研究背景動機與目的:
急診多是以急重症患者為主，於急診提供安寧緩和醫療服務可減少不必要的醫療資源使用，隨著近年來各界對急診安寧緩和醫療的重視，在面對疾病末期患者時，不再是以急診提供的積極治療為主。另外，安寧緩和醫療也不單單可用於癌症疾病，也已發展至非癌症疾病，但與癌症疾病相比，非癌症疾病患者安寧緩和醫療的使用率是較低的，轉診時間也相對較晚。然而在繁忙的急診提供安寧緩和醫療服務，可能會面臨許多障礙，需具備正確的知識及技能，才能使患者獲得更好的醫療品質，因此了解並增強醫護人員對安寧緩和之觀念是相當重要的。本研究之目的是為探討台灣急診醫護人員對非癌症疾病安寧緩和醫療的知識、態度、行為及團隊合作的認知現況看法。
研究方法:
研究為橫斷式的量性研究，研究對象為全國的急診醫師及護理師，於2022年3月1日-3月22日採用結構式自填問卷，以便利抽樣之方式進行數據的收集，共回收有效問卷251份，問卷分為個人基本資料、安寧緩和醫療條例知識量表、非癌症疾病安寧緩和醫療量表、團隊合作量表四部分，急診醫師及急診護理師問卷的專家效度CVI值為0.930、0.934，而內在一致性 Cronbach’s α值則為0.877、0.917，最終完成數據收集後，使用SPSS 28之統計軟體進行數據的分析。
研究結果:
急診醫師在條例知識、非癌症疾病安寧緩和醫療知識、態度、行為及團隊合作得分皆高於急診護理師。整體醫護人員的條例知識與非癌症知識呈現顯著相關(r=0.185，p<0.05)，條例知識、總知識與態度呈現顯著相關(r=0.153、r=0.158，p<0.05)，態度與行為呈現顯著相關(r=0.552，p<0.001)。另外，在團隊合作方面與總知識、態度、行為呈現顯著相關(r=0.130、r=0.544、r=0.709，p<0.05)。「性別」是影響急診醫護人員對安寧緩和醫療條例知識的預測因素(p=0.046)。「急診工作總年資」、「工作職稱」是影響急診醫護人員對非癌症疾病安寧緩和醫療知識的預測因素(p=0.013、p<0.001)。「性別」、「工作職稱」是影響急診醫護人員對總知識的預測因素(p=0.026、p<0.001)。「工作職稱」是影響急診醫護人員對非癌症疾病安寧緩和醫療態度的預測因素(p=0.012)。「醫療機構所在地」是影響急診醫護人員對非癌症疾病安寧緩和醫療行為的預測因素(p=0.015)。「婚姻狀況」、「最高學歷」是影響急診醫護人員對團隊合作的預測因素(p=0.007、p =0.004)。
結論:
建議在未來可將本研究結果作為參考，對急診的醫護人員建立一套有關於非癌症疾病安寧緩和醫療的教育訓練課程，使醫護人員在執行醫療過程中能具備正確知識及技能，並且透過良好的團隊合作，以帶給病人及家屬更好的建議及更高的醫療照護品質，以利未來急診非癌症疾病安寧緩和醫療之推行發展，使更多非癌症疾病患者能獲得良好的安寧緩和醫療服務。

