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系統識別號 U0007-2701201111133000
論文名稱(中文) 簽署不予施行心肺復甦術癌症病人照顧者家屬的 感受與其相關因素之探討
論文名稱(英文) Exploring Family Caregivers’ Experience and Associated Factors While They Consented to “Do Not Resuscitate” for Cancer Patients
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 99
學期 1
出版年 100
研究生(中文) 曲幗敏
研究生(英文) Kuo-Min Chu
學號 G455095001
學位類別 碩士
語文別 中文
口試日期 2011-01-17
論文頁數 143頁
口試委員 指導教授-廖媛美
委員-林佳靜
委員-林寬佳
中文關鍵字 不予施行心肺復甦術  癌症病人  照顧者家屬 
英文關鍵字 Do Not Resuscitate  cancer patients  family caregivers 
學科別分類
中文摘要 中 文 摘 要
當急救的效益遠不如不予急救時,臨床上越來越多的癌症病人家屬傾向簽署不予施行心肺復甦術(Do Not Resuscitate, DNR),研究顯示80%之DNR是由家屬簽署的,但是相關於家屬簽署DNR時之感受的文獻卻很有限。好的臨終照顧除了包含病人本身之照顧之外,亦須含括照顧者家屬的照顧。因此瞭解此類家屬之感受,將有助於醫護人員提供符合此類癌症病人家屬所需之照護服務,進而促進此類病人及其家屬之身、心、靈安適。
本研究為描述性、相關性研究,採橫斷式研究法,探討簽署不予施行心肺復甦術癌症病人照顧者家屬的感受及其相關因素與預測因子。本研究邀請80位簽署DNR之癌症病人照顧者家屬參與,以結構性問卷為研究工具,問卷內容包含:病人及家屬之屬性、家屬照顧情境、臺灣版安德森症狀量表、中文版家屬情緒狀態量表、簡短評估照顧者量表與自擬簽署DNR相關感受之八個題目。資料分析方式,包括:描述性統計、獨立t檢定、單因子變異數分析、皮爾森積差相關與階層式迴歸分析。
本研究採用簡短評估照顧者量表與自擬之簽署DNR相關感受量表測量簽署DNR癌症病人照顧者家屬之感受。研究結果顯示:與簡短評估照顧者量表有關的變項是家屬情緒狀態;與自擬之簽署DNR相關感受有關的變項,包括:病人之年齡、家屬之年齡、教育程度、是否與病人同住、家屬感受到的病人症狀嚴重程度與症狀干擾病人生活感受與功能程度以及家屬之情緒狀態。簽署DNR相關感受的重要預測因子為:病人預立醫療指示、家屬之年齡、性別、是否與病人同住、教育程度以及情緒狀態,其解釋簽署DNR照顧者家屬DNR相關感受之總變異量為73.1%(p=0.00)。
本研究之結果,除了有助於醫護人員瞭解替癌症病人簽署DNR之照顧者家屬的感受與相關因素之外,亦可協助我們發展臨終照顧之相關臨床教育課程。我們希望藉由病人、家屬與醫護人員之有效溝通,能改善此類病人及照顧者家屬的照顧品質,並緩和照顧者家屬於簽署DNR時產生的不良感受。
關鍵字:不予施行心肺復甦術、癌症病人、照顧者家屬
英文摘要 Abstract
Title of Thesis:Exploring Family Caregivers’ Experience and Associated Factors While They Consented to “Do Not Resuscitate” for Cancer Patients
Institution:Graduate Institute of Nursing, Taipei Medical University
Author: Kuo-Min Chu
Thesis directed by: Yuan- Mei Liao, Ph.D., Associate Professor
More and more cancer patients’ family caregivers tend to choose Do Not Resuscitate (DNR) for their ill family members when an effective cardiopulmonary resuscitation is unlikely to be successful in rescuing patients’ lives. Although about 80% of the DNR consents were gave by family caregivers, however, information related to family caregivers’ experience while they consented to DNR was limited. Good quality of "end of life care" should include not only the care of patients but also the care of family caregivers. Understanding the experience and associated factors of cancer patients’ family caregivers could help health care providers deliver needed care services and further improve cancer patients’ and their family caregivers’ physical, mental, spiritual well beings.
This study was a descriptive, correlational, cross-sectional study. Study aim was to explore family caregivers’ experience and associated factors (predictors) while they consented to DNR for cancer patients. Eighty cancer patients’ family caregivers were invited to participate in this study. Study instrument was a structured questionnaire. Content of the instrument included patients’ and their family caregivers’ individual characteristics, caregivers’ caring situation, The Chinese version of the short form of Profile of Mood States, M. D. Anderson symptom inventory: Taiwan Form, Brief Assessment Scale for Caregivers, and 8 self-developed items related to family caregivers’ experience of consenting to DNR. Data analyses included descriptive statistics, independent t-test, one-way ANOVA, pearson’s correlation test, and hierarchical regression analysis.
In this study, the Brief Assessment Scale for Caregivers and a self- developed scale related to family caregivers’ experience of consenting to DNR were used to measure caregivers’ experience. Caregivers’ experience measured by Brief Assessment Scale for Caregivers was associated with family caregivers’ emotional status. Patients’ age, family caregivers' age, educational level, living with patients or not, patients’ symptom severity and symptom interference with life and functional status perceived by family caregivers, and family caregivers’ emotional status were related to caregivers’ experience of consenting to DNR. Hierarchical regression model accounted for 73.1% (p=0.00) of variance in family caregivers’ experience of consenting to DNR and the main predictors included patients’ living wills, family caregivers’ age, gender, educational level, living with patients or not, and emotional status.
In addition to help health care providers understand family caregivers’ experience and associated factors while they consented to DNR for cancer patients, study results of this study could also be used to develop clinical education programs about end of life care. We hope that effective communications between patients, family caregivers, and health care providers would improve the care of cancer patients and their family caregivers, and ease family caregivers’ negative experience while they consented to DNR.
Key works: Do Not Resuscitate, cancer patients, family caregivers
論文目次 目 錄

