[[alternative]]The Related Factors Toward Terminal Diseases Elderly Do-Not-Resuscitate among Adult’s Intensive Care Unit Nurses

[[abstract]]本研究目的旨在探討成人加護單位護理人員對疾病末期老人「不施予心肺復甦術」的態度傾向及其相關因素。本研究為量性、橫斷式研究設計，採分層隨機抽樣法，選擇台北（北市、北縣）地區教學醫院（含）以上，總計收案190位服務於成人加護單位護理人員且工作年資滿半年（含）以上者為研究對象。研究工具為自填式結構式問卷，內容包含護理人員基本資料、護理人員個人死亡態度、「不施予心肺復甦術」的相關認知、成人加護單位護理人員對疾病末期老人「不施予心肺復甦術」的態度傾向等四大部分。研究資料以SPSS 13.0版套裝軟體進行資料分析與建檔，統計方法包括描述性分析、獨立樣本t檢定分析、單因子變異數分析、多項式logistic迴歸分析(Multinomial logistic regression)等。研究結果顯示，以「低態度傾向組」為參照組，於模式一分析時，護理人員個人死亡態度的「中性死亡接受」面向分數愈高，成人加護單位護理人員對疾病末期老人執行「不施予心肺復甦術」高態度傾向組，比低態度傾向組高出2.73倍；而中等態度傾向組則比低態度傾向組高出3.857倍，解釋15.9%的變異量。於模式二分析時，在護理人員個人死亡態度的「中性死亡接受」面向仍具有統計上的顯著差異，高態度傾向組比低態度傾向組高出2.672倍；而有4.4倍的機會成為中等態度傾向組，可解釋18.5%變異量。故在護理人員個人死亡態度的「中性死亡接受」面向，最能有效預測成人加護單位護理人員對疾病末期老人執行「不施予心肺復甦術」的態度傾向。 當成人加護單位護理人員能接受死亡為生命過程自然的一部份，便愈能正向的面對疾病末期老人執行「不施予心肺復甦術」時的相關問題，減輕負向的感受，以坦然的態度和老人、家屬及醫師共同討論末期醫療的處置方式，幫助家屬面臨此問題時做出適當的決策，才能兼顧疾病末期老人的自主權及家屬的決定權。對於安寧緩和醫療條例的瞭解應更加落實並持續關注安寧療護的議題及相關法令，以實際運用於工作上，未來則應繼續探討其他可能的影響因素，將有助於落實安寧療護的四全理念，進而提供疾病末期老人完善的臨終照護。[[abstract]]The purpose of the study is to discuss the attitudes and the related factors toward terminal disease elderly do-not-resuscitate(DNR)among adult’s intensive care unit nurses.The study is based on quantity, cross-sectional and probability proportional samplings. The sources are the volunteers’ questionnaires from 190 nurses who work in teaching hospitals in Taipei city and county for at least six month. The contents of the questionnaires include nursing staff's demographics data, nurses’ death attitudes, the knowledge of DNR, and the DNR attitudes of the nurses in the adult’s intensive care unit to terminal diseases elderly. The data is built analyzed by SPSS 13.0 software and the statistical methods include descriptive analysis, independent t-test, one way ANOVA and multinomial logistic regression.Use "low attitude tendency group" as the reference group. In model 1 analysis,the result showed the higher scores of the “neutral acceptance”, it is 2.73 times higher to compare the “high attitude tendency group” with “low attitude tendency group”.But it is 3.857 times higher to compare the “medium attitude tendency group” with “low attitude tendency group”. And it explains the 15.9% of the total variance. In the analysis of model 2,the “neutral acceptance” is still significantly differences. “High attitude tendency group” is 2.672 times higher than "low attitude tendency group" and there are 4.4 times chances to become “medium attitude tendency group” and it explains the 18.5% of the total variance. Therefore, the nurses’ death attitudes to “neutral death acceptance” can predict the related factors toward terminal disease elderly do-not-resuscitate among adult’s intensive care unit nurses.When the nurses in the adult’s intensive care unit can accept death is a part of life, they can face the related problem positively to Do-Not-Resuscitate, and reduce their negative feelings. Then they can use peaceful attitudes to discuss the medical services of terminal diseases with the elders, their family members and doctors and help their family members to make a suitable judgment, so it will consider both the autonomy of the terminal diseases elderly and the decision of their family members. As to the better knowledge of hospice rules and more care about hospice topics and related regulations, other possible factors will be discussed in the future in order to carry out comprehensive hospice care and provide the dying care for terminal diseases elderly