長期照護機構提供緩和照護之護理經驗－讓在地善終成為可行的事實

An Experience of Providing Palliative Care in a Long-Term Care Facility: Let Good Death in Place Become a Feasible Reality

10.6224/JN.000032

陳銘渼(Ming-Mei Chen)；周春珍(Chun-Chen Chou)；許貴英(Kuei-Ying Hsu)；顏永豐(Yung-Feng Yen)；楊雅婷(Ya-Ting Yang)；黃秀梨(Hsiu-Li Huang)

緩和照護 ； 預立指示 ； 善終 ； 長期照護機構 ； palliative care ； advance directive ； good death ； long-term care facility

護理雜誌

64卷2期（2017 / 04 / 01）

130 - 135

繁體中文

隨著人口老化及入住長期照護機構的老人增加，住民在機構內死亡的機會漸增，長期照護機構未來可能成為末期照護主要的場域，因此，提升機構內末期照護品質是當今重要的課題。目前有四類型安寧照護可供末期病人使用，包括醫院內的安寧病房或安寧共照服務及居家或社區安寧照護。但至今，長期照護機構內如何推動緩和照護仍缺乏討論，本文描述於機構照顧一位末期住民的過程，經由推動預立安寧緩和照護指示，連結社區安寧緩和照護團隊、營造溫馨陪伴環境、運用跨團隊服務緩解個案末期症狀、提供心理、社會及靈性支持與陪伴家屬經歷預期性哀傷等處置，協助末期住民尊嚴善終的護理經驗，此案例顯示末期住民留在熟悉的機構在地終老的可行性。

As the number of elderly in long-term care facilities (LTCFs) continues to increase, the number of resident deaths in these facilities is expected to increase. Thus, LTCFs may become a main focus for end-of-life (EoL) care in the future. Therefore, promoting quality EoL care in LTCFs should be a priority issue. Currently, the four types of hospice services include hospice wards and hospice-shareservices in hospitals and home hospice care and community hospice care in patient homes. However, to date, there has been limited discussion regarding promoting palliative care in LTCFs. The present article describes the LTCF nursing process that was used in caring for an EoL resident. Several interventions were used to assist this EoL resident to experience a dignified and peaceful death. These interventions included promoting the advance directive on hospice palliative care, linking community hospice palliative teams, ceating a warm environment, integrating the multidisciplinary team to alleviate the resident's distress symptoms, supporting the resident's psycho-social-spiritual needs, and accompanying family members through the process of anticipatory grief. This experience illustrates the feasibility of maintaining EoL residents in familiar LTCF environs in order to help them experience a good death in place.

1. 趙可式(2015)。安寧療護是普世價值且為護理的本質。護理雜誌，62(2)，5-12。
   連結：
2. Detering, K. M.,Hancock, A. D.,Reade, M. C.,Silvester, W.(2010).The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial.BMJ: British Medical Journal,340,c1345.
3. Fosse, A.,Schaufel, M. A.,Ruths, S.,Malterud, K.(2014).End-of-life expectations and experiences among nursing home patients and their relatives-A synthesis of qualitative studies.Patient Education & Counseling,97(1),3-9.
4. Givens, J. L.,Selby, K.,Goldfeld, K. S.,Mitchell, S. L.(2012).Hospital transfers of nursing home residents with advanced dementia.Journal of the American Geriatric Society,60(5),905-909.
5. Hulme, C.,Wright, J.,Crocker, T.,Oluboyede, Y.,House, A.(2010).Non-pharmacological approaches for dementia that informal carers might try or access: A systematic review.International Journal of Geriatric Psychiatry,25(7),756-763.
6. Jeong, S. Y. S.,Higgins, I.,McMillan, M.(2011).Experiences with advance care planning: Older people and family members' perspective.International Journal of Older People Nursing,6(3),176-186.
7. Kramer, B. J.,Boelk, A. Z.(2015).Correlates and predictors of conflict at the end of life among families enrolled in hospice.Journal of Pain and Symptom Management,50(2),155-162.
8. Kupeli, N.,Leavey, G.,Moore, K.,Harrington, J.,Lord, K.,King, M.,Jones, L.(2016).Context, mechanisms and outcomes in end of life care for people with advanced dementia.BMC Palliative Care,15
9. Laging, B.,Ford, R.,Bauer, M.,Nay, R.(2015).A meta-synthesis of factors influencing nursing home staff decisions to transfer residents to hospital.Journal of Advanced Nursing,71(10),2224-2236.
10. Lo, Y. T.,Wang, J. J.,Liu, L. F.,Wang, C. N.(2010).Prevalence and related factors do-not-resuscitate directives among nursing home residents in Taiwan.Journal of the American Medical Directors Association,11(6),436-442.
11. Miller, S. C.,Lima, J. C.,Looze, J.,Mitchell, S. L.(2012).Dying in U.S. nursing homes with advanced dementia: How does health care use differ for residents with, versus without, end-of-life medicare skilled nursing facility care?.Journal of Palliative Medicine,15(1),43-50.
12. Nazarko, L.(2009).A time to live and a time to die: Palliative care in dementia.Nursing & Residential Care,11(8),399-401.
13. Shanley, C.,Whitmore, E.,Conforti, D.,Masso, J.,Jayasinghe, S.,Griffiths, R.(2011).Decisions about transferring nursing home residents to hospital: Highlighting the roles of advance care planning and support from local hospital and community health services.Journal of Clinical Nursing,20(19-20),2897-2906.
14. Tsai, H. S.,Tsai, Y. F.,Huang, H. L.(2016).Nursing home nurses' experiences of resident transfers to the emergency department: No empathy for our work environment difficulties.Journal of Clinical Nursing,25(5-6),610-618.
15. van der Steen, J. T.,Radbruch, L.,Hertogh, C. M. P. M.,de Boer, M. E.,Hughes, J. C.,Larkin, P.,Volicer, L.(2014).White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care.Palliative Medicine,28(3),197-209.
16. van Soest-Poortvliet, M. C.,van der Steen, J. T.,de Vet, H. C. W.,Hertogh, C. M. P. M.,Deliens, L.,Onwuteaka-Philipsen, B. D.(2015).Comfort goal of care and end-of- life outcomes in dementia: A prospective study.Palliative Medicine,29(6),538-546.
17. World Health Organization(2004).Palliative care: Symptom management and end-of-life care.Geneva, Switzerland:Author.
18. Worth, H.,Schacher, C.,Dethlefsen, U.(2009).Concomitant therapy with Cineole (Eucalyptole) reduces exacerbations in COPD: A placebo-controlled double-blind trial.Respiratory Research,10

1. 簡翠薇,陳美麗,陳依琳,余琇楓(2020)。運用輔助療法於長期照護機構乳癌末期長者的護理經驗。志為護理-慈濟護理雜誌，19(6)，115-124。
2. 簡惠慧,賴甫誌,游曼玲,陳柏安,朱正偉(2022)。住宿式長照機構跨專業健康照護人員實施安寧療護經驗之質性研究。護理雜誌，69(5)，34-43。
3. 謝至鎠,胡文郁,王淑貞(2017)。老人安寧緩和療護的需求及處置探討。領導護理，18(2)，3-12。
4. (2021)。後疫情下機構式晚期失智者安寧照護倫理議題初探。社區發展季刊，175，179-193。
5. (2023)。佛教生死觀運用於安寧療護靈性照顧。亞東學報，43，15-25。
6. (2024)。強化居家醫療及安寧療護善終－澎湖經驗。醫學與健康期刊，13(1)，107-118。