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????,?????DNR

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Title: ????,?????DNR


1
????,?????DNR
  • ?????????

2
?????
  • ??????????????
  • ???????????????????
  • ????????????????

3
??????
  • ????????????????????,???????????????????????????,?
    ???????????,??????????????????,???????!
  • ??????????????????????,??????????????,???????????
    ???????

4
????????
  • ???????2002??????
  • ?????????????????????????????,????????????????????
    ??????????????,???????,????????????
  • ??????,??????????????????????????????????????????
    ???,??????????????????????????World Health
    Organization. (2002). National cancer control
    programmes Policies and managerial guidelines.
    (2nd ed.). Geneva World Health Organization.

5
????????(????)
  • ????(?)?
  • ?????
  • ?????
  • ?????
  • ????(?)?
  • ????
  • ????
  • ????
  • ????(?)
  • ?????
  • ??
  • ??
  • ??
  • ??
  • ????(?)?????
  • ????
  • ????
  • ????
  • ????

????? ??
6
????????
  • ???????? ? ????
  • ????????????
  • ??????????

???????????????????????????? ??????????????????
7
???? vs. ????
  • ????(palliative care)??????(hospice care)?????
  • ??????????(palliative medicine)?????(palliative
    nursing)????????????????????,?????

8
Palliative vs. Hospice Care
  • Division made between these two terms in the
    United States
  • Hospice is a type of palliative care for those
    who are at the end of their lives.

Palliative Care
End of life care
Image courtesy of http//www.ersj.org.uk/content/3
2/3/796.full
9
???? vs???
  • ???????????????,??????????????
  • ?????????????? ???????????????

10
Palliative Care Settings
Anywhere
??????????? ????????
11
????????
????????
????
????
????
????
12
????????
  • Death
  • Diagnosis

???????
  • ?????
  • ????
  • ?????
  • ?????
  • ??????

13
?????????
14
2009.09 ??????????????????????
  • ??????,??????
  • ??????
  • ????????
  • ?????????
  • ?????????,????
  • ??
  • ???????
  • ??????????????
  • ??????
  • ????

15
????????
  • ????????????,??????????1?2??????
  • ?????????????,???????????????
  • ?????????????????????
  • ????????????????????
  • ????????????????????????????????????????

16
?????????????
  • ??????????
  • ?????????
  • ????????
  • ???????????????
  • ??????????????
  • ?????????
  • ??????????????

17
??????(?)???
  • 1.????--???????????(???)?
  • 2.????--????,??????
  • 3.????--????????,?????????????
  • 4.????--??????????????????????????????,??????????
  • 5.???????????

18
??????? (1)
  • ???1993 ????????????????????,?????????????????????
  • 65 ?????????????,2012????11.15,(???,2012),?114?(2
    025?)???20,??????????????????????????????????????
    ???,?????????????

19
??????? (2)
  • ???????????,???????????????????????,????(end
    of-life care)?????????,??????????????????????????
    (Geriatric palliative care),??????????????????????

20
???????(3)
  • ?????????,??????????,????????????
  • ???????????????????????,???????????,??????????????
    ???,????????,?????????,????????

21
????
  • ?? ?
  • ?? ?
  • ?? ??
  • ?? ??
  • ?? ??
  • ????????

????????????
22
???????
  • ????????????????????????,?????????????
  • ????????????????,?????????????????????,?????????

23
????????
  • ????
  • ????????
  • ??????
  • ????
  • ??????
  • ????????
  • ????

24
????????????????
  • ????????????????
  • ???????????????
  • ?????????????????
  • ?????????????????
  • ???????????????
  • ?????????????????

25
????????????
  • ??????????,????????
  • ??????
  • ?????????
  • ????????

26
??????????

???? (??)
???? (??)
? ? (???)
27
?????????
????2007?4???????????????
????
?????
????
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????
????
????
???????
????
?????? ?????? ???? ?????? ?????? ????
????
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????
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????
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???????
28
?????? ????????
  • ??????????????????????????????????????,???????????
    ?????????????????????,???92?3????,???????????,????
    ??????????????,?????????,?????????????,?????????

29
???????????
  • ??????????????????????,???????????????????????????
    ,??????????????????????????,???????????????????,??
    ????????,?????????????????????

30
????????????
  • ???????????,?103?1?1??????????????
  • ????????????(??)
  • ??????????13?????????8???
  • ?????4????????

31
??????????
  • ????????????,??????????????
  • ???????????????????,????????,??????

32
?????????102?7?1???
  • ?????????/????????1?????,26????????????,?????????
    ??????7?1?????????,????????????,??????????????????
    ??,????????,??????????? ??????,?????,?????????????
    ,??????????,????????????????????,??????????

33
????? ???????
  • ??????,??????????,??????????????????????,?????????
    ????????,?????????,???????????

34
??????????
  • ???????????????????????????,??????????????????????
    ????????????????,??????????????????,?????????

35
??????????
  • ??????????,?????????????????????????????,
  • ?????????????????80??(?40??????)??,
  • ??????????20??,?????????????????????

36
??????????
  • ???????????????????13?????????????8??(????????2??,
    ????e-learning),???????????????????????1??????????
    ??2???
  • ?????????????????????????????,????????
  • ????????????????????????
  • ????????????
  • ?????????4??(????e-learning)?


