進階搜尋


  查詢北醫館藏
系統識別號 U0007-2607200913284000
論文名稱(中文) 探討某醫學中心新生兒加護病房之臨終照護
論文名稱(英文) The Dying Care in a Neonatal Intensive Care Unit of Medical Center
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 97
學期 2
出版年 98
研究生(中文) 張育菁
研究生(英文) Yu-Ching, Chang
學號 M406094015
學位類別 碩士
語文別 中文
口試日期 2009-07-22
論文頁數 102頁
口試委員 指導教授-張碧真
委員-胡文郁
委員-高碧霞
中文關鍵字 新生兒  臨終照護  舒適藥物  不施行心肺復甦術  家庭會議 
英文關鍵字 Neonate  Dying care  Comfort medication  DNR  Family conference 
學科別分類
中文摘要 新生兒死亡至今仍是1歲以下兒童死亡的主要族群,但文獻中顯出,新生兒的臨終照護至今仍遠落後於成人及兒童,因此,開始有研究探討面臨新生兒臨終照護所面臨的問題,但在各國不同文化差異下而造成不一致的結果,而本國目前仍未有類似研究。所以,本研究目的在瞭解新生兒加護病房內死亡個案之臨終照護的品質。
本研究採回溯性病歷回顧的研究設計,以立意取樣選取192位死亡新生兒為研究對象。以自擬式的研究調查表為研究工具,至病歷室進行資料的收集。
研究結果發現,(1)瀕死新生兒給予舒適藥物的情況為,佔12%在死亡前曾給予止痛藥物,佔13.6%的個案只使用鎮靜藥未合併使用止痛藥。(2)新生兒家屬簽署DNR的比率為67.2%,簽署距離死亡的時間由<1小時至80天(median=8.2 hr),高達86%的家屬在簽署DNR時其新生兒的疾病嚴重度分類(NTISS)為重度以上(>21分),在簽署前新生兒曾接受胸外按壓的比率高達72.1%,在簽署DNR後仍有5.4%的新生兒接受胸外按壓。(3)新生兒家屬參與家庭會議的比率為13.5%,當出生天數越大時其舉辦家庭會議的比率越高,而在舉辦前新生兒曾接受胸外按壓的比率為57.7%,佔65.3%舉辦家庭會議時其新生兒的疾病嚴重度分類(NTISS)為重度以上(>21分)。
本研究探討臨床新生兒執行臨終照護的基本描述,希望本研究結果可作為發展新生兒安寧療護的參考。
英文摘要 Neonatal mortality still represents the largest percentage of overall infant mortality, but several studies show the neonatal end-of-life care to fall behind the adults and children, and the different culture backgrounds may have an influence on the end-of-life care, therefore, this study aimed to discuss the process of dying care in the neonatal intensive care unit in Taiwan.
The design of this study is retrospective, purposive sampling was used to select 192 cases that die in the neonatal intensive care unit. The date collection tools included A self-structured questionnaire and NTISS (Neonatal Therapeutic Intervention Scoring System).
The results of this study were as below: 1.) The situation of dying neonate received comfort medication, 12% had received analgesics and 13.6% had only received sedatives without analgesics. 2.) 67.2% family of newborn decided to signed “Do not Resuscitate (DNR)”. The median time of decision made till death is 8.2 hours (range, 1 hour ~ 80 days). 86% newborns had high NTISS scores (> 21) while DNR decision was made. 72.1% newborns had received cardiopulmonary resuscitation before the DNR decision was made, yet still 5.4% newborn received cardiopulmonary resuscitation after the DNR decision was made. 3.) 13.5% family of neonatal attended the family conference. More conferences would be held if the patient was older. 57.7% newborn had received cardiopulmonary resuscitation before the conference, and 65.3% newborn had high NTISS scores(>21) while the conference was held.
This study describes the basic situations while medical care members implement dying care in newborn. The results may provide some usefully experiences in the hospice care of newborn.