致 謝……………………………………………………………………Ⅰ
中文摘要……………………………………………………………………Ⅲ
英文摘要……………………………………………………………………Ⅴ
目 錄……………………………………………………………………Ⅶ
圖表目次……………………………………………………………………Ⅹ
第一章 緒論
第一節 研究動機與重要性……………………………………………1
第二節 研究目的. ……………………………………………………..4
第三節 研究架構………………………………………………………5
第四節 名詞解釋………………………………………………………7
第二章 文獻查證
第一節 心肺復甦術與不予施行心肺復甦術…………………………9
第二節 癌症病人照顧者之感受……………………………………..16
第三節 照顧者感受之相關因素……………………………………..26
第三章 研究方法
第一節 研究設計……………………………………………………..33
第二節 研究對象……………………………………………………..33
第三節 研究工具……………………………………………………..34
第四節 研究步驟……………………………………………………..43
第五節 資料分析……………………………………………………..46
第四章 研究結果
第一節 病人屬性與家屬屬性………………………………………..49
第二節 家屬照顧情境………………………………………………..53
第三節 簽署DNR照顧者家屬之感受………………………………58
第四節 病人屬性與簽署DNR照顧者家屬感受之相關性…………62
第五節 家屬屬性與簽署DNR照顧者家屬感受之相關性…………65
第六節 家屬照顧情境與簽署DNR照顧者家屬感受之相關性……72
第七節 簽署DNR相關感受之預測因子……………………………75
第五章 討論
第一節 病人屬性、家屬屬性及家屬照顧情境………………….….82
第二節 簽署DNR照顧者家屬之感受…………………………..…..88
第三節 簽署DNR相關感受與其相關因素…………………….…...93
第四節 簽署DNR相關感受的重要預測因子……………………..100
第六章 結論與建議
第一節 結論…………………………………………………….……105
第二節 建議…………………………………………………….……107
第三節 研究限制……………………………………………….……108
參考資料
中文部份…………………………………………………………….….110
英文部分……………………………………………………….……….114
附錄
附錄一 病人與家屬屬性及家屬照顧情境……………………….….131
附錄二 臺灣版安德森症狀量表(病人症狀嚴重程度)………… 132
附錄三 臺灣版安德森症狀量表(病人症狀干擾病人生活感受
與活動程度…………………………………………………133
附錄四 中文版情緒狀態量表…………………………………………134
附錄五 簡短評估照顧者家屬感受量表………………………………135
附錄六 簽署DNR相關感受(自擬題目).…………………………136
附錄七 專家內容效度評量……………………………………………137
附錄八 受試者同意書…………………………………………………138
附錄九 量表使用授權同意函…………………………………………142

圖 表 目 次
圖一 概念架構…………………………………………………………….6
表一 照顧者家屬感受測量工具……………………………………….…25
圖二 資料收集流程………………………………………………………...45
表二 統計方法………………………………………………………….…..47
表三 病人屬性………………………………………………………….…51
表四 家屬屬性………………………………………………………….…52
表五 照顧者家屬感受到的病人症狀嚴重程度與症狀干擾病人生
活感受與活動程度………………………………………………….55
表六 正式研究中量表之內在一致性……………………………….……56
表七 照顧者家屬情緒狀態…………………………………………….…..57
表八 簽署DNR照顧者家屬感受(簡短評估照顧者量表) ………….…....60
表九 簽署DNR相關感受(自擬量表) ……………………………….……61
表十 病人屬性與簽署DNR照顧者家屬感受(簡短評估照顧者量
表)的差異性分析……………………………………………….……63
表十一 病人屬性與簽署DNR相關感受(自擬量表)的差異性分析….…64
表十二 家屬屬性與簽署DNR照顧者家屬之感受(簡短評估照顧
量者表)的差異性分析...………………………………………66~68
表十三 家屬屬性與簽署DNR相關感受(自擬量表)的差異性分析.…69~71
表十四 家屬照顧情境與簽署DNR照顧者家屬感受(簡短評估照顧
者量表)的差異性分析……………………………………….…….73
表十五 家屬照顧情境與簽署DNR相關感受(自擬量表)的差異
性分析……………………………………………………………...74
表十六 簽署DNR照顧者家屬感受(簡短評估照顧者量表) 之階層
式迴歸分析…………………………………………………….78~79
表十七 簽署DNR相關感受 (自擬量表)之階層式迴歸分析 ……… 80~81

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