Japques DP. Miner TJ: Surgical palliation: getting back to our roots. Surg Clin North Am. 2009:89:27-41 Caralis PV, Hammond JS(1992).Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment. Crit Care Med,20:683-90. Curtis JR: Communicating about end-of-life care with patients and families in the intensive care unit. Crit Care Clin. 2004:20:363-80. Curtis JR:Caring for Patient With Critical Illness and Their Families: the Value of the Integrated Clinical Team. Respir Care. 2008:53:480-7. Medical futility in end-of-life care. Report of the Council on Ethical and Judicial affairs. JAMA 1999; 281: 937-41. JM Liu, WC Lin, YM Chen et al.. The status of do-not resuscitate order in Chinese clinical trial patientsin a cancer center. J Med Ethics 1999,25,309-314. Steinhauser, K., Vig, C. C., Maya, M., Nicholas,et al.. In search of a good death: Observations of patients, families, and providers. Annals of Internal Medicine, 2000, 132(10), 825-832. National Consensus Project. National consensus project for quality palliative care: Clinical practice quidelines for quality palliative care, executive Summary. Journal of Palliative Medicine, 2004. 7(5), 611-627. Lacey, D. End-of-Life Decision Making for Nursing Home Residents with Dementia: A Survey of Nursing Home Social Services Staff. Health & Social Work,J1(3) 2006, 189-1099. Hu Wen-Yu, Chiu Tai-Yuan, Lue Bee-Horng, et al. An Educational Need to “Natural Death Act” in Taiwan. J Med Education, 2001, 5:21-32. Truth-telling. The New York Academy Medicine , 78(1):59-71. American Medical Association Council on Ethical and Judicial Affairs, Code of Medical Ethics: Current Opinions with Annotations (1996-1997 Edition)(Chicago: AMA, 1996); xxix-xl. http://www.ama-assn.org/ama/pub/phycian-resources/medical-ethics/code-medical-ethics/opinion220.page | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/60205 | - |
dc.description.abstract | 本研究旨在了解重症單位醫護人員對於撤除微升至療之認知態度與行為及其影響因素。以橫斷式描述研究,採立意取樣,使用結構式問卷進行資料收集,研究對象以臺灣北部某醫學中心急重症單位醫護人員為研究對象,醫師與護理人員共收案262名個案,醫師90名,護理人員172名。研究工具為自擬問卷,經專家效度,及表面信度修改後,以探索性因素分析進行建構效度測試。問卷內容包括「基本屬性調查表」、「撤除維生治療認知量表」、「撤除維生治療態度感受量表」、「撤除維生治療的影響因素調查表」與「撤除維生治療行為意向調查表」五部分。所得資料以描述性統計呈現基本屬性及各變項,並以單因子變異數分析、皮爾森積差相關及逐步迴歸分析,找出急重症單位醫護人員對於執行撤除維生治療行為意向之重要相關影響因素。研究結果發現:1) 醫師在撤除維生治療認知量表之正確率 (74.6%)較護理師(67.9%)高。2)醫護人員均對撤除維生治療態度趨於正向,護理師對於撤除維生治療好處的感受相較於威脅性及壞處感受得分較高。3)對急症生命末期情境之撤除維生治療行為意向得分,較慢性末期情境高,即傾向撤除。4)對安寧條例與撤除維生治療之接受度、近期有親友末期經驗者、好處感受高或壞處感受少,均為影響醫護人員撤除維生治療行為意向的重要預測因子,總解釋變異量達28%。
本研究建議醫護人員應先建立生命末期之共識,加強生命教育,提升對安寧條例與撤除維生治療之認知與接受度,以減少醫療團隊及病患家屬陷入倫理困境,並在撤除維生治療執行的態度與行為意向方面,建立本土化資料,提供未來照護之參考依據,讓醫護人員提供優質之急重症生命末期病患照護。 | zh_TW |
dc.description.abstract | Although the idea of palliative care was widely recognized and accepted, the restrictions of regulations and laws made the medical staff face the ethical and legal predicaments caused by futile medical care. The aim of the study was to understand the medical staff’s intentions toward withdrawing life supporting systems, factors impeding the execution of withdrawing life supporting treatment and related factors affecting the withdrawal of life supporting systems in divisions of critical care and to provide the references for medical staff in charge of critical care. The study was cross-sectional study with purpose sampling, collecting data with structured questionnaires and establishing localized data by focusing the attitudes, behavioral intentions and related factors about the withdrawal of life supporting systems. The study subjects were recruited from a medical centers in northern Taiwan, including nurses and physicians. The data were further analyzed by descriptive statistics for “demographic characteristics”, and “independent-sample t-test”, “one way ANOVA”, “Pearson's product-moment correlation coefficient” and “multiple regression analysis” for other factors associated about the knowledge, attitude and Intention behavior in withdrawing life supporting treatment. We hope to understand the medical staff’s intentions toward withdrawing life supporting systems, factors impeding the execution of withdrawing life supporting systems and related factors affecting the withdrawal of life supporting systems in divisions of critical care and to provide the references for medical staff in charge of critical care through the study and to decrease the risk of facing the dilemmas for both medical staff and patients’relatives. The results of this study revealed that there is higher percentage of correct answering the question about the withdrawing of life support system in physicians group (74.6%), while compairing to the nurse group(67.9%). The attitude of life support system withdrawing had positive relationship in both group and the objective positive feedback for the life support system withdrawing is stronger in the nurse group. While considering the disease factor for the decision-making tendency in life support system withdrawing, withdraw for a patient in acute end of life issue had more tendency than chronic one. Other important factos affecting the decision making of life support system withdrawing in medical staff includes: the acceptability of Hospice Palliative Care Regulation, the recent personal experience in dealing with the issue of end of life, better objective positive feedback, or poor objective positive feedback. The over all Total Variance Explained after adjustement was 28%.
