探討中老年人於非正規教育機構參與善終課程後之DNR觀點轉化   全文下載

The Exploration of DNR Perspective Trans format ion for the Elder s who Participated in Good Death Course in Non-Formal Educational Institute

我國社會與醫療環境存在著善終障礙，據研究發現，高齡者「不施行心肺復甦術」（do-not-resuscitate, DNR）的自主權常被忽略，而簽署DNR有助善終。本研究於非正規教育機構針對中老年人實施善終課程，以Mezirow（1991）之轉化學習理論為基礎，研究目的為探討中老年人：一、參與課程前對DNR的認識；二、經歷親友急救與死亡經驗對DNR的反思與參與課程後對DNR的反思；三、參與課程後之DNR觀點轉化情形。研究對象為參與研究者於樂齡中心開設的善終課程之7位中老年人，採質性研究法，以半結構式深度訪談蒐集資料，輔以觀察筆記進行資料分析。本研究獲致3項結論：一、中老年人於參與課程前對DNR缺乏正確且完整的認識；二、從經歷親友急救與死亡的經驗，以及參與課程後的反思而對DNR產生新觀點，知其有權主張DNR；三、於參與課程後依據新觀點採取立即或延遲行動，包括決定簽署DNR與將DNR自主權的概念向親人、他人分享。

There are still many obstacles in current medical and social environment for the elders to achieve end well/good death. The autonomy of Do-Not-Resuscitate（DNR） for the elders has been often neglected, and good death can be better fulfilled by signing DNR. In the study, the author implemented the Good Death course for the elders in non-formal education institute. This study was based on the transformative learning theory proposed by Mezirow and the research purposes included: (1) exploring the elder participants’ understanding on DNR before the course; (2) exploring the reflection of the experience of expiring relatives’ death of the elders and the reflection after attending the course; (3) exploring the perspective transformation of the elders after attending the course. The research subjects are seven elders who attended the Good Death course in the Senior Active Learning Center. Qualitative methodology was applied and semi-constructive in-depth interview was conducted for data collection, and observation note was used for supplement to data analysis eventually. Major conclusions shown in the study with three folds: (1) The elders’ understanding to DNR is not enough in general before attending the course. (2) The elders came to have new perspectives through the reflection of experiencing the relatives’ death and the reflection of attending the course, and then they knew they have right to dominate DNR. (3) Based on new perspectives of DNR to sign DNR and share the autonomy of DNR with families or others, they have immediate or delayed action after attending the course.