論文目次 目錄
致謝………………………………………………………………………Ⅰ
中文摘要…………………………………………………………………Ⅱ
英文摘要…………………………………………………………………Ⅳ
目錄………………………………………………………………………Ⅵ
圖表目次…………………………………………………………………Ⅸ

第一章 緒論…………………………………………………………1
第一節 研究動機與重要性……………………….…………………1
第二節 研究目的…………………………………….………………4
第三節 研究問題…………………………………….………………4
第四節 名詞界定……………………………………….……………5
第二章 文獻查證………………………………...……….………7
第一節 新生兒加護病房的臨終照護……………………….………7
第二節 舒適藥物的給予…………………………….……..10
第三節 新生兒生命末期的醫療決策………………….……..14
第四節 DNR的運用……………………………………………….17
第五節 「溝通」於臨終照護的重要性.……………….…………27
第三章 研究方法………………………………………………….39
第一節 研究設計…………………………………..………………39
第二節 研究對象………………………………………………..…39
第三節 研究工具……………………………………….……….…39
第四節 研究過程………………………………………….....…41
第五節 研究倫理考量………………………………………..……42
第六節 資料統計分析方法…………………………....……..42
第四章 分析與結果……………………………………………….43
第一節 研究對象基本屬性…………………………………………43
第二節 新生兒加護病房中新生兒在死亡前使用促進舒適
藥物的現況……………………………………………….48
第三節 新生兒加護病房中死亡新生兒運用DNR的現況….……50
第四節 新生兒加護病房中死亡新生兒舉辦家庭會議的現況……59
第五章 討論及建議………………………………………..……62
第一節 死亡新生兒使用促進舒適藥物情形……………………..62
第二節 死亡新生兒運用DNR的情形……………………………..65
第三節 死亡新生兒舉辦家庭會議的情形………………………..71
第四節 研究限制……………………………………………………74
第五節 建議…………………………………………………………75

參考資料…………………………………………………………………78
中文部分……………………………………………………………78
英文部分……………………………………………………………81
附錄………………………………………………………………………96
附錄一 研究調查表………………………………………………96
附錄二 專家效度分數及問卷修改………………………………99
附錄三 疾病嚴重度調查表………………………………………106
附錄四 研究倫理委員會同意書…………………………………108


圖表目次
圖一 診斷長條圖………………………………………………….47
表一 新生兒使用限制醫療的相關研究………………………………16
表二 新生兒及兒童使用DNR的相關研究…………………………..24
表三 舉辦家庭會議的研究……………………………………………30
表四 研究對象基本屬性………………………………………………45
表五 新生兒父親及母親的教育程度…………………………………46
表六 死亡新生兒給予促進舒適的藥物………………………………49
表七 新生兒加護病房於2000-2008年間簽署DNR的比率…………53
表八 簽署DNR與基本資料間之分析…………………………………54.
表九 簽署DNR與基本資料間之分析(續)……………………………55
表十 簽署DNR個案的疾病嚴重度分數………………………………56
表十一 每年間執行DNR前接受胸外按壓的比率……………………57
表十二 簽署DNR至死亡的時間………………………………………58
表十三 新生兒加護病房於2000-2008年間舉辦「家庭會議」的比率.60
表十四 舉辦家庭會議的時機…………………………………………61
參考文獻 參考資料
中文部分:
王志嘉、楊奕華、邱泰源、羅慶徽、陳昇平(2003)•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」•台灣家庭醫學雜誌,13•101-108。
立法院(1986,12月26日)•醫師法第二十一條條文•2008年9月16日取自http://npl.ly.gov.tw/do/forward?dest=www.billVolumn Content&url=http://lis.ly.gov.tw/lghtml/lawstat/html/0250800.htm
立法院(1986,11月24日)•醫療法第六十條條文•2008年9月16日取自http://npl.ly.gov.tw/do/forward?dest=www.billVolumn Content&url=http://lis.ly.gov.tw/lghtml/lawstat/html/0253300.htm
立法院(1991,5月17日)•護理人員法第二十六條條文•2008年9月16日取自http://npl.ly.gov.tw/do/forward?dest=www.billVolumn Content&url=http://lis.ly.gov.tw/lghtml/lawstat/html/0254200.htm
立法院(2000,11月22日)•修正安寧緩和醫療條例第三條及第七條條文•2007年6月7日取自http://www.ly.gov.tw/
立法院(2002,11月22日)•安寧緩和醫療條例條文•2007年6月7日取自http://www.ly.gov.tw/
行政院衛生署(2008)•藥物資訊網•2009年7月14日取自http://203.65.100.151/DO8180T.asp?Type=Lic&LicId=02019456
行政院衛生署(2006,6月17日)•民國97年度死因統計記者會發布資料•2009年7月14日取自http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10642&class_no=440&level_no=3
