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

The Hospice-Care Promotion Experiences of Multidisciplinary Care Providers in Residential Long-Term Care Facilities: A Qualitative Study

10.6224/JN.202210_69(5).06

簡惠慧(Hui-Hui CHIEN)；陳柏安(Bor-An CHEN)；朱正偉(Chen-Wei CHU)；游曼玲(Man-Ling YU)；賴甫誌(Fu-Chih LAI)

住宿式長期照護機構 ； 跨專業健康照護人員 ； 安寧療護 ； 質性研究 ； residential long term care facility ； multidisciplinary health care provider ； hospice care ； qualitative study

護理雜誌

69卷5期（2022 / 10 / 01）

34 - 43

繁體中文

背景：長照機構住民是高齡化社會推動安寧療護重要的族群之一，體現在地老化與善終重要的一環。實施五全（全人、全隊、全程、全家、全社區）安寧療護時，機構跨專業健康照護人員在評估、溝通與實施扮演著關鍵角色。目的：了解住宿式長照機構跨專業健康照護人員，實施安寧療護之經驗，作為未來住宿式長照機構實施安寧療護研究之參考。方法：本研究為質性研究設計，收案時間從2019年4月至7月，以半結構性訪談指引，進行一對一深入訪談共收集14位跨專業健康照護人員，平均每位訪談時間約為40－68分鐘，並以內容分析法進行資料分析。結果：歸納五主題為：「缺乏安寧識能與跨專業溝通」、「資源不足難以實施安寧療護」、「理性與內心的矛盾」和「面對瀕死的抉擇與不捨」、「住民與家屬身、心兩安的期待」。結論／實務應用：此經驗強化住宿式長照機構跨專業健康照護人員安寧療護知識的教育訓練、制定住宿式長照機構安寧療護標準作業流程和增加人力及環境設備資源以利實施住宿式長照機構安寧療護的重要性。

Background: In aging societies, residents of residential long-term care facilities (RLTCF) are a population that can significantly influence the success of efforts to promote hospice care and to achieve societal goals of domestic aging in place and good death. Multidisciplinary healthcare providers in RLTCF play vital roles in assessing, coordinating, and implementing the ＂five whole concepts＂ of hospice care. Purpose: To explore multidisciplinary healthcare providers' experiences with implementing hospice care in RLTCF. Study results may be referenced for future research into hospice care in RLTCF. Methods: In this qualitative study, one-on-one interviews were conducted with 14 multidisciplinary healthcare providers working for three hospital-affiliated RLTCFs in Northern Taiwan from April to July 2019. Each interview lasted between 40 and 68 minutes. Data were transcribed and then analyzed using the content analysis technique. Results: The emergent themes derived from participant experiences were ＂lack of hospice care literacy and multidisciplinary communication＂, ＂insufficient resources for hospice care implementation＂, ＂a dilemma between reasonability and sensibility＂, ＂quandary about and bearing from facing family dying＂, and ＂expectation of mental and physical well-being for family and residents＂. Conclusions/Implications for Practice: The experiences of the participants illuminate the importance of strengthening hospice care training for multidisciplinary RLTCF healthcare providers; establishing standard operating procedures; and increasing the manpower, environmental, and equipment resources available for implementing hospice care in RLTCF.

1. Lin, L.-C.(2018).The challenges of manpower in long-term care: Intergenerational learning approach from ageism to caregiving.The Journal of Nursing Research,26(4),228-