博碩士論文 etd-0827109-173617 詳細資訊


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姓名 鍾立民(Li-min Chung) 電子郵件信箱 asama0702@yahoo.com.tw
畢業系所 高階經營碩士班(EMBA)
畢業學位 碩士(Master) 畢業時期 97學年第2學期
論文名稱(中) 癌症病患簽署不施行心肺復甦術同意書之分析研究
論文名稱(英) The Related Factors Toward Terminal Cancer Patients Do-Not-Resuscitate
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    摘要(中) 癌症位居國人十大死因之首已經十幾年,相關治療的進步給罹患癌症的病患與其家屬帶來無限的希望與鼓舞,國人平均餘命的延長及死亡率的下降,使得病患與其家屬面對死亡的態度相對積極,希望透過各種先進設備與藥物能儘量延長其親人的生命,而生命盡頭使用維生治療延長生命或預立DNR維持生命末期生活的品質與尊嚴,是醫療人員與病患及家屬的兩難,因此本研究的目的是探討癌症末期病患及家屬簽署不施行心肺復甦術同意書的各種情況,希望能分析出影響其簽署時機的相關因素。
        以南部某區域教學醫院之癌症末期病患或家屬簽署的「不施行心肺復甦術」同意書共80份為例,回溯其病歷紀錄並分析探討各相關因子,是否影響同意書簽署的時間。
        研究結果顯示,多數癌症末期病患與家屬簽署「不施行心肺復甦術」同意書的時間距離病患死亡的時間很近,大於二週的僅佔12.5%,有55%病患與家屬於死亡前五天才簽署同意書,三成的病患與家屬在簽署同意書後6-14天死亡,更有兩成(21.25%)病患與家屬於死亡當天才簽署同意書;病患的年齡、性別、原發癌症的種類、是否有肺或肋膜的轉移、病患是否曾接受癌症相關治療治療對簽署時間的影響並沒有統計上的差異,在推論性統計類別變項的卡方統計分析中發現教育程度、病患或家屬簽署同意書時是否病危以及止痛藥使用的情況等三項因素與病患簽署的時間有顯著相關。有72.5%的病患教育程度為小學、國中與高中程度的佔18.75%,八成的病患於病況危急時才簽署同意書,國小(含)以下學歷的病患簽署DNR後至死亡總天數大於6天者有32位,國中學歷(含)以上者僅有4位(p值=0.003);53.75%的病患於簽署DNR同意書時曾使用中低效度以上的類鴉片止痛藥,其中包括25%病患使用嗎啡類止痛藥,有使用止痛藥物病患簽署DNR後至死亡總天數大於6天者有18位,少於無止痛藥物使用的26位(p值=0.011);病危情況下簽署DNR後至死亡總天數大於6天者有42位,小於6天者有23位具顯著差異
    (p值=0.000)。
        建議加強醫護同仁及一般社區居民對安寧療護的認識,醫療人員關於DNR 的觀念有賴透過教育予以釐清,醫護同仁必須更深入瞭解癌症末期病患的身心狀況,提供適當的關懷與協助,協助獲得更好的生活適應,並找到生命的意義與價值,安然面對人生的終點。
    摘要(英) Cancer was the most common cause of the death in Taiwan in the past two decades. The recent advanced improvements of cancer treatment took endless encouragements and hopes to patients and their families, so they intended aggressively while dealing with the issue of death because of the decline of mortality rate and prolonged mean lifespan. It was difficult for families and doctors to decide whether to prolong life by life sustaing treatments (including cardiopulmonary resuscitation) or to sign Do-Not-Resuscitate (DNR) consent for terminal cancer patients .We want to analyze the related factors toward terminal cancer patients DNR and point out some ones correlated closely with the time of signing consent in this restrospective research.
        We corrected 80 DNR consents signed by terminal cancer patients or their families from one general teaching hospital in south Taiwan and analyzed factors toward the time of signing consents.
