加護單位護理人員對重症病患生命末期決策態度

The Attitudes about End of Life Decision-Making in Critically Ill Patients among Intensive Care Nurses

本研究目的為探討加護單位護理人員對重症病患生命末期決策之態度。採橫斷性、描述性研究設計，選取178位南部某區域醫院加護單位護理人員為研究對象。研究工具包含自擬基本資料表及「護理人員對病患生命末期決策之態度」量表，此中文版量表專家效度值為.95，內在一致性係數為.57。所得資料以SPSS for Windows 13.0 版進行描述性統計分析。研究結果顯示97.2％護理人員同意「當病人權益未被重視，自身有責任與醫療團隊討論其醫療處置」；關於止痛藥部分，94.9％護理人員認為「即使可能加速病人死亡，給予止痛藥以緩解疼痛仍是恰當的」；然而有90.4％護理人員表示「即使終止如呼吸器及透析等生命支持療法，人工營養及水分仍應持續下去」。雖臨床護理人員普遍能覺察自身有責任為病人代言，且了解疼痛控制的重要性，然而對於病人自主權、及提供末期病人人工營養及水分知識則較不足夠，因此，護理教育及實務應著重相關知識的建立並強化倫理道德的素養。

This study was a cross-sectional descriptive design that collected information from 178 intensive care nurses working in a regional hospital in the south Taiwan. Structural instruments used were basic demographic questionnaire developed by the researchers and a Chinese version of the “professional attitudes about end of life decision-making”. The CVI value of questionnaire was .95 and the internal reliability coefficient was .57. Data were managed using SPSS 13.0 software and analysed with descriptive statistics. The results showed that 97.2% nurses agree that they have the responsibility to confer with the doctors about medical treatment of their patients if patients’ rights have not been well considered. About analgesic medicine, 94.9% nurses think that it is appropriate to give medication in relieving patients’ pain even if this may hasten their death. However, 90.4% nurses agree that even if life-support equipments, such as mechanical ventilation and dialysis are stopped, artificial nutrition and hydration should be continually provided. Most nurses were aware that they have the responsibility to advocate for their patients and understand the importance of pain management. However, they were less knowledgeable about the patients’ autonomy and whether artificial nutrition and hydration should be continually used or not in terminal patient. Therefore, more nursing education in terms of knowledge and ethical issues should be emphasized.