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研究生: 莊惠蓉
Chuang Hui Jung
論文名稱: 進入臨床前的醫學生對預立醫囑的經驗、認知、態度及教育需求之探討
Experience , Acknowledge , Attitudes and demand of education toward advance directive among Pre-Clinical medical students
指導教授: 董貞吟
Tung, Chen-Yin
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2014
畢業學年度: 102
語文別: 中文
論文頁數: 106
中文關鍵詞: 臨床前之醫學生預立醫囑醫學教育需求
英文關鍵詞: pre-clinical students, advance directive, demand of advance directive education
論文種類: 學術論文
相關次數: 點閱:504下載:34
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  • 隨著社會人口的老化及醫療的進步,生命末期的照護方式漸漸受到重視,而「預立醫囑」成為一個重要的依據。
    本研究想了解即將進入臨床的醫學生對於預立醫囑的經驗、認知、態度與教育需求的現況。採自擬問卷調查,立意取樣四所公私立大學之醫學系四年級、五年級學生500位。得有效問卷354份。以卡方檢定、t 檢定、費氏正確檢定、變異數分析、皮爾森積差相關進行資料統計分析。結果發現:
    一、 預立醫囑認知與系級有顯著相關(五年級分數高於四年級)。
    二、 預立醫囑的態度與認知沒有顯著相關,但預立醫囑態度與教育需求有顯著正相關。
    三、 七成以上學生願意推廣及預立醫囑。
    四、 醫學生認為預立醫囑是生命重要的議題且認為自己決定生命末期治療方向很重要,但因為討論死亡在台灣文化中是禁忌,且不熟練與病人、家屬溝通解釋病情成為推廣上的障礙。
    五、 課程上希望加強維生器的撤除時機、預立醫囑介入時機、病情告知等技巧。學生肯定預立醫囑教育的需求,多數認為應列入必修及實習課程。
    最後針對本研究結果提出建議,以作為後續預立醫囑推廣及規劃醫學教育課程與研究之參考

    As the coming of aged society and the improvement of medicine, the care of terminal patient become a big issue as well as advance directives.
    Our research is using a structured questionnaire to investigate the experience, acknowledge, attitudes and demand of education toward advance directives among pre-clinical medical students. The effective samples were 354. The data were analyzed by t-test, Chi-Square test, Fisher’s Exact test, Anova test and Pearson product-moment correlation. The major findings of the study were as follows:
    1. The acknowledge of advance directives was significantly difference on grade.
    2. Ther is no significant relationship between attitude and acknowledge of advance directives, but attitudes and demand of education correlated positively.
    3. More than 70% students would like to promote and do advance directives
    4. Students view advance directives as an important life issue and also think it is important to make advance care planning by self. However to discuss death is an prohibition in Taiwan culture, also without enough confidence to discuss disease prognosis with patient and their family may discourage students.
    5. The time to remove life-survive machine, the time to discuss advance directives, the skill of trueth-telling of illness are the most 3 point that studens want to know. Students have positive attitude toward educational demand and think advance directives teaching should be a must-learn class and including in internship.

    Based on the finding of the study, recommendations which was suggestions for future study and demand of education intervention were drawn

    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 第三節研究問題與假設 5 第四節名詞界定 6 第二章文獻探討 8 第一節預立醫囑的內涵與定義 8 第二節預立醫囑的經驗、認知與態度 12 第三節預立醫囑的簽署狀況 14 第四節 預立醫囑的影響因素……..……………………………….16 第三章研究方法 20 第一節研究架構 20 第二節研究對象 21 第三節研究工具 22 第四節實施步驟 25 第五節資料處理與分析 26 第四章 研究結果與討論………………………………….…………..28 第一節 研究對象基本資料及預立醫囑經驗分析…………………...28 第二節 研究對象預立醫囑認知探討………………………………...36 第三節 研究對象預立醫囑態度探討………………………………...51 第四節 研究對象預立醫囑教育需求探討…………………………...65 第五章結論與建議……………………………….……………………76 第一節結論…………………………………………………………….76 第二節建議………………………………………………………….…78 參考文獻 一、中文部分 81 二、英文部分 85 附錄 附錄一 專家效度問卷 89 附錄二 預試問卷…………………………………………………94 附錄三 正式問卷………………………………………………..98 附錄四 問卷專家效度名單…………………………………….102 附錄五 同意臨床研究證明書………………………………….103 附錄六 安寧緩和醫療條例………………………………………….104