        Results of this study showed that the time of signing consents was very close with that of their death . Only 12.5% of the patients with survival more than 2 weeks after signing DNR consents, 55% of the patients or their families did not sign the consents until five days before their death, 30% of the patients died in 6-14 days after signing DNR consents, and there were even more twenty percent (21.25%) of the patients died in the day of which the consents were just signed by their families. The patients’age, gender, kinds of their primary cancer, whether the pulmonary or pleural metastasis were present or not, and the treatments of these patients had no significant correlations with the time of signing DNR consents. Only three factors including of education level of patients, whether the patients’illness was critical while signing consents and kinds of patients’painkiller use contributed to the time of DNR signing significantly in this research. 72.5% of these patients had the degree for the primary school, and 80% of the patients or their families signed the consents just when the patients’illness was critical. There were 32 patients with degree of the primary school and only 4 with degree of the junior high school within the patients wih survival more than 6 days after signing DNR consents (p value =0.003); There were 53.75% of the patients had ever used opioid painkillers while siging DNR consents, 25% of them had even received morphine for pain control. For the patients with survival more than 6 days after signing DNR consents, there were 18 patients prescribed opioid painkillers, and 26 patients without taking painkillers that meaned significant difference (p value =0.011); For the patients with critical illness while signing DNR consents, it meaned statistic difference for that 42 patients got survival more than 6 days and 23 patients with survival less than 6 days. (p value =0.000).
        We highly suggest to inforce the knowledge of hospice care to people in community and the colleagues of doctors and nurses by any kinds of education and introduction. We all need to pay more attentions to psychiatric status of terminal cancer patients and supply adequate help and care for them, so we could all get more close to meanings of human life.
    關鍵字(中)
  • 心肺復甦術
  • 不施行心肺復甦術意願書
  • 維生治療
  • 關鍵字(英)
  • Cardiopulmonary resuscitation
  • Do-Not-Resuscitate
  • Life sustaining treatments
  • 論文目次 論文提要 ………………………………………………………………………… i
    中文摘要…………………………………………………………………………….i
    英文摘要…………………………………………………………………………… iv
    誌謝詞……………………………………………………………………………… v
    目錄………………………………………………………………………………….vii
    表目錄……………………………………………………………………………….ix
    圖目錄……………………………………………………………………………… x
    第一章 緒論