姚建安、邱泰源、胡文郁、陳慶餘(2004)•國內外安寧緩和醫學教育之現況•安寧療護,9(1),28-43。
倫委會(2007,9月28日)•新生兒及兒童照護倫理•2009年7月8日取自http://www.mc.ntu.edu.tw/tcen/7-1-2.pcm/
陳健文、蕭學誠、林明慧、吳彬源、陳振文、黃信彰等人(1993)•家庭會議在安病房的實行情形•台灣家庭醫學雜誌,(1)•31-39。
許煌汶(2008)•家庭會議概觀•安寧療護雜誌,13(1)•58-65。
詹美珠、李淑秋、胡瑞桃(2005)•加護病房護理人員對DNR的態度及其照顧病患相關因素探討•安寧療護雜誌,10(3)•272-285。
陳榮基(2004)•安寧緩和醫療條例的實施與困境•台灣醫誌,8(5)•684-687。
陳榮基(2008)•以拒絕臨終急救預約善終•台灣醫學會雜誌,12(4)•470-472。
黃錦鳳(2007)•加護病房重症病人簽署不予急救同意書對醫療處置之影響• 未發表之碩士論文,台北:台北醫學大學。
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)•台灣癌症末期病人對善終意義的體認•護理雜誌,44(1),48-55。
趙可式(2007)•安寧伴行•台北:天下遠見。
趙可式(2009)•台灣安寧療護的發展與前瞻•護理雜誌,56(1),5-10。
蔡翊新、林亞陵、黃勝堅(2007)•重症病患之生命末期照護•安寧療護雜誌,12(3),312-320。
賴維淑、楊婉萍、趙可式•安寧療護的教育-護生、一般護理人員及專科護理師•護理雜誌,56(1),11-16。
鄒海月、王守容、何裕芬(1999)•癌症末期病患對家屬不急救之態度及其相關因素•榮總護理,16(4),344-356。
顏慧芳、邱麗文(2005)•急重症醫護人員的疼痛處理知識與態度及其相關因素•實證護理,1(4),292-301。






英文部分:
Ahrens, T., Yancey, V., & Kollef, M. (2003). Improving family communication at the end of life: Implications for length of stay in intensive care unit and resource use. American Journal of Critical Care, 12(4), 317-324.
Althabe, M., Cardigi, G., Vassallo, J. C., Allende, D., Berryeta, M., & Codermatz, M. (2003). Dying in the intensive care unit: Collaborative multicenter study about forgoing life-sustaining treatment in argentine pediatric intensive care unit. Pediatric Critical Care Medicine, 4(2), 164-168.
American Academy of Pediatrics. (2000). Palliative care for children. Pediatrics, 106, 351-356.
American Heart Association. (2005). Statements and Practice Guidelines. Retrieved February 1, 2009, from the World Web: http://www.americanheart.org/presenter.jhtml?identifier=3003999
American Medical Association. (1991). Guidelines for the appropriate use of do-not-resuscitate orders. The Journal of American Medical Association, 14, 1868-1871.
American Medical Association. Healthy and ethics policies of the AMA house of delegates. Retrieved February 20, 2009, from the World Web: http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf
Arlettaz, R., Mieth, D., Bucher, H. U., Duc, G., Faucher, J. C. (2005). End-of-life decisions in delivery room and neonatal intensive care unit. Acta Paediatrica, 94, 1626-1631.
Azoulay, E., Chevret, S., Leleu, G., Pochard, F., Borboteu, M., Adrie, C., et al. (2000). Half the families of intensive care unit patients experience inadequate communication with physicians. Critical Care Medicine, 28(8), 3044-3049.
Azoulay, E., & Sprung, C. L. (2004). Family-physician interaction in the intensive care unit. Critical Care Medicine, 32(11), 2323-2328.
Barker, D. P., & Rutter, N. (1995). Exposure to invasive procedures in neonatal intensive care unit admissions. Archives of Disease in Childhood Fetal and Neonatal Edition, 72(1), 47F-48F.
Bell, S. G. (2004). The pharmacology of palliative care. Neonatal Network, 23(6), 61-64.
