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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。
    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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