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    Please use this identifier to cite or link to this item: http://asiair.asia.edu.tw/ir/handle/310904400/111237


    Title: 呼吸器依賴患者照護者對氣切決策之歷程
    Authors: 邱虹瑜
    Contributors: 健康產業管理學系長期照護組
    Keywords: 慢性呼吸照護病房、照護者、氣切決策、respiratory care ward、caregiver、Decision-making for Tracheostomy
    Date: 2018
    Issue Date: 2018-07-30 13:18:34 (UTC+8)
    Publisher: 亞洲大學
    Abstract: 當疾病造成多重器官衰竭、功能無法復原時,往往需要藉由呼吸器輔助來維持基本呼吸功能與維持生命。由於這些病患皆經歷過急性期及呼吸器脫離失敗的階段,且在住院期間有可能院內感染或是其他器官併發症發生,導致病患多次面臨病危或是瀕臨死亡。
    使用呼吸器的決策比一般的醫療決策困難很多,照護者主要會有幾個重要的決定:緊急情況下是否要插管、無法脫離呼吸器後是否要做氣切、出院後是要選擇居家照護或是機構照護。目前研究多為選擇呼吸照護病房因素、瞭解病患之照護需求及照護者照護壓力等相關議題,少有針對呼吸器依賴患者照護者於決策氣切期間之歷程進行探討,故本研究以呼吸照護病房內病患照護者為主,探討呼吸器依賴患者照護者對氣切之抉擇進行分析並瞭解其困境與影響。
    本研究採用質性研究法,針對中部某地區醫院慢性呼吸照護病房之呼吸器依賴患者照護者,採用立意取樣進行收案。擬定半結構式訪談指引,與受訪者面對面深度訪談,將訪談內容謄寫成逐字搞,以質性內容分析法進行分析。
    本研究受訪者共10位,包含氣管內管患者照護者5位,氣切患者照護者5位。根據資料分析結果發現,呼吸器依賴患者照護者面對氣切之決策歷程會經歷4個階段,區分為「預後評估」、「訊息消化」、「內心衝擊」、「重要決定」;於「預後評估」,不同的疾病診斷有不同的預後,住院期間會依病患情況定期進行呼吸訓練,評估病患呼吸訓練的情況,將影響呼吸器脫離的可能;於「訊息消化」,確定病患呼吸器無法脫離,到醫護人員開始與照護者討論建議做氣切,照護者受到認知影響,包含照顧者對氣切的接受度、對氣切的想法及迷思;於「內心衝擊」,照護者未決定是否做氣切,到決定做氣切,照護者受到行為反應影響,包含意見來源、照護資訊及倫理部分;於「重要決定」,照護者決定接受氣切原因,因個案呼吸器無法脫離,為減緩個案因氣管內管造成的不適感及喉嚨疼痛,而拒絕氣切原因包含病患的意願、年齡問題、保持身體完整性。
    希望本研究,可讓醫療人員深入瞭解照護者於照護過程所面臨的抉擇,助於與照護者的溝通,進一步發展雙方能接受的決策與照護措施,提升整體性照護品質。
    When a disease causes multiple organ failure and the function cannot be recovered, it is often necessary to maintain basic respiratory function and sustain life by ventilator-assisted. Because these patients have experienced acute stage and ventilator from the failure of the stage, and in the hospital may be nosocomial infection or other organ complications, resulting in many times the patient is critically ill or near death.
    The decision to use a respirator is much more difficult than a general medical decision, and caregivers will have a number of important decisions: whether to intubate in an emergency, whether to be cut off from the ventilator, and to choose home care or institutional care after discharge. At present, there are few related topics, such as choosing the factors of respiratory care ward, understanding the needs of patients ' care and the care pressure of caregivers, and discussing the course of the patients who are dependent on the ventilator for the decision-making. Therefore, the study takes the patient care in the respiratory care ward as the main factor to study the choice of gas-cut among the caregivers of ventilator-dependent patients and to understand its dilemma and influence.
    In this study, a qualitative study was conducted to patients with ventilator-dependent patient caregiver in a hospital with chronic respiratory care in a central region. To develop a semi-structured interview guideline, interview with face-to-face interviews, transcribe the interview content into a verbatim manuscript, and analyze it by qualitative content analysis.
    There were 10 respondents in this study, including 5 patients with endotracheal tube, 5 patients with tracheostomy caregiver.According to the data analysis, it is found that the decision course of the patients who depend on the respirator will undergo 4 stages, which is differentiated as "prognostic assessment", "message digestion", "Inner impact" and "important decision". In the "Prognostic assessment", different disease diagnoses have different prognosis, during hospitalization, the patient will be regularly carried out breathing training, assessment of the patient's breathing training, will affect the possibility of ventilator detachment ; in the "Digest of Information", to determine the patient's ventilator can not be separated, to the medical staff began to discuss with caregivers to do the tracheostomy, caregivers are affected by the cognitive, including the caregiver on the tracheostomy acceptance, the idea of tracheostomy and myth; In the "inner impact ", the caregiver decides whether to do the tracheostomy, to decide to do the tracheostomy, the caregiver is affected by the behavioral reaction, including the opinion source, the care information and the ethical part;In the "important decision", caregivers decided to accept the reason for the tracheostomy, because the case of ventilator can not be separated, in order to reduce the case of tracheal tube caused by discomfort and sore throat, and the refusal of the cause of tracheostomy diseases including the patient's will, age problems, maintain physical integrity.
    It is hoped that this study will enable medical staff to understand the choice of caregivers in the process of care, to help them communicate with caregivers, to further develop both acceptable decision-making and care measures, and to improve the quality of holistic care.
    Appears in Collections:[健康產業管理學系] 博碩士論文

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