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DNR DNR

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    1. DNR???DNR?? ??? 070702

    3. Do not resuscitate, DNR 1991?,???????????????? ??????????(Medicare?Medicaid)?????,?????????????????? 2000???????????????? 2002???????????,??????????,??????? ????:???????,???????????,????????,????????????????(?3?) ?????????????? 1976?,?????????????(Natural Death Acts,NDA) ????,?????? MODS(multiple organ dysfunction score)0??--4????(Marshall, 1995) ????:??????????????????? 9—12, ???25% 13--16,50% 17-20,75% >20,100% Vincent JL et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction / failure. Intensive Care Med. 1996;22:707-710 Knaus WA et al. APACHE II : A severity of disease classification system. Crit Care Med. 1985;13:818-291976?,?????????????(Natural Death Acts,NDA) ????,?????? MODS(multiple organ dysfunction score)0??--4????(Marshall, 1995) ????:??????????????????? 9—12, ???25% 13--16,50% 17-20,75% >20,100% Vincent JL et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction / failure. Intensive Care Med. 1996;22:707-710 Knaus WA et al. APACHE II : A severity of disease classification system. Crit Care Med. 1985;13:818-29

    4. DNR ??20????????????,??????(?5?) ??????????????????,??????????????(?7?) ??????????????,?????????????(?6?) ??????,???????????????????????,?????????????????????(Luce, 1990) ??>?????????>??>????>???>????????????>?????? ??>?????????>??>????>???>????????????>??????

    5. ?? ???? ??????(von Neumann & O. Morgenstern, 1944) ????(Daniel Kahneman & Amos Tversky, 1979) ???(heuristics or rule of thumb):???(representativeness)????(availability)??????(anchoring and adjustment) ????????????,????????(O’Connor, Jacobsen, & Stacey, 2002) ????:??????????????(Charles, Gafni, & Whelan, 1999) ??????????????,?????????????????????????????????????????????????(O’Connor, Jacobsen, & Stacey, 2002) ??????????????,?????????????????????????????????????????????????(O’Connor, Jacobsen, & Stacey, 2002)

    6. ??????(O’Connor & Jacobsen, 2006 ) ??????????? ?????????????????????????????????????????(???????????????????) ?????????????? ????????????????????????????????? ??????? ??????????????????,??????????????????????????????? ?????? ????????????????????????????????????????

    7. ????????? ????????????(Fagerlin, Ditto, Danks, & Houts, 2001;Azoulay et al., 2000) ????(Kirchhoff et al., 2002) ?????? ?????????????? ??????? ????????? ???????(Pochard et al., 2001 ) ????? ??????(Studdert et al., 2003;Abott, Sago, Breen, Abernethy, & Tulsky, 2001) ???? ????????? ?????????

    8. ??????????(Hampe, 1975 ) center on the relationship with the dying person needing to be with the dying person to feel helpful to that person to be informed of the dying person’s condition being assured that the dying person is receiving the best care possible needs that center on the family member the need to ventilate emotions receive support, comfort, and caring

    9. ????

    10. DNR??? CPR????? ???????????????? ??????????,????CPR??????????????? DNR?????? ??????????????

    11. DNR??? ???????????CPR????????????,???????????? 8-44%??????????/????????????????????????CPR?????????????

    12. DNR??? ?DNR??????? ,??DNR??? ??????????CPR???????????DNR?????????????DNR????????????? ???????????CPR???????????????CPR????????????????

    13. DNR??? ??????????????????????????????????DNR????? ????????????

    14. ??DNR??????? ???????:????????,????????????????????????? ????????:??????????,???????????????,??????????????????????

    15. ??DNR????????? DNR??? 63%?????????? ,31%???????? 92%?????????????? ???????? 36%??????????????????? 35%??????????????,??????????????? ????????????????DNR??,???13%???? ?????????????????DNR????????????

    16. ??DNR??????? 36%????DNR?37%?????DNR?27%???? 91%??????????????????,??????????????????????,9%?????????????

    17. ??DNR??????? ???? ?????????? ?????????DNR,?????????? ????????????,???????,??????,???????DNR ???????? ????????,??????????DNR ???????????,????????DNR ??????????????????????????????,?????DNR

    18. ??DNR??????? DNR??? ????DNR????????????DNR? DNR???????,???????????,????????DNR,???,??0??,?????????DNR DNR??? ????DNR?????????????,??DNR???????

    19. ??DNR??????? ???? ?????????????,??????????DNR???? ??DNR??????? ????DNR?????????????DNR??????????????????,????????

    20. ????????DNR?????????????? ????:????????DNR(n=73) DNR?????????DNR????????????????????????54%???? ??????DNR??????,??DNR??????1.9? ?DNR????????,??DNR??????3.1? ???????????????,??DNR???????????4.3?

    21. Thanks for your attention