探討醫生對於長期臥床老人執行氣管切開術態度之研究

The attitude of doctor for the tracheostomy on the long-time bed rest elde

隨著人口的老化，許多呼吸治療中心如雨後春筍般的成立，被執行氣切需仰賴呼 吸機之病患也大量竄升，雖然延長病人的生命，但是生活品質卻是苦不堪言，面對之 家屬更造成長期的身心負荷，對於政府日益沉重之健保又是一大負擔。本研究預探索 對於長期臥床老人執行氣管切開術的適宜性，運用對醫生的深度訪談法為主軸，本研 究採用滾雪球抽樣法取樣，由某一級教學醫學中心之腫瘤科、腦神經內科、腦神經外 科、胸腔內科、胸腔外科之主治醫生及主任為對象；採用「分析者的三角檢證」以增 加本研究之效度，並運用質性研究的確實性、可轉換性、可靠性此三個指標，提出本 研究所進行的嚴謹度控制。探討醫生對於長期臥床病患執行氣管切開術態度的結果資 料概念化得到：一、以維持生命為宗旨的醫療導向。二、以旁觀者為建議的醫療服務。 三、以明哲保身為依據的醫療認知。四、以生活品質為區隔的醫療措施。五、以人己 殊異的醫療判斷。澄清「生命的延續」不等於「生活品質的確保」之觀念，提供家屬 或醫療專業人員在醫療措施的抉擇上，應站在老人的角色切身的思考。

With elder population increasing and average life prolonging, make respiratory therapeutic center mushroom like bamboo shoots after rain. At the same time the patient by tracheostomy that must depend on respiratory machine to survive. It is suffering for patient and their families to accept tracheostomy procedures like suction. At the same time it result in the burden of health insurance. The purpose of this study is to explore the attitude of doctor to execute tracheostomy in the long-time bed rest elder. The sampling method is snowball drawn from the doctor in charge and director of the oncological , neuro-medicine, neuro-surgery , chest medicine department in medical center. The data were collected from in-depth interviews, memo, and from observations in which the participants exposed their feelings and emotions. Instruments used for data collection include semi-construction questionnaire. The validity of qualitative research are assured by the analyst of the triangulation method. The exactitude are assured by credibility. transferability and dependability. The concept of outcome include:1. The medical direction for the purpose of maintaining the life. 2.The regard onlooker as the medical care proposed. 3. The medical recognition would like to reduce the responsibility of the doctor as possible as he could.4. The regard quality of the life as the medical measure that the district separates. 5.The difference medical decision between self and others. Clarify the idea not meaning of ' the continuity of the life ' that ' the quality of the life is really protected ', offer to relatives or the medical professional personnel it on the choice of the medical measure, should stand in the elder role's personal thinking .