      第一節 研究動機                        1
      第二節 研究目的與問題                     4
      第三節 名詞界定                        5
    第二章 文獻探討
      第一節 安寧緩和醫療的相關概念                 6
      第二節 臨終病患之照護                     11
      第三節 死亡態度的探討                     15
    第三章 研究方法
      第一節 研究架構                        20
      第二節 研究樣本                        21
      第三節 研究流程                        21
      第四節 變項的說明                       24
      第五節 資料處理與統計方法                   27
    第四章 研究結果
      第一節 樣本的描述性統計分析                 29
      第二節 樣本的推論性統計分析                 33
    第五章 討論
      第一節 病患基本資料之分析                  38
      第二節 疾病相關資料之分析                  38
      第三節 醫護人員對「不施予心肺復甦術」相關認知及其相關因素  39
    第六章 結論、研究限制與研究建議
      第一節 結論                         40
      第二節 研究限制                       41
      第三節 研究建議                       41
    文獻參考
      一、中文文獻                         43
      二、英文文獻                         45
    附錄一、安寧緩和醫療條例                     48
    附錄二、安寧緩和醫療條例施行細則                 52
    表目錄
    表3-1:各種變項的說明                       24
    表4-1:樣本的描述性統計(依變項和自變項病患資料)           30
    表4-2:樣本的描述性統計(自變項疾病相關資料)            31
    表4-3:樣本的描述性統計(自變項DNR 簽署內容)            32
    表4-4:獨立樣本t 檢定分析                     34
    表 4-5:單因子變異數分析-止痛藥物使用情況與簽署DNR後之存活總日數
    薛費法                           36
    表 4-6:單因子變異數分析表 教育程度與簽署DNR後之存活總日數薛費法  36
    參考文獻 ﹙﹙一﹚中文文獻
    王志嘉、楊奕華、邱泰源、羅慶徽、陳聲平(2004)•安寧緩和醫療條例有關「不施行,以及終止或撤除心肺復甦術」之法律觀點•台灣家醫誌,13(3),101-108。
    王志嘉、陳聲平(2003)•拒絕心肺復甦術(DNR)的醫療與法律問題•台灣醫界,
    46(4),48-50。
    王桂芸、馬桐齡(1989)•護理人員對瀕死病人態度之探討•護理雜誌,36(3),77-88。
    台北榮總護理部研究發展委員會(2002)•『不實施心肺甦醒術』之臨床應用•榮總護理,19(1),103-105。
    汪素敏、顧乃平(2000)•照顧瀕死病人的倫理考量•國防醫學,31(1),72-79。
    吳麗玉、林旭龍、呂昌明(1999)•護理學院學生死亡態度之研究•康寧學報,3,
    83-106。
    林慧珍(2000)•器官捐贈與安寧療護•於林綺雲主編,生死學(一版,413-427 頁)•
    台北:洪葉文化。
    林世崇(2003)•急救與生死倫理學•台灣醫界,45(9),38-42。
    邱泰源、胡文郁、蔡甫昌、周玲玲、姚建安、陳慶餘(1998)•緩和醫療照顧的倫
    理困境•台灣醫學,2(6),633-640。
    胡文郁、邱泰源、呂碧鴻、陳慶餘、謝長堯、陳月枝(2001)•醫護人員對「安寧緩和醫療條例」之教育需求•醫學教育,5(1),21-32。
    姜安波(1993)•重症醫療倫理綜論•內科學誌,4(4),263-278。
    姚建安、邱泰源、胡文郁、陳慶餘(2004)•安寧緩和醫學教育現況•安寧療護雜誌,9(1),28-43。
    莊淑茹(2001)•死亡教育課程對護校學生死亡態度之影響•未發表的碩士論文,嘉義:南華大學生死學研究所。
    黃琪璘(1991)•台北市綜合醫院醫師對死亡及瀕死態度之研究•未發表的碩士論文,台北:國立臺灣師範大學衛生教育研究所。
    馮雅芳(2002)•加護病房醫護人員對疾病末期病人醫療決策行為意向及其影響因素之研究•未發表的碩士論文,台北:國立臺灣大學護理學研究所。
    陳玉黛、林佩芬(2004)•影響加護單位護理人員面對瀕死病患態度之因素探討•慈濟護理雜誌,3(4),49-59。
    陳民虹、蔡甫昌(1996)•臨終病人之照顧-醫病關係及其倫理•基層醫學,11(3),
    54-58。
    陳榮基(1999)•拒絕心肺復甦術的法源探討•醫事法學,7(1),6-8。
    陳榮基(2001)•醫療人員如何幫助病人善終•安寧療護雜誌,6(2),12-16。
    陳榮基(2004)•安寧緩和醫療條例臨床作業手冊•台北:財團法人中華民國安寧照顧基金會。
    陳榮基(2006)•醫界應積極推廣臨終DNR 的觀念•慈濟醫學雜誌,18(2),155-157。
    馮雅芳(2002)•加護病房醫護人員對疾病末期病人醫療決策行為意向及其影響因素之研究•未發表的碩士論文,台北:國立臺灣大學護理學研究所。
    曾建元(2003)•病人權利的倫理難題•應用倫理研究通訊,25,31-39。
    鈕則誠(2003)•醫護生死學•台北:華杏。