Background: The emergency department mainly focuses on patients with acute and severe illnesses. Providing hospice palliative care in the emergency department can reduce unnecessary waste of medical resources. With hospice palliative care, the emergency department has been valued recently; therefore, medical professionals have begun paying attention to it. The active treatment provided by the emergency department is no longer the main focus when facing terminally ill patients. In addition, hospice palliative care can be used for cancer and has also been developed for non-cancer diseases. But compared with cancer, the use rate of hospice palliative care in patients with non-cancer diseases is lower, and the referral time is also relatively late. However, providing hospice palliative care in a busy emergency department may face many obstacles. The correct knowledge and skills enable patients to obtain better medical quality, so it is important to understand and enhance the doctor and nurse’s concept of hospice palliative care. The purpose of this study is to investigate the current views of knowledge, attitudes, behaviors and teamwork among Taiwan’s emergency doctors and nurses on the cognition of hospice palliative care for the non-cancer disease.
Methods: A cross-sectional, quantitative research design was employed. The research subjects are Taiwan’s emergency doctors and nurses. The questionnaire was structured and self-administered to collect data through convenience sampling from March 1 to March 22, 2022. A total of 251 valid questionnaires were recovered. The questionnaires were divided into four parts: basic personal information, knowledge scale of hospice palliative care regulations, hospice palliative care scale of the non-cancer disease, and teamwork scale. The CVI of the questionnaires for emergency doctors and nurses are 0.930 and 0.934, and the Cronbach’s α are 0.877 and 0.917. The statistical software of SPSS 28 was used for data analysis.
Results: All of emergency doctors’ scores were higher than nurses’, including knowledge of regulations, knowledge, attitudes and behaviors of non-cancer palliative care and also teamwork. The overall emergency doctors’ and nurses’ knowledge of regulations was significantly correlated with non-cancer knowledge (r=0.185, p<0.05), and the knowledge of regulations, total knowledge and attitude (r=0.153, r=0.158, p<0.05), attitude and behavior were significantly correlated (r=0.552, p<0.001). In addition, teamwork was significantly correlated with total knowledge, attitude and behavior (r=0.130, r=0.544, r=0.709, p<0.05). “Gender” was a predictors of emergency doctors’ and nurses’ knowledge of regulations (p=0.046). “Total experience in the emergency department” and “Job title” were predictors of emergency doctors’ and nurses’ knowledge of hospice palliative care for non-cancer diseases (p=0.013、p<0.001). “Gender” and “Job title” were predictors of emergency doctors’ and nurses’ total knowledge (p=0.026、p<0.001). “Job title” was a predictor of emergency doctors’ and nurses’ attitudes (p=0.012). “Location” was a predictor of emergency doctors’ and nurses’ behaviors (p=0.015). “Marital status” and “highest education” were a predictor of emergency doctors’ and nurses’ teamwork (p=0.007、p =0.004).
Conclusions: The results of this study can be used as a reference in the future to establish a set of emergency doctors’ and nurses’ education and training courses on hospice palliative care for non-cancer diseases so they can have correct knowledge and skills. Also, good teamwork brings better advice and higher quality of medical care to patients and their families and facilitates the development of hospice palliative care for the emergency department’s non-cancer diseases. Then more non-cancer patients can access good hospice palliative care.

論文審定書........................................................................................................i
致謝...................................................................................................................ii
中文摘要..........................................................................................................iii
英文摘要...........................................................................................................v
目錄.................................................................................................................vii
圖目錄..............................................................................................................ix
表目錄...............................................................................................................x
第一章 緒論......................................................................................................1
第一節 研究背景與動機..................................................................................1
第二節 研究目的..............................................................................................4
第二章 文獻探討..............................................................................................5
第一節 安寧緩和醫療之定義..........................................................................5
第二節 安寧緩和醫療之發展..........................................................................7
第三節 急診安寧緩和醫療............................................................................10
第四節 知識、態度、行為之模型................................................................12
第五節 影響醫護人員安寧緩和醫療知識、態度、行為及團隊合作的相關因素.............................................................................................................14
第六節 文獻小結............................................................................................18
第三章 研究方法............................................................................................19
第一節 研究設計及架構................................................................................19
第二節 研究假設............................................................................................21
第三節 研究步驟............................................................................................22
第四節 研究工具............................................................................................24
第五節 研究對象及場所................................................................................27
第六節 資料處理與分析................................................................................28
第四章 研究結果............................................................................................30
第一節 急診醫護人員基本資料之描述性統計............................................30
第二節 急診醫護人員非癌症疾病知識、態度、行為及團隊合作之描述性統計.............................................................................................................36
第三節 急診醫護人員基本資料與非癌症疾病安寧緩和知識、態度、行為及團隊合作之相關分析............................................................................66
第四節 急診醫護人員非癌症疾病安寧緩和醫療知識、態度、行為及團隊合作間之相關性........................................................................................97
第五節 急診醫護人員基本資料對非癌症疾病安寧緩和醫療知識、態度、行為及團隊合作之影響......................................................................100
第五章 討論.................................................................................................132
第一節 急診醫護人員基本資料與非癌症疾病安寧緩和醫療知識、態度、行為及團隊合作關係之探討..............................................................133
第二節 急診醫護人員對非癌症疾病安寧緩和醫療知識、態度、行為及團隊合作之探討..........................................................................................137
第三節 急診醫護人員基本資料與非癌症疾病安寧緩和醫療知識、態度、行為及團隊合作關係之影響..............................................................142
第六章 結論與建議.....................................................................................147
第一節 研究結論.........................................................................................147
第二節 研究限制.........................................................................................149
第三節 未來建議.........................................................................................150
第四節 研究貢獻.........................................................................................151
參考文獻......................................................................................................152
附錄..............................................................................................................166
附錄1 安寧緩和醫療條例...........................................................................166
附錄2 專家效度鑑定評審名單...................................................................169
附錄3 急診醫師、護理師問卷量表...........................................................170

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