37
??????????
38
??????????
39
??????????
40
??????????
  • ???????????????2????,??????????,??????2??,????????
    ????,??????
  • ?????????????45????
  • ??????????????????????????????????????????????????
    ??????

41
????????
42
???????
  • ???????
  • ???????? ????
  • ??????????????????????????????
  • ????????
  • ???????????

43
????????????????
???? ?????
?? ??
??????
??? ???? ???
?? ??
44
??????????????
  • ???????
  • ?????????
  • ???????????
  • ???????????????????????????????,?????????????????
    ????????????????????

45
???????????????????
  • ???,98????????????????????????????????????????????
    ???????,??????????????????????????????????,???????
    ???????????????????

46
???????????????
  • ????????????????????,?????5???,???????????????????
    ??????????????????????????????????????????2010.09.
    18

47
????????
  • ???????????????????????,????????????????????????,
  • ????????????????????,??????????????

48
?????? ???14
2010?7?4??????????????????????????????,?????40????
?????14?(?????)
49
????????????
  • ????????
  • ????????????
  • ??????????????
  • ????????????

50
????????Advance Care Planning(ACP)
  • ???????????????,??????????????????,??????????????
    ?
  • ?????????????
  • ????????,??????(No decision about me without me)?

51
?????????????
  • ????????????
  • ???????
  • ?????????
  • ?????????
  • ?????????
  • ??????????????????
  • ???????

52
?? DNR
  • DNR ????2000? 5? 23???????????????,?????????(Do
    Not Resuscitate),
  • ??????????????????,????????????????????,???????(CP
    R)?,?????????,????????????

53
DNR ??
  • ??DNR ???????????????,???????,?????????,
  • ????????????,???????????,??,???????,??????????????
    ?????????????????

54
DNR ??
  • ??DNR ?????????
  • ??DNR ?????????
  • ??DNR ???????
  • ???????????,?????????????
  • ?????????,DNR??????,???????????

55
???????????
  • ??????(???)????????????????????????????,??????????
    ?(????????????????????????)?
  • ????????,????????????????????

56
??????
  • ???/?????
  • ????????????????
  • ?????????????????,??????(withhold)???(withdraw)?

57
????????
  • ?89???????,???????
  • ?89????????????
  • ??????????,????????????
  • ???????????
  • ??????????????????,??????.


58
????????
  • ?? ??89?
  • ??????????????????????
  • ????? 91?
  • ??????????????????????

59
????????
  • ????? 100?
  • ???6-1????IC???????????
  • ???????????????????????????????????????????????,?
    ????????????????

60
????????
  • ????? 102?
  • ???????????????
  • ?????????????????????
  • ?????,???????????????,??????????????????

61
????????
???
  • ????????????????????????????,??????????????,?????
    ???
  • ???????????,???????????,?????????????????????????

Yu - Ling
62
????????
???
  • ???????????????????????,?????????????????????????
    ??????????????????????????????
  • ????????????????????,??????,??????????????

63
???????????(????????????????)
  • ?????????????????
  • ?????????????????????????,????????????
  • ?????????,?????????????????
  • ??????????????????,??????????,????????????????????
    ????????????????????????????

64
????????
  • ?????????????,???????????????,
  • ??????????????????????????,
  • ?????????????????,????????????????????,???????????
    ????

65
?????????,???? (1/2)
  • ?????
  • ??20????????????
  • ??
  • ???IC??? --gt????????.??????,??????????????,???????
    ?????,??????,?????????
  • ?????,????????????

66
?????????,???? (2/2)
  • ???????DNR???,???????????????
  • ???????????????
  • ????????????????????????????????????????????????

Yu - Ling
67
??????????????
  • ???????????????????????

68
????,???DNR???????????????????????? 2012?12?21?
  • ??????????,???????????????????,??????????????????
    ?????????,?????????????,?????????????????

69
????????????
  • ?????????,?????????????????
  • ?????????????????????,??????????????
  • ???????????????
  • ????????????????
  • gt ????

70
(??????)?????? (???)?????????
6 ????? ???????
55 ???
3??
7 ???????
4 ????
??
??
1
7
2 ???????
6 ????
71
  • ???????????DNR??????????????CPR,????????

72
???????? (??????????????????)
  • ??????????,?????????????????,?????????????????????
    ????

73
(No Transcript)
74
DNR ???
  • ?????????,????,???????

75
DNR ??????
76
???IC???????????????(102?8?12??????)(1/2)
  • ??
  • ?1???????
  • ?2?????????
  • ?3???????????
  • ?4???????????????????????????
  • ?5????????????????
  • ?6??????????????????
  • ?7????????????????????
  • ??????????
  • ?????102.05.15????????

77
???IC???????????????(102?8?12??????)(2/2)
  • ??
  • ?A??????????
  • ?B?????????????????
  • ?C???????????????????
  • ?D?????????????????????
  • ?E?????????????????????????????????????
  • ?F??????????????????????????
  • ?G????????????????????????????
  • ?H??????????????????????????????

78
?????
79
DNR????????
80
(No Transcript)
81
(No Transcript)
82
(No Transcript)
83
????????
0800-008520
84
????????????????,???, 0800-220-927?
  • ?????????????????,???????????????????????,????????
    ,??????????,?102?3??,?????????????????0800-220-927
    (???,???),??????????????????,??????????,??????????

85
??
  • ?????????????-??????????????,????????????,?????
    ???????????????????????????????????????

86
???? ????
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