| Summary: | 碩士 === 長榮大學 === 護理學研究所 === 96 === Background: In Taiwan, tracheotomy has become a routine procedure for
patients with respiratory failure who have been depending on an endotracheal
tube for ventilation for over two weeks. After tracheotomy, elderly patients either
die shortly or depend on mechanical ventilation for years until they die.
Furthermore, for some Taiwanese, dying with the body whole, that is, without
a hole in the throat, is important. Thus, whether to receive a tracheotomy is
a very difficult decision, compounded by the fact that most patients are unable
to communicate. As a result, family members are the ones to decide and
conflicts between family members over this issue are very common.
In the acute care setting, matters are made worse by busy health care
providers who often give technical explanations that are difficult to comprehend.
Objective: The purpose of this qualitative study is to explore the meaning
of tracheotomy to the patent’s family, the family decision making process,
and how they have come to accept or reject a tracheotomy for their loved one.
Methods: The investigator is recruiting potential participants from a respiration
care unit in a medical center. Family members whose loved ones have been
on the respirator for more than 21 days are being recruited for this study.
Semi-structured, open-ended questions are used in the in-depth interviews.
The interviews are recorded on tape and transcribed verbatim. Eight interviews
have been conducted thus far, with five families accepting and the other five
rejecting tracheotomy.
Results: Eight themes have emerged from the data analysis with impressions
in tracheotomy: life length, suffers, quality of life, body whole, faith, caregiver
burden, seriously ill, and test piece. Ten themes have emerged from
the data analysis of decision making in tracheotomy: perceptions, autonony,
age, struggle and dilemma, experience, decision pattern and hope. Many factors
influence the family’s decision regarding tracheotomy and the family members
require time to think it through. The results suggest that health care providers
must allow family members sufficient time to make the decision and provide
information to meet each individual family’s needs during this difficult time.
KEYWORDS: tracheotomy, decision making, family members
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