影響急診醫護人員對安寧緩和醫療條例認知及不施行心肺復甦術態度之因素

Factors Associated with the Knowledge of “ Hospice and Palliative Care Act” and Attitude Towards “Do not Resuscitation” Among the Medical Staff in Emergency Department

本研究目的在探討影響急診醫師與護理人員對安寧緩和醫療條例知識認知及不施行心肺復甦術（do not resuscitate, DNR）的態度因素之探討。本研究為橫斷式相關性研究設計，以結構式問卷為研究工具。以北、中、南及東部4 個醫學中心及5 個區域醫院附設急診部為研究場所。自民國97 年4 月1 日至5 月15日止，共發出問卷429 份，回收有效問卷299 份。本研究除進行描述性統計外，另使用複迴歸分析、獨立t 檢定、one-way ANOVA 瞭解急診醫護人員對於安寧緩和醫療條例知識認知程度及不施行心肺復甦術態度之差異。研究結果顯示醫師對安寧緩和醫療條例知識程度高於護理人員。醫師對不施行心肺復甦術的態度高於護理人員。「醫院等級」會影響醫師對安寧緩和醫療條例知識的認知；「教育程度」會影響護理人員對安寧緩和醫療條例知識的認知。影響醫師對不施行心肺復甦術的態度僅「醫院等級」。本研究顯示醫護人員對安寧緩和醫療條例知識瞭解程度僅6 成。建議醫院針對第一線的醫護人員繼續執行教育訓練為當務之急，讓醫護人員明瞭安寧緩和醫療條例知識的重要性，在參與醫療決策過程中能具備正確的知識。

This study is aimed to analyze factors affecting the regulation and attitude towards ‘do not resuscitate’ in medical staffs who work in the emergency department. It was a cross-sectional and correlational design and data were collected by structured questionnaire. This was conducted in the emergency department of 4 medical centers and five local hospitals in Taiwan. A total of 429 questionnaires were distributed and 299 effective questionnaires were collected from 1st April 2008 to 15th May 2008, 299. Data were analyzed by descriptive statistics, multiple regression analysis, independent t test and one way ANOVA to determine the variations among the medical staffs. Results showed that physicians reported a higher level of comprehension of the regulation and attitude towards ‘do not resuscitate’ than the nursing staffs. Hospital classification affected the physicians’ comprehension of the regulation towards ‘do not resuscitate’. On the other hand, education affected the nursing staffs’ comprehensions of the regulation of ‘do not resuscitate’. However, hospital classification was the only factor associated with the attitude towards ‘do not resuscitate’ in physicians. This study found that the comprehension level of medical staffs was only 60%. Thus, continuous education for the medical staffs is strongly suggested to ensure the precision of decision-making.