    詹美珠、李淑秋、胡瑞桃(2005)•加護病房護理人員對DNR 態度及其照顧病患相關因素探討•安寧療護雜誌,10(3),272-285。
    楊克平(2001)•安寧與緩和療護學•台北:偉華。
    楊琇茹(2004)•從病患自主權看病患家屬參與醫療決定之權限•未發表的碩士論文,桃園:中原大學財經法律學系研究所。
    趙可式(1996)•臨終病人照護的倫理與法律問題•護理雜誌,43(1),24-28。
    趙可式(1997)•台灣癌症末期病患對善終意義的體認•護理雜誌,44(1),48-55。
    趙可式(2000)•安樂死、自然死與安寧療護•於戴正德、李文濱編著,醫學倫理導論(初版,109-123 頁)•台北:教育部。
    鄒海月、王守容、何裕芬(1999)•癌症末期病患家屬對「不予急救」之態度極其相關因素之初探•榮總護理,16(4),344-356。
    蔡明昌(1995)•老人對死亡及死亡教育態度之研究•未發表的碩士論文,高雄:高雄師範大學成人與繼續教育研究所。
    蔡麗雲、李英芬、劉景萍、賴允亮、張澤芸、杜金錠(2003)•實施「安寧緩和醫療條例訓練方案」成效之初探•安寧療護雜誌,8(4),364-379。
    鄭貞枝(2001)•護理學校臨床指導教師對死亡教育需求之探討•未發表的碩士論文,嘉義:南華大學生死學研究所。
    藍育慧、李選(1997)•死亡教育對改善護專學生死亡恐懼成效之探討•長庚護理,
    8(1),42-52。
    鍾思嘉(1986)•老人死亡態度之調查研究•國科會研究論文摘要,497。
    顧艶秋(2000)•護理人員照護瀕死病患行為及其相關因素之研究•未發表的博士論文,台北:國立臺灣師範大學衛生教育研究所。
    顧艶秋(2001)•護理人員的死亡態度•安寧療護雜誌,6(2),32-41。
    ﹙二﹚英文文獻
    Aroskar, M.A. (1985). Access to hospice.Ethical dimensions. The Nursing Clinics of NorthAmerican, 20(2), 299-309.American Nurses Association(2003,n.d.). ANA position statments: Nursing care and Do-Not-Resuscitate(DNR*)decisions. Retrieved March 12, 2005, fromhttp://www.ana.org/readroom/position/ethics/etdnr.htm
    American Nurses Association(1991,September 5). ANA position statments: Ethics and
    human rights. Retrieved June 25, 2005, from http://www.nursingworld.org/readroom/position/ethics/etethr.htm
    Barbus, A.J.(1997). Towards a dignified death. Michigan Nurse, 50(9), 8-9.
    Blackhall, L.J.(1987). Must we always use CPR?. New England Journal of Medicine, 317(20), 1281-1287.
    Biegler, P.(2003). Should patient consent be required to write a do not resuscitation
    order?. Journal of Medical Ethics, 29(6), 359-363.
    Bucher, L., Wimbush, F.B., Hardie, T., & Hayes, E.R. (1997). Near death experiences:
    critical care nurses’ attitudes and interventions. Dimensions of Critical Care Nursing,16(4), 194-201.
    Choudhry, N.K., Choudhry, S., & Singer, P.A.(2003). CPR for patients labeled DNR:
    The role of the limited aggressive therpy order.Annals of Internal Medicine, 138(1),
    65-69.
    Cherniack, E.P.(2002). Increasing use of DNR orders in the elderly worldwide: whose
    choice is it?. Journal of Medical Ethics, 28(5), 303-307.
    Cranston, R.E. (2001, December14). Advance directives and “Do Not Resuscitate” orders.Retrieved June 24, 2005, from
    http://www.cbhd.org/resources/endoflife/cranston_2001-12-14_print.htm
    Dawe, U.,Verhoef, M.J., & Page, S.A.(2002).Treatment refusal:the beliefs and
    experiences of Alberta nurses.International Journal of Nursing Studies,39,71-77.
    Dickinson, G.E., & Mermann, A.C.(1996). Death education in U.S. medical schools,
    1975-1995. Academic Medicine: Journal of The Association of American Medical
    Colleges, 71(12),1348-1349.
