| 摘要: | 背景與目的：推動預立醫療指示是對「善終」自主權尊重的政策體現，然而避談死亡的文化背景下，國人對於相關政策的討論與推動亦顯的消極緩步。即便台灣已於2000年通過「安寧緩和醫療條例」，但推動迄今全國預立醫療指示簽署比例依然偏低且簽署時間偏晚。另一方面，站在病人簽署的推展立場，護理人員本身的簽署意圖與行為結果扮演著示範角色，同時影響其推廣成效，造成的影響不容忽視，因此本研究乃探討影響護理人員簽署意願書的相關因素。
方法：本研究採橫斷性調查法，採立意取樣法。問卷設計以「創新擴散」與「創新抵制」為理論指導。以南部某醫院中心服務滿三個月以上護理人員為研究對象。調查期間為2019/3/20～2019/4/10，共發放310份問卷，回收率為92.90%。分析方法使用描述性統計、獨立樣本t檢定、單因子變異數分析、皮爾森相關分析、多元線性複迴歸分析。
結果：有效樣本288份，有簽署意圖佔78%，影響預立醫療指示簽署意圖的因素包含人口學特徵的「與家人或他人討論生命末期醫療決策經驗」（p<0.01）、「科別」（p<0.05）、創新擴散構念的「複雜性」（p<0.01）、「可觀察性」（p<0.001）及創新抵制構念的「傳統障礙」（p<0.001）。
結論：「科別」、「討論末期醫療決策經驗」、創新擴散的「複雜性」、「可觀察性」及創新抵制的「傳統障礙」是影響護理人員簽署預立醫療指示意圖的重要因素，建議可朝「參與末期決策的經驗」、「預立醫療指示的相關知識」、「與家人溝通的技巧」等相關議題推廣，進而引發自身對此議題的主張，進而取得家人間的共識，增強簽屬意願。本研究亦依據研究提出相關政策與管理建議，以供後續各界參考之用。
Background and objective: Promoting Advance Directives (AD) is embodied in Taiwan’s policy making showing respects for the right of autonomy at the end of life appropriately. However, under our social cultural background of avoiding mentioning “death”, the discussion and promotion of relevant policies by Taiwanese have been facing negatively progressed at a slow pace. Even though the Hospice Palliative Care Regulation has already passed in Taiwan in 2000, the percentage of Taiwanese signing AD is still very low. On the other hand, the intention and behavioral results of signing AD by nursing staffs themselves play a model role for promoting signing AD among patients. At the same time, it also can influence the promotion effectively, so the impact results cannot be ignored. Thus, the study aims to explore the relevant factors which affect the willingness of signing AD among nursing staffs.
Method: This research used a cross-sectional study with purposive sampling method. The design of the structured questionnaires was derived from two theoretical perspectives, including “innovation diffusion” and “innovation resistance”. The sample source was the clinical nursing staffs who work for more than three months in a medical center in southern Taiwan. From March 20 to April 10 in 2019, a total of 310 questionnaires were distributed to nursing staffs, with a response rate of 92.90%. Statistical analysis methods were used including descriptive statistics, independent sample t-test, one-wau ANOVA, Pearson correlation analysis, multiple linear regression analysis.
Result: Of the 288 valid questionnaires, 78% of the participants showed highly intention to sign the AD, the following items have the statistical significances affecting the intention to sign AD, including the experiences of discussing end-of-life decision making with family or others(p<0.01), work unit(p<0.05), complexity, (p<0.01) and observability(p<0.001) of Innovation Diffusion Theory, a traditional barrier of Innovation Resistance Theory(p<0.001) .
Conclusion:The results of the study showed that the work unit, the experiences of discussing end-of-life decision making, complexity, and observability of Innovation Diffusion Theory, a traditional barrier of Innovation Resistance Theory is the important predictor to affect nursing staffs signing AD. This study suggests that it can be promoted in the context of “the experience of participating end-of-life decision,” “the related knowledge of AD,” and “the skill of communicating with family.” In this way, it can inspire their own opinions on this issue and gain consensus among family members to enhance the willingness of signing AD. Finally, we provide several suggestions for further research and policy making. |
