| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 98 === Research Background
There is an increasing trend of long-term ventilator-dependent patients. With the limited medical resources, in order to maximize the utilization of resources, the government implemented in Year 2000 the “Pilot Project of National Heath Insurance Integrative Care for Ventilator-dependent Patients”, which aims to transfer the long-term intensive care unit (ICU) patients with severe chronic diseases out of the ICU so that other patients who need intensive care may receive proper quality care. Throughout the implementation process, families faced various kinds of plight, including plight from the medical team, which accounted for the majority, while the medical team played a role of the clinical plan executor in the policy implementation process. To the medical team, the families’ demands, compliance with the policy implementation, and conflicts between members due to the opposing views they hold are all extremely difficult and a huge challenge. The pressure faced by the team during the transfer process, and the difficulties faced by the medical units that rendered care for the ventilator-dependent patients have not yet been explored.
Research Purpose
1. To discuss the plight faced by the first-line medical
team members when rendering care for the ventilator-
dependent patients and their families.
2. To discuss the expectations for managing by the first-
line medical team members when rendering care for the
ventilator-dependent patients and their families.
3. To discuss the necessary assistance needed by the
first-line medical team members when rendering care for
the ventilator-dependent patients and their families.
4. To discuss the process of solving a plight and the
policies adopted by the first-line medical team members
when rendering care for the ventilator-dependent
patients and their families.
Research Method
In this paper, the exploratory and qualitative research method targeting the respiratory intensive care unit of a regional teaching hospital in the south and a first-line medical team of a respiratory care center was employed. The study subjects recruited are mainly the physicians, nurses, and respiratory therapists, while the purposive sampling was adopted for the recruitment of cases. A semi-structured interview guide was then developed for in-depth interviews with the first-line medical members. The interview content was transcribed for qualitative content analysis and compilation.
Results
In this study, 30 first-line medical team members were recruited, including 14 nurses, 9 physicians, and 7 respiratory therapists, of which 11 were men (9 physicians, 1 nurse, and 1 respiratory therapist). The age range is 24-45 years old, mostly married. The work years range from the shortest of 5 months to the longest of 20 years.
The study results have shown that the plights faced by the first-line medical team members when rendering care mainly include: “inappropriate expectations for the medical team,” “heavy workload,” “the medical team’s lack of effective coordination,” and “the management decision-maker’s difficulties faced.” In Section Four, the plights faced by the first-line medical staff in the different stages and the corresponding necessary assistance are compiled.
The results have shown that the plight-solving processes for the medical team members when faced with plights include four stages: “confirm the plight stage,” “resource-seeking stage,” “the plight-solving policy stage,” and the “re-coordination stage.” In the plight-solving policy stage, the five plight-solving policies include: “build trust,” “establish effective communication (more listening),” “retreat,” “offer bargaining space,” and “enhance team cohesion.”
Conclusion
In this study, the problems such as transfer, tracheotomy implementation, and communication with families faced by the ICU medical staff were transferred to the downstream unit (i.e. undertaken by the medical staff of the respiratory care center). Although the policy for transfer is defined, it is not strictly implemented. Therefore, the medical team is still pressured and faces difficulties when offering care to patients and during the transfer execution process. The government is actively promoting a long-term care plan. This plan that targets long-term care institutions and home care will be implemented after the integration pilot project. Thus, with the sustained implementation of the transfer system, the medical team will continue to face transfer and family communication related problems. The first-line medical team members that offer care to the ventilator-dependent patients may, based on the results in this study, co-develop the “medical version” and “family version” care policy guidelines with collaborated efforts of professional medical staff.
Keywords
ventilator-dependent patient, first-line medical team member, physician, nurse, respiratory therapist, respiratory intensive care unit, respiratory care center, dilemma, needed help
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