Berner, M. E., Rimensberger, P. C., Huppi, P. S., Pfister, R. E. (2006). National ethical directives and practical aspects of forgoing life-sustaining treatment in newborn infants in a swiss intensive care unit. Swiss Medical Weekly, 136, 597-602.
Berger, T. M., & Hofer, A. (2009). Causes and circumstances of neonatal deaths in 108 consecutive cases over a 10-year period at the children’s hospital of Lucerne, Switzerland. Neonatology, 95, 157-163.
Boyle, D. K., Miller, P. G., & Forbes-Thompson, S. A. (2005). Communication and end-of-life care in the intensive care unit. Critical Care Nursing Quarterly, 28(4), 302-316.
Breen, C. M., Abernethy, A. P., Abbott, K. H., & Tulsky, J. A. (2001). Conflict association with decisions to limit life-sustaining treatment in intensive care units. Journal of General Internal Medicine, 16(5), 283-289.
Burns, J. F., Mello, M. M., Studdert, D. M., Puopolo, A. N., Truog, R. D., & Brennan, T. A. (2003). Results of a clinical trial on care improvement for critical ill. Critical Care Medicine, 31(8), 2107-2117.
Bushinski, R. L., & Cummings, K. M. (2007). Practices of effective end-of-life communication between nurses and patients/families in two care settings. Creative Nursing, 3, 9-12.
Campbell, M. L., & Guzman, J. A. (2004). A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Critical Care Medicine. 32(9), 1839-43, 20.
Cantor, M. D., Braddock, C. H., Derse, A. R., Edwards, D. M., Logue, G. L., Nelson, W., et al., (2003). Do-not-resuscitate orders and medical futility. Archives of Internal Medicine, 163, 2689-2694.
Carter, B. S. (2004). Comfort care principles for the high risk newborn. NeoReview, 5(11), e484-e490.
Carter, B. S., & Bhatia, J. (2001). Comfort/palliative care guidelines for neonatal practice: Development implementation in an academy medical center. Journal of Perinatology, 21, 279-283.
Carter, B. S., Howenstein, M., Gilmer, M. J., Throop, P., France, D., & Whitlock, J. A. (2004). Circumstances surrounding the deaths of hospitalized children: Opportunities for pediatric palliative care. Pediatrics, 114(3), e361-e366.
Catlin, A., Armigo, C., Volat, D., Valle, E., Hadley, M. A., Gong, W., Bassir, R., & Anderson, K. (2008). Conscientious objection: A potential neonatal nursing response to care orders that cause suffering at the end of life? Study of a concept. Neonatal Network, 27(2), 101-108.
Craig, F., & Goldman, A. (2003). Home management of the dying NICU patient. Seminars in Neonatology, 8, 177-183.
Curtis, J. R., & Engelberg, R. A. (2006). Measuring success of interventions to improve the quality of end-of-life care in the intensive care unit. Critical Care Medicine, 34(11), S341-S347.
Curtis, J. R., Patrick, D. L., Shannon, S. E., Treece, P. D., Engelberg, R. A., & Rubenfeld, G. D.(2001). The family conference as a focus to improve communication about end-of-life care in the intensive care unit: Opportunities for improvement. Critical Care Medicine 29(2), Suppl. N26-N33.
Curtis, J. R., Engelberg, R. A., Wenrich, M. D., Nielsen, E. L., Shannon, P. D., Treece, P. D., et al. (2002). Studying communication about end-of-life care during the ICU family conference: Development of a framework. Journal of Critical Care, 17, 147-160.
Curtis, J. R., Engelberg, R. A., Wenrich, M. D., Shannon, P. D., Treece, P. D., & Rubenfeld, G. D. (2005). Missed opportunities during family conferences about end-of-life care in the intensive care unit. American Journal of Respiratory and critical care medicine, 171, 844-849.
Curtis, J. R. Wenrich, M. D., Carline, J. D., Shannon, S. E., Ambrozy, D. M., & Ramsey, P. G. (2001). Understanding physicians’ skills at providing end-of-life care Perspectives of patients, families, and health care workers. Journal of General Internal Medicine, 16(1), 41-49.
Curtis, J. R., & White, D. B. (2008). Pratical guidance for evidence-based ICU family conferences. Chest, 134(4), 835-843.