The study discovered that by means of redefined defenition of end of life, augmented life education, thoroughly understood of Hospice Palliative Care Regulation in the medical staff, the ethical conflicts of life support system withdrawing which bothered the medical staff and patient’s relatives would be softened. We are looking for the localizaed data base about the medical staff attitude and factors affecting the decision making process in such situiation. Finally, we hope to offer a reference for clinicians to make a proper decision while being caught in a dilemma. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T10:13:38Z (GMT). No. of bitstreams: 1 ntu-102-R96426002-1.pdf: 30497877 bytes, checksum: 0deb99add7d9c4687fc48e440b9935bc (MD5) Previous issue date: 2013 | en |
dc.description.tableofcontents | 目錄
口試委員審定書……………………………………………………… i 授權書 ……………………………………………………………… ii 中文摘要………………………………………………………… vi 英文摘要………………………………………………………………vii 第一章 緒論…………………………………………………… 1 第一節 研究動機與重要性………………………………… 1 第二節 研究目的……………………………………………… 3 第二章 文獻查證…………………………………………………… 4 第一節 生命末期的定義……………………………………………. 4 第二節 安寧緩和醫療條例修法沿革及重大改變……………………9 第三節 撤除維生治療的現況與困境………………………………… 13 第四節 名詞定義……………………………………………………. 16 第三章 研究方法……………………………………………………… 17 第一節 研究架構……………………………………………………… 17 第二節 研究場所及對象……………………………………………… 19 第三節 研究工具之信效度…………………………………………… 20 第四節 資料收集過程………………………………………………… 38 第五節 資料處理與分析……………………………………………… 39 第六節 研究倫理考量………………………………………………… 40 第四章 結果分析……………………………………………………… 41 第一節 基本資料……………………………………………………… 41 第二節 醫護人員撤除維生治療的行為意向與意願………………… 59 第三節 其他影響撤除維生治療行為意向之影響因素………… 65 第四節 基本資料與各變項間的相關性……………………… 74 第五節 醫護人員各連續變項間的相關性………………………… 80 第六節 醫護人員撤除維生治療重要影響因素………………………84 第五章 研究分析與討論……………………………………………… 87 第一節 醫護人員對於撤除維生治療的認知、態度與行為意向 87 第二節 醫護人員對於撤除維生治療認知、態度與行為意向之間相關性 90 第三節 醫護人員執行撤除維生治療行為意向之影響重要因素 92 第四節 醫護人員對撤除維生治療的認知態度與行為意向異同. 94 第六章 結論與建議………………………………………………… 93 第一節 研究結論……………………………………………………. 93 第二節 研究建議……………………………………………………… 96 第三節 後續研究建議……………………………………………. 98 參考資料………………………………………………………… 99 中文部份……………………………………………………………… 99 英文部份…………………………………………………… 100 圖表目錄 圖一 撤除生命末期病人維生治療行為意向之研究概念架構圖 18 圖二 撤除維生治療態度感受量表之自覺同意程度 28 圖三 撤除維生治療態度感受量表之重要性感受 28 圖四 撤除維生治療意影響因素調查表探索性因素分析之陡坡圖 31 圖五 情境一執行撤除維生治療的行為意向因素分析之陡坡圖 33 圖六 情境二執行撤除維生治療的行為意向因素分析之陡坡圖 35 表一「撤除維生治療性感受態度量表」之探索性因素分析 29 表二「撤除維生治療意影響因素調查表」之探索性因素分析 32 表三 情境一執行撤除維生治療的行為意向之探索性因素分析 34 表四 情境二執行撤除維生治療的行為意向之探索性因素分析 36 表五 問卷各量表內部一致性信度分析 37 表六 基本屬性 51 表七 執行撤除維生治療的行為意向 62 表八 執行撤除維生治療的行為意向調查表 64 表九 安寧緩和醫療條例有關撤除維生治療知識認知量表答對率 67 表十「撤除維生治療態度感受量表」 自覺同意程度與重要程度 70 表十一 撤除維生治療的影響因素調查表 72 表十二 醫護人員各量表平均得分情形 73 表十三 基本屬性與各變項之單變量分析(ANOVA) 77 表十四 基本屬性與各變項之的相關性分析 83 表十五 醫護人員於「慢性末期撤除之行為意向」的重要預測因子 84 表十六 醫護人員於「急性末期撤除之行為意向」的重要預測因子 85 表十七 醫護人員於「執行撤除可能性之行為意向」重要預測因子85 附錄 附錄一、醫護人員執行生命末期病人撤除維生治療之行為意向及其影響因素醫師問卷調查表………………………………… 102 附錄二、醫護人員執行生命末期病人撤除維生治療之行為意向及其影響因素護理人員(非醫師版)問卷調查表 111 附錄三、受試者同意書………………………………… 120 附錄四、臨床試驗證明書…………………………………………23 附錄五、專家效度之專家名單…………………………… 125 | |
dc.language.iso | zh-TW | |
dc.title | 醫護人員撤除生命末期病人維生治療行為意向之影響因素 | zh_TW |
dc.title | The Associated Factors about Behavior Intentions of
the Medical Personnel to Withdraw Life Support Treatment with Patients at End of Life | en |
dc.type | Thesis | |
dc.date.schoolyear | 101-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 柯文哲(Wen-jen Ko),黃勝堅 | |
dc.subject.keyword | 撤除維生治療,行為意向,緩和醫療,生命末期,態度, | zh_TW |
dc.subject.keyword | Withdrawal of life supporting treatment,Intention Behavior,palliative care,End of life,Attititude, | en |
dc.relation.page | 125 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2013-08-20 | |
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 |
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