探討不施予心肺復甦術的倫理議題

The Ethical Issues of Do-Not-Resuscitation

本研究旨在探究護理人員面對不施予心肺復甦術所遭遇的困境，以質性研究之焦點團體訪談收集資料，進行14次焦點團體，每次團體進行時都以分享「醫院裡的哲學家」一書的內容為開端，參加團體的護理人員共計11人，每次團體人數5~10人。團體及訪談資料轉成文字後，以繼續比較分析找出各項主題。內容分析分別找出(一)家屬方面:對不施予心肺復甦術意義的誤解、救與不救間的矛盾。(二)醫護人員方面:自身預設的立場、告知責任的歸屬、告知內容的可理解性、告知的時機。最後討論照顧臨終病人面臨不施予心肺復甦術時由誰告知、告知什麼、何時告知、如何告知等專業態度。

This study aimed to understand the ethical dilemmas nurses encountered in patient care situationswhereDo-Not-Resuscitate (DNR) order was made. Focus group interviews were conductedto capture the nurses' experience. A total of 11 nurses voluntarily participated in the interviews in14 sessions, with five to ten nurses attending each session. The nurses were encouraged to sharetheir own clinical encounters upon reading the relevant ethical cases described in the book entitledPhilosopher in the Hospital. The interviews were audio-recorded and transcribed verbatim forqualitative analysis using constant comparative method. Emergent themes were categorized intofamily concerns and health professional concerns. The family concerns revolved around issues ofmisconception in relation to the meaning of DNR order, and the conflict between forgoing orcontinuing resuscitative measures. For the health professionals, some brought their unreflectivepersonal standpoints to the patient care situation, and some were uncertain about who should beaccountable in the DNR decision-making. Confusion arose regarding the use of evasive wordingand the optimal time for information disclosure.