Da Costa, D. E., Ghazal, H., & Khusaiby, S. A. (2002). Do not resuscitate orders and ethical decisions in a neonatal intensive care unit in a Muslim community. Archives of Disease in Childhood Fetal & Neonatal Edition, 86(2), 115-119.
Dowdy, M. D., Robertson, C., & Bander, J. A. (1998). A study of proactive ethics consultation for critical and terminally ill patients with extended lengths of stay. Critical Care Medicine, 26(2), 252-259.
Duff, R. S., & Campbell, A. G. (1973). Moral and ethical dilemmas in the special-care nursery. New England Journal of Medicine, 289(17), 890-894.
Engelberg, R. (2006). Measuring the quality of dying and death: Methodological considerations and recent findings. Current Opinion in Critical Care, 12, 381-387.
Faber-Langendoen, K., & Lanken, P. N. (2000). Dying patients in the intensive care unit: Forgoing treatment, Maintaining care. Annals of Internal Medicine, 133, 886-893.
Feudtner, C. (2004). Perspective on quality at end of life. Archives of Pediatrics and Adolescent Medicine, 158, 415-417.
Franck, L. S. (2001). A pain in the act: Musings on the meaning for critical care nurse of the pain management standards of the joint commission on accreditation of healthy care organization. Critical Care Nurse, 21(3), 8-16.
Furman, C. D., Head, B., Lazor, B., Casper, B., & Ritchie, C. S. (2006). Evaluation of an educational intervention to encourage advance directive discussion between medicine resident and patients. Journal of Palliative Medicine, 9(4), 964-967.
Garros, D. (2003). A good death in a pediatric ICU? Is it possible? Journal De Pediatria, 79(2), S243-S254.
Ger, L. P., Lee, M. C., Wong, C. S., Chao, S . S., Wang, J. J., & Ho, S. T. (2003). The effect of education and clinical practice on knowledge enlightenment to and attitudes toward the use of analgesics for cancer pain among physicians and medical students. Acta Anaesthesiologica Taiwanica, 41(3), 105-114.
Gray, J. E., Richardson, D. K., McConmick, M. C., Workman-Daniels, K., & Goldman, D. A. (1992). Neonatal therapeutic intervention scoring system: A therapy based severity-of-illness index. Pediatrics, 90, 561-567.
Gries, C. J., Curtis, J. R., Wall, R. J., & Englberg, R. A. (2008). Family member satisfaction with end-of-life decision making. Chest, 15, 1-31.
Hakim, R. B., Teno, J. M., Harrell, F. E., Knaus, W. A., Wenger, N., Phillips, R. S., et al. (1996). Factors associated with do-not-resuscitate orders: Patients' preferences, prognoses, and physicians' judgments. SUPPORT Investigators. Annals of Internal Medicine, 125(4), 284-293.
Hall, R. J., & Rocker, G, M. (2000). End of life care in the ICU treatments provided when life support was or not withdrawn. Chest, 118, 1424-1430.
Hall, R. J., & Rocker, G, M. (2004). Simple changes can improve conduct of end-of-life care in the intensive care unit. Canadian journal of anaesthesia, 51(6), 631-636.
Hansen, P., Cornish, C., & Kayser, K. (1998) Family conference as forum for decision making in hospital setting. Social Work in Healthy Care, 27(3), 57-74.
Haverkate, L., an Delden, J. J., an Nijen, A. B., & an der Wal G. (2000). Guidelines for the use of do-not-resuscitate orders in Dutch hospitals. Critical Care Medicine, 28(8), 3039-3043.
Hentschel, R., Lindner, K., Krueger, M., & Reiter-Theil. (2006). Restriction of ongoing intensive care in neonates: A prospective study. Pediatrics, 118(2), 563-569.
Hilden, H. M., Louhiala, P., Honkasalo, M. L., & Palo, J. (2004). Finnish nurses’ views on end-of-life discussions and a comparison with physicians’ views. Nursing Ethics, 11(2), 165-178.
Horbar, J. D., Badger, G. J., Carpenter, J. H., Fanaroff, A. A., Kilpatrick, S., LaCorte, M., et al. (2002). Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics, 110(1), 143-151.
