Exploration of Good Dying Care Model:Perspective of Taiwan''s Nurses in Adult Critical Care Units

• Main Authors: Mei-Jou Hsu, 許美柔
• Other Authors: Chia-chin LIn
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/34450569598367616538

碩士 === 臺北醫學大學 === 護理學研究所 === 96 === The purpose of this research is to understand the current state of the nursing model to take care of dying patients in adult intensive care units (ICU), to realize the factors influencing nursing staffs’ decision to provide good death care, to identify the help that nursing staffs need to provide good death care for dying patients, and to find out goals for patients in adult ICU to acquire good death care in order to establish a model with the culture and the over-all medical system, based on the viewpoint of clinical nurses in ICU. This research adopts “between method triangulation”, targeting nursing staffs of adult ICU in a medical center in northern Taiwan and sending questionnaires to them to collect information. The data is analyzed by descriptive statistics and qualitative content analysis method. Current nursing staffs in ICU to take care of dying patients could be divided into four periods: first, a medical team assesses that the condition of the patient is not optimistic; secondly, the response to medical care is not good, and the family of the patient has been informed of the possibility of death; thirdly, preparing for the patient’s death; and fourthly, the patient’s approaching death. There are different focuses in different periods; but nonetheless, they all include physical and mental care of the patient and his family. The content of care includes three perspectives: the nursing capacity of evaluation, the participation in medical decision, and caring conduct by nurses. Moreover, the predictive factors for ICU nurses to care dying patients are: the nursing capacity to evaluate, the participation in medical decision, the seniority of the ICU unit, and the self-consciousness of devotion to religion. The factors to influence nursing staffs in adult ICUs to provide good dying care could be divided into positive and negative ones. Positive factors include: good professional ability of nursing staffs, the recognization that nursing is a job to help people, and to obtain the support of the medical team. In contrast, negative factors include: limited time of nursing, the shortage of support by the medical team, the lack of environment to provide good dying care, and the inability to talk about death.The help needed by nursing staffs in adult ICUs is to have regular meetings to improve the communication among doctors, nursing staffs, and the patient and his family as well as to provide on-the-job training and legal information about good death care. Lastly, the goals to provide good death care in ICU are: to alleviate uncomfortable symptoms (such as dyspnea or pain), to ensure that the patient can acquire meaningful support by their parties, to help conscious patient to express his wishes, to make sure that the patient and his family have the same understanding about the illness, to ascertain the time of death would not be delayed for meaningless reasons or arrive earlier due to inappropriate medical care, to help the patient and his family to receive religious support, to provide information and to assist the patient’s family to prepare funeral affairs, and to keep stable the mental state of the patient and to avoid negative verbal expressions.