醫護人員面對重症早產兒照護之倫理困境與相關因素探討

Ethical Dilemma of Medical Personnel While Providing Care for the Critical Premature and Relative Factors

本研究旨在探討醫護人員在面對重症早產兒照護時所遭遇之倫理困境、對生命和倫理規範的看法，以及相關因素的影響。研究設計採描述性研究，以台北某醫學中心新生兒單位之醫護人員為研究對象，採便利取樣方式收得137份有效問卷。研究結果發現：(1)曾經面臨倫理困境者，在倫理規範之行為態度上較傾向一致性的看法；(2)有子女者比無子女者在面臨積極拯救困境上所引發的痛苦程度為高；(3)在臨床實務中，醫師遭遇倫理困境之頻率較其他研究對象來得低；(4)在病嬰室與嬰兒室工作的護理人員發生積極拯救困境的頻率較其他新生兒工作單位來得低；(5)引發倫理困境的來源主要是來自早產兒的父母或家屬，其次是醫師及其他護理人員；(6)是否獲得足夠醫療相關訊息為醫護人員下治療決策時最重要之影響因素；(7)醫護人員對倫理規範量表內容之一致性高；(8)醫護人員在實務情境中最大的倫理困境為在人力與工作環境上遭遇到不良的管控。此研究結果有助於醫護人員了解實務困境的深度面與廣度面，並提供決策過程之架構，以降低臨床實務中倫理決策所帶來之衝擊。

The purposes of this study were to explore the ethical dilemma that medical personnel were faced with while providing care for the critical premature, and to explore their values and belief in life and ethics. The descriptive research approach was used to make this design to select the medical personnel of the newborn unit in VGH as its samples. In the 137 questionnaires retrieved from convenient sampling, researcher found: (1) Those who were faced with ethical dilemmas would adapt similar behaviors and attitudes in ethical principles; (2) The level of ethical dilemmas appeared higher for those having children than those without children; (3) Doctors had less degree and frequency of ethical dilemmas among the various types of medical personnel; (4) Nursing personnel in NBR and BR had lower frequency in facing aggressive care dilemmas than personal in other care units; (5)Primary causes of ethical dilemmas come to parents and relatives, then doctors, and other medical personnel; (6) The major influential factor for medical personnel to make a medical decision was the sufficient medical related informations; (7) Medical and nursing personnel were highly consistent in scaling ethical principles; (8) The biggest ethical dilemma facing medical personnel was the inferior control and administration in manpower and working environments. The results of this research will help understand the ethical dilemmas in depth and width, so as to provide a structure for decision making, thus reducing the impact of ethical decision making.