Hsieh, W. S., Jeng, S. F., Hung, Y. L., Chen, P. C., Chou, H. C., & Tsao, P. N. (2005). Outcome and hospital cost for infants weighing less than 500 grams: A tertiary centre experience in Taiwan. Journal of Paediatrics & Child Health. 43(9):627-631.
Jaing, T. H., Tsay, P. K., Yang, S. H., Chen, S. H., Yang, C. P., & Hung, L. J. (2007). “Do-not-resuscitate” orders in patients with cancer at a children’s hospital in Taiwan. Journal of Medical Ethics, 33(4), 194-196.
Kostelanetz, A. S., & Dhanireddy, R. (2004). Survival of the very-low-birth-weight infants after cardiopulmonary resuscitation in neonatal intensive care unit. Journal of Perinatology, 24(5), 279-283.
Kouwenhoven, W. B., Jude, J. R., & Knickerbocker, G. G. (1960). Closed-chest cardiac massage. Journal of American Medical Association, 173, 94-97.
Lai, Y. H., Dalton, J. A., Belyea, M., Chen, M. L., Tsai, L. Y., & Chen, S. C. (2003). Develompent and testing of pain opioid analgesics beliefs scale in Taiwanese cancer patients. Journal of pain and symptom management, 25(4), 376-385.
Leuthner, S. T., & Pierucci, R. P. (2001). Experience with neonatal palliative care consultation at the medical college of Wisconsin-children’s hospital of Wisconsin. Journal of Palliative Medicine, 4(1), 39-47.
Lilly, C. M., De Mon, D. L., Sonna, L. A., Haley, K. J., Massaro, A. F., Wallace, R. F., et al. (2000). An intensive communication intervention for the critical ill. The American Journal of Medicine, 109, 469-475.
Limerick, M. H. (2007). The process used by surrogate decision makers to withhold and withdraw life sustaining measures in an intensive care environment. Oncology Nursing Forum, 34, 331-339.
Lo, B., & Steinbrook, R. (2004). Resuscitating advanced directives. Archives of Internal Medicine, 164, 1501-1506.
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 34, 382-385.
Mack, J. W., & Wolfe, J. (2006). Early integration of pediatric palliative care: For some children palliative care starts at diagnosis. Current Opinion in Pediatrics, 18, 10-14.
Matthews, A. L., & O’Conner-Von, S. (2008). Administration of comfort medication at end of life in neonates: Effects of weights. Neonatal Network, 27(4), 223-227.
McCaffery, M., & Ferrell, B. R. (1994). Nurse’s assessment of pain intensity and choice of analgesics dose. Contemporary Nurse, 3(2), 68-74.
McCallum, D. E., Byrne, P., & Bruera, E. (2000). How children die in hospital. Journal of Pain & Symptom Management, 20(6), 417-423.
McHaffie, H. E., Cuttini, M. Brolz-Voit, G., Randag, L., Mousty, R., Duguet, A. M., et al. (1999). Withholding/withdrawing treatment from neonates: legislation and official guidelines across Europe. Journal of Medical Ethics, 25, 440-446.
Medical staff conference. (1987). California’s Natural Death Act. Western Journal of Medicine, 128(4), 318-328.
Meert, K. L., Thuraton, C. S., & Sarnaik, A. P. (2000). End-of-life decision-making and satisfaction with care: Parental perspectives. Pediatric Critical Care Medicine, 1(2), 179-185.
Miller, J. J., Marlene, H., Rummans, T. A., Huschka, M., Atherton, P., Brown, P., et al., (2007). Role of a medical social worker in improving quality of life for patients with advanced cancer with a structured multidisciplinary intervention. Journal of Psychosocial Oncology, 25(4), 105-119.
Moro, T., Kavanaugh, K., Jones, S. O., & Vankleef, J. A. (2006). Neonatal end-of-life care a review of the research literature. The Journal of Perinatal and Neonatal Nursing, 20(3), 262-273.
Nieswiadomy, R. M. (2008). Foundation of Nursing Research. Upper Saddle River, NJ: Pearson.
Oh, D. Y., Kim, J. H., Kim, D. W., Jim, S. A., Kim, T. Y., & Heo, D. S. (2006). CPR or DNR? End-of-life decision in Korean cancer patients: A single center’s experience. Support cancer care, 14, 103-108.
O’Mara, M. S., Chapyak, D., Greenhalgh. D. G., & Palmieri, T. L. (2006). End of life in the pediatric burn patient. Journal of Burn Care & Research, 11, 803-808.
