拒絕心肺復甦術之末期病人臨終時使用急救藥物之探討

NHUIR > College of Humanities > Department of Life-and-Death Studies > Disserations and Theses(M. A. Program in Life-and-Death Studies) > Item 987654321/23142

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Title:	拒絕心肺復甦術之末期病人臨終時使用急救藥物之探討
Other Titles:	A Study in the Utilization of Emergency Medicine in Pre-dying Patients with Do-Not-Resuscitation
Authors:	王淑如 Wang, Shu-Ru
Contributors:	生死學系碩士班王枝燦 Chih-Tsan Wang
Keywords:	急救藥物;拒絕心肺復甦術;臨終;末期病人;無效醫療 Do-Not-Resuscitate (DNR);hospice;terminated patients;emergency medication;futility
Date:	2015
Issue Date:	2015-08-25 16:05:38 (UTC+8)
Abstract:	拒絕心肺復甦術(Do-Not-Resusciation,DNR)，是希望末期病人在心肺停止時，不用無效醫療來延長瀕死期。但臨床上常遇到病人的DNR上會附註「使用急救藥物」，故本研究欲探討簽署DNR之末期病人死亡或臨終出院時，仍使用急救藥物之現況。本研究藉由回溯2011年台灣中部某醫學中心的死亡病歷，並針對該醫院之醫護人員進行問卷調查。將資料以SPSS18.0軟體進行統計分析。結果發現在病歷回溯中，安寧病房、一般病房及加護病房，急救藥物使用呈顯著差異(p<.000)，安寧病房幾乎不使用，一般病房使用比率為35%，加護病房為75%。進一步分析發現，住院病人臨終使用急救藥物，與診斷(p<.05)、所屬科別(p<.001)、是否附註使用急救藥物(p<.001)、最後24小時內使用急救藥物的劑量(p<.001)及出院狀態(p<.05)呈顯著差異。而問卷採Likert-type量表計分法，得分越高者，越傾向認為末期病人臨終不使用急救藥物。問卷調查發現，安寧病房成員態度得分最高，其次是一般病房，最低則是加護病房；曾上過DNR相關課程者態度得分較沒上過者高；認為病人在簽署DNR時，應該保留急救藥物使用，及醫療團隊建議臨終返家時使用升壓劑者，態度的得分較低；醫師的認態度得分是高於護理師的。而本研究無法呈現使用急救藥物，是否與不同病房屬性的制度文化，或病人及家屬決策過程有關，這些都有待更進一步研究。並於結論中，藉由本研究之發現，提供從事末期照護者一些建議，並利未來在政策推動之參考。　　The definition of Do-Not-Resuscitate (DNR) is to refuse to use emergency medication to prolong patients’ near death experiences. In clinics, often patients would put a notice of using emergency medication under DNR, the study aimed to explore what extent the emergency medication is used for those terminated patients signed DNR in Taiwan. Retrospective study design was used in this study to review medical charts of died patients give Cognition and Attitude Scale in Emergency medication use for Terminated Patients (CASETP) to medical personnel in a medical center of Middle Taiwan in 2011. The higher score the participants gave, the lower tendency they would use emergency medication. The SPSS 18.0 statistical software was used for analyses. We found a significant difference of emergency medication use among Hospice ward, general wards and Intensive Care Unit (ICU) (p< .00005); the percentage of using emergency medication was shown as follows: none in Hospice ward, 35% in general wards and 75% in ICU. Further analysis showed significant correlation between emergency medication use and diagnosis (p< .05), department (p< .001), using notice for emergency medication use (p< .001), dosage of emergency medication at the last 24 hours (p< .001) and discharge situation (p< .05). The results showed that medical personnel who work in the hospice care ward had the highest scores, and those work in the general wards had the second highest scores and those work in the ICU had the lowest scores. In addition, the medical personnel who have attended DNR related courses had higher scores than those who haven’t. The medical personnel who suggested to keeping emergency medication use under signing DNR, and the medical teams who suggest to using vasopressors had lower scores, doctors gave higher scores than did nurses. The relationships between emergency medication use and department and decision making from patients or relatives were not found to be significant and need further investigation. The findings in this study would provide some suggestions for those who involved in hospice care and policy makers.
Appears in Collections:	[Department of Life-and-Death Studies] Disserations and Theses(M. A. Program in Life-and-Death Studies)

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