    Dunn, K.S.,Otten, C., & Stephens,E.(2005).Nursing experience and care of dying
    patients.Oncology Nursing Forum ,32(1),97-104.
    Ferrand, E., Rober, R., Ingrand, P.,& Lemaire, F.(2001).Withholding and withdrawal of
    life support in intensive-care units in France: a prospective survey. The Lancet, 357,
    9-14.
    Field, D., & Kitson, C. (1986). Formal teaching about death and dying in UK nursing
    schools.Nurse Education Today, 6(6),270-276.
    Iammarino, L.(1975).Relationship between death anxiety and demographic variables.
    Psychological Reports,37, 362.
    Kao, S.F.,& Lusk, B.(1997).Attitudes of Asian and American graduate Nursing students towards death and dying.International Nursing of study , 34(6), 438-443.
    Keck, V.E.,& Walther, L.S.(1977).Nurse encounters with dying and nondrying patients. Nursing Research, 26(6),465-469.
    Lester, D.(1967).Experimental and correlational studies of the fear of death.
    Psychological Bulletin , 67(1),27-36.
    Lev, E. (1986).Teaching humane care for dying patients.Nursing Outlook,34(5),241-243.
    Lee, T.T., Lee, T.Y., Lin, K.C.,& Chang, P.C. (2005).Factors affecting the use of nursing
    information systems in Taiwan. Journal of Advanced Nursing,50(2), 170–178.
    Looda,L.A.,Clements,R.,& Jordan,M.L.(1999).Nurses’ attitudes toward death and caring for dying patients.Oncology Nursing Forum,26(10),1683-1687.
    Norton, S.,& Bowers, B.(2001).Working toward consensus: providers' strategies to shift
    patients from curative to palliative treatment choices. Research In Nursing & Health,24(4),258-269.
    Phillips, R.S., Wenger, N.S., Teno, J., Oye, R.K., Youngner, S., Califf, R. et al.(1996)
    Choices of seriously ill patients about cardiopulmonary resuscitation: correlates and
    outcomes. SUPPORT Investigators. Study to understand prognoses and preferences
    for outcomes and risks of treatments. The American Journal of Medicine, 100
    (2),128-137.
    Printz, L.A. (1992).Terminal dehydration, a compassionate treatment. Archives of Internal Medicine,152(4),697-700.
    Stoller, E.P.(1980).Effect of experience on nurses’ responses to dying and death in the
    hospital setting. Nursing Research, 29(1),35-38.
    Steinhauser, K.E., Clipp, E.C., McNeilly, M., Christakis, N.A.,Mclntyrc, L.M.,& Tulsky,
    J.A.(2000).In search of a good death observations of patients families and providers.
    Annals of Internal Medicine, 132 (10),825-832.
    Templer, D.I.(1970).The construction and validation of a death anxiety scale.The Journal of General Psychology, 82,165-177.
    Templer, D.I.(1972).Death anxiety in religiously very involved persons. Psychological
    Reports, 31(2),361-362.
    Thorns, A.R.,& Ellershaw, J.E. (1999).A survey of nursing and medical staff views on the use of cardiopulmonary resuscitation in the hospice. Palliative Medicine, 13(3),
    225-232.
    Tomlinson, T.,& Brody, H.(1998).Ethics and communication in DNR orders.New
    England Journal of Medicine, 318,43-46.
    Wong, P.T.P., Reker, G.T.,& Gesser, G.(1994).Death attitude profile-revised:A
    mutidimensional measure of attitudes toward death. In Neimeyer, R.A.(Ed.),Death
    anxiety handbook: Research, instrumentation and application (pp.121-148).
    口試委員
  • 陳世哲博士 - 召集委員
  • 李英俊博士 - 委員
  • 葉淑娟 博士 - 指導教授
  • 口試日期 2009-06-13 繳交日期 2009-08-27

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