    一、 中文部分
    王淑貞、范聖育、章淑娟、張智容、王英偉(2013)。推動預立醫療自主計畫之宣導—初探。安寧療護雜誌,18(2),p129-141
    方慧芬、張惠玉、林佳靜(2009)。末期病人面臨預立醫囑、生前預囑之現況及與生命自覺之倫理議題。護理雜誌,56(1),17-22。
    呂幸蓉、翁秀霞、謝伶瑜(2011)。探討急重症護理人員參與病患末期決策之經驗。台灣重症照護醫學,12,p175-181。
    李震山(1999)。從生命權與自決權之關係論生前預囑與安寧照護之法律問題。中正大學法學集刊,2,325-350。
    林慧美、楊嘉玲、陳美妙、邱泰源、胡文郁(2011)。住院病人簽屬預立醫囑指示的意願及接受宣導的意象。安寧療護雜誌,16(3),p281-295。
    邱泰源、胡文郁、鄧錦慧(2002)。癌末期病人之照護體系:台灣安寧和緩和醫療文獻之回顧。台灣醫學,6(3),p332-339。
    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。
    胡文郁、邱泰源、陳慶餘(2004)。癌症末期真相告知指引之訂定:癌末患者、家屬、醫師及護理人員的態度和行為意向觀點。國民健康局92 年科技研究發展計畫(DOH92-HP-1508)。
    胡文郁、蔡甫昌、鄭安理(2007)。癌末病情告知指引。台北市:行政院衛生署國民健康局。
    胡文郁、楊嘉玲(2009)。生命末期之病情告知與預立照護計畫。護理雜誌,56(1),23-28。
    柯莉珊、胡文郁、邱泰源(2005)。提供癌末病患人工營養與水分之反思。安寧療護,10(2),125-138。
    張慧玉(2009)。探討終末病患照護中有關預立醫囑、生前預囑之現況及倫理法律問題。臺北醫學大學護理學研究所碩士論文,台北市。
    張惠雯(2011)。彰化某醫院家醫科門診病人對預立醫囑知識及態度之研究。國立成功大學醫學院老年學研究所碩士論文,台南市。
    陳慶餘、邱泰源、胡文郁、姚建安(2005)。緩和醫療照護臨床技能之醫學教育。國科會科學教育計劃。2005/8~2008/9。
    黃俊逢、周希諴、呂宗學、林宜柏、洪逸茹、袁素娟、蔡宗博(2003)。台灣中部某醫學中心之醫師與護士對於安寧緩和醫療態度之研究。中山醫學雜誌,14(2),215-220。
    黃惠美、郭碧照、胡中傑、謝玉玲、黃曉峰(2005)。台中某社區民眾之安寧療護知識及其影響因素。安寧療護,10(4),371-383。
    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。臺北醫學大學護理學研究所碩士論文,台北市。
    楊嘉玲、陳慶餘、胡文郁(2008)。醫療預立指示。安寧療護雜誌,13(1),30-41。
    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,10(3),272-285
    蔡秀芬、林佳靜、陳品玲、黃璉華、詹秀妹(2002)。癌症病患病情告知現況與探討。腫瘤護理雜誌,2(1),17-27。
    蔡甫昌、方震中、楊尚儒、顏瑞昇、石崇良(2008)。急診醫療倫理議題探討。台灣醫學,12 (2),221-130。
    蔡甫昌、劉珈麟、朱怡康(2006)。醫師協助自殺與安樂死的倫理法律議題。台灣醫學,10(5),641-651。
    蔡甫昌、潘恆嘉、吳澤玫、邱泰源、黃天祥(2006)。預立醫療計畫之倫理與法律議題。台灣醫學,10(4),517-36。
    謝伶瑜(2011)。醫護人員預立醫囑知識與相關因素之探討。長庚護理,22(2),p153-162。
    謝伶瑜、林淑英、江姿瑢(2010)。護理人員推行預立醫囑之知識、態度、經驗與自信。護理暨健康照護研究,6(4),p280-288。
    鄒海月、王守容、何裕芬(1999)。癌症末期病患家屬對「不予急救」之態度及其相關因素之初探。榮總護理,16(4),344-356。
    盧美秀(2006)。護理倫理與法律。台北市:華杏。
    蘇文浩(2006)。癌末病患的醫療倫理。哲學與文化,33(4),5-15。
    顧乃平、李從業(2002)。預立指示及倫理考量。護理雜誌,49(6)
    18-25。


    二、英文部分
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    Catt, S., Blanchard, M., Addington-Hall, J., Zis, M., Blizard, R., &King, M. (2005). Older adults' attitudes to death, palliativetreatment and hospice care. Palliative Medicine, 19(5),402-410. .
    Chao, C. S. (2002). Physicians’ attitudes toward DNR of terminally illcancer patients in Taiwan. Journal of Nursing Research, 3(10),161-167.
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    Davis, B. A., Burns, J., Rezac, D., Dillard, B., Kieffner, E., Gargus, J.et al. (2005). Family stress and advanced directives: acomparative study. Journal of Hospice and Palliative Nursing,7(4), 219-227.
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    Douglas, R., & Brown, H. N. (2002). Patients’ attitudes towardadvance directives. Journal of Nursing Scholarship, 34(1), 61-65.
    Ersoy, N., & Gündoğmuş, Ü. N. (2003). A study of the ethical sensitivity of physicians in Turkey. Nursing Ethic,10(5),472-484.
    Ersek, M., Kagawa-Singer, M., Barnes, D., Blackhall, L., & Koenig, B.A. (1998). Multicultural considerations in the use of advancedirectives. Oncology Nursing Forum, 25, 1683-1690.
    Ewer, M.S., Kish, S. K., Martin, C. G., Price, K. J., & Feeley, T. W.(2001). Characteristics of cardiac arrest in cancer patients as apredictor of survival after cardiopulmonary resuscitation. Cancer,92(7), 1905- 1912.
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    Jezewski, M. A., Brown, J., Wu, Y. W., Meeker, M. A., Feng, J. Y., &Bu, X.(2005). Oncology nurses' knowledge, attitudes, andexperiences regarding advance directives. Oncology NursingForum, 32(2), 319-327.
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    Morrison, R. S., & Meier, D. E. (2004). High rates of advance careplanning in New York City's elderly population. Archives ofInternal Medicine, 164(22), 2421-2426.
    Maxfield, C. L., Pohl, J. M., & Colling, K. (2003). AdvanceDirectives: A Guide for Patient Discussions. Nurse Practitioner,28(5), 43-47.
    Nicolasora, N., Pannala, R., Mountantonakis, S., Shanmugam, B.,DeGirolamo, A., Amoateng-Adjepong, Y., et al. (2006). If asked,hospitalized patients will choose whether to receivelife-sustaining therapies. Journal of Hospital Medicine, 1(3),161–167.
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