Partridge, J. C., & Wall, S. N. (1997). Analgesia for dying infants whose life support is withdrawn or withheld. Pediatrics, 99(1), 76-79.
Pierucci, R. L., Kirby, R. S., & Leuthner, S. R. (2001). End-of-life care for neonates and infants: The experience and effects of a palliative care consultation service. Pediatric, 108(3), 653-660.
Pochard, F., Azoulay, E., Chevret, S., Lemaire, L., Hubert, P., Canoui, P., et al. (2001). Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision making capacity. Critical Care Medicine, 29(10), 1893-1897.
Poirier, S., & Brauner, D. J. (1990). The voice of the medical record. Theoretical Medicine, 11, 29-39.
Provoost, V., Cools, F., Deconinck, P., Ramet, J., Deschepper, R., Bilsen, J., et al. (2006). Consultation of parents in actual end-of-life decision-making in neonates and infants. European Journal of Pediatrics, 165, 859-866.
Provoost, V., Deliens, L., Cools, F., Deconinck, P. G., Ramet, J., & Mortier, F., et al. (2004). A classification of end-of-life decisions in neonatal and infants. Acta Paediatrica, 93(3), 301-305.
Provoost, V., Mortier, F., Bilsen, J., Ramet, J., Vandenplas, Y., & Deliens, L. (2005). Medical end-of-life decisions in neonates and infants in Flanders. Lancet, 365, 1315-1320.
Randolph, A, G., Zollo, M, B., Egger, M. J., Guyatt, G. H., Nelson, R. M., & Stidham, G. L. (1999). Variability in physician opinion on limiting pediatric life support. Pediatrics, 103(4), 46.
Reempts, P. J., & Acker, K. V. (2001). Ethical aspects of cardiopulmonary resuscitation in premature neonate: Where do we stand? Resuscitation, 51(3), 225-232.
Romesberg, T. L. (2007). Building a case for neonatal palliative care. Neonatal Network, 26(2), 111-115.
Roy, R., Aladangady, N., Costeloe, K., & Larcher, V. (2004). Decision making and modes of death in a tertiary neonatal unit. Archives of Disease in Childhood, 89, 527-530.
Rummans, T. A., Clark, M. M., Sloan, J. A., Frost, M. H., Bostwick, J. M., Atherton, P. J., et al., (2006). Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: A randomized controlled trial. Journal of Clinical Oncology, 24(4), 635-642.
Schneiderman, L. J., Gilmer, T., Teetzel, H. D., Dugan, D. O., Blustein, J., Cranford, R., et al. (2003). Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: A randomized controlled trial. The Journal of American Medical Association, 290(9), 1162-1172.
Schulz-Baldes, A., Huseman, D., Loui, A., Dudenhausen, J. W., & Obladen, M. (2007). Neonatal end-of-life practices in a German perinatal centre. Acta Pediatrica, 96, 681-687.
Sharman, M., Meert, K. L., & Sarnaik, A. P. (2005). What influences parent’s decisions to limit or withdraw life support? Pediatric Critical Care Medicine, 6(5), 513-518.
Singer, P. A., Barker, G., Bowman, K. W., Harrison, C., Kernerma, P., & Kopelow, J., et al. (2001). Hospital policy on appropriate use of life-sustaining treatment. Critical Care Medicine, 29(1), 187-191.
Singh, J., Lantos, J., & Meadow, W. (2004). End-of-life after birth: Death and dying in a neonatal intensive care unit. Pediatrics, 114(6), 1620-1626.
SOUPPORT. (1995). A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The Journal of American Medical Association, 274(20), 1591-1598.
Spence, K. (2000). The best interest principle as a standard for decision making in the care of neonatal. Journal of Advanced Nursing, 31(6), 1286-1297.
Stapleton, R. D., Engelberg, R. A., Wenrich, M. D., Engelberg, R. A., Wenrich, M. D., Goss, C. H., et al. (2006). Clinician statements and family satisfaction with family conference in the intensive care unit. Critical Care Medicine, 34(6),1679-1685.
Steinhauser, K. E., Christakis, N. A., Clipp, E. C., McNeilly, M., McIntyre, L., & Tulsky, J. A. (2000). Factor considered important at the end of life by patient, family, physicians, and other care providers. The Journal of American Medical Association, 284(19), 2476-2482.
Stinger, M., Shaw, V. D., & Savani, R. C. (2004). Comfort care at neonates at the end of life. Neonatal Network, 23(5), 41-46.
Teno, J. M., Fisher, E., Hamel, M. B., Wu, A. W., Murphy, D. J., Wenger, N. S., et al. (2000). Decision-making and outcomes of prolonged ICU stays in seriously ill patients. Journal of the American Geriatrics Society, 48(5) Suppl. S70-S74.
Thibault, J., Jensen, L. A., & Hodgins, M. (2000). Critical care nurses’ perceptions of DNR status. Journal of Nursing Scholarship, 32(3), 259-265.
Tonelli, H. A. F., Mota, J. A. C., & Oliveira, J. S. (2005). A profile of the medical conduct preceding child death at a tertiary hospital. Journal de Pediatric, 81(2), 118-125.
Truog, R. D., Cist, F. M., Brackett, S. E., Burns, J. P., Curley, M. A., Danis, M., et al. (2001). Recommendations for end-of-life care in the intensive care unit: The ethics committee of the society of critical care medicine. Critical Care Medicine, 29(12), 2332-2348.
Tsao, P. N., Teng, R. J., Wu, T. J., Tang, J. R., Yau, K. I. (1998). Early outcome of extremely low birth weight infants in Taiwan. Journal of Formosan Medical Association, 97(7), 471-476.
Verhagen, A., Spilkerman, J., Muskiet, F., & Sauer, P. (2007). Physician end-of-life decision-making in newborns in a less developed health care setting insight in considerations and implementation. Acta Pediatrica, 96, 1437-1440.
Verhagen, A. A. E., Dorscheidt, J. H. H. M., Engels, B. Hubben, J. H., & Sauer, P. (2009). Analgesics, Sedatives and neuromuscular blockers as part of end-of-life decision in Dutch NICU’s. Archives of Disease in Childhood Fetal & Neonatal Edition, Jul, 1-15.
Walden, M., Sudia-Robinson, T., & Carrier, C. T. (2001). Comfort care for infants in the neonatal intensive care unit at the end of life. Newborn and Infant Nursing Reviews, 1(2), 97-105.
Walther, F. J. (2005). Withholding treatment, Withdrawing treatment, and palliative care in the neonatal intensive care unit. Early Human Development, 81, 965-972.
Wall, S., & Partriage, J. C. (1997). Death in the intensive care nursery: Physician practice of withdrawing and withholding life support. Pediatrics, 99(1), 64-70.
Welch, S. B. (2008). Can death of the child be good. Journal of Pediatric Nursing, 23(2). 120-125.
Winzelberg, G. S., Hanson, C. C., & Tulsky, J. A. (2005). Beyond autonomy: Diversifying end-of-life decision-making approaches to serve patients and families. American Geriatrics Society, 53, 1046-1050.
White, D. B., Braddock, C. H., Bereknye, S., & Curtis, J. R.(2007). Toward shared decision making at the end of life in intensive care units. Archives of Internal Medicine, 167, 461-467.
Whitfield, J. M., Siegel, R. E., Glicken, A. D., Harmon, R. J., Powers, L. K., & Goldson, E. J. (1982). The application of hospice concepts to neonatal care. American Journal of Diseases of Children,136(5), 421-424.
Wong, M., & Lam, B. (2004). End of life decision and care in neonatal care unit. Hong Kong Journal of Paediatric, 9, 138-143.
World health organization. (1998). Palliative care for children. Retrieved February 18, 2009,from the World Web: http://www.who.int/cancer/palliative/definition/en/
Yellin, P., Levin, B., Krantz, D., Shinn, M., Driscoll, J., & Fleischman, A. (1998). Neonatologists’ decisions about withholding and withdrawing treatments from critical ill newborns. Pediatrics, 102, S757.
論文全文使用權限
  • 同意授權瀏覽/列印電子全文服務,於2010-08-18起公開。


  • 若您有任何疑問,請與我們聯絡!
    臺北醫學大學 圖書館 李秀珍
    E-mail:hsiujen@tmu.edu.tw
    Tel:(02) 2736-1661 ext.2513
    Fax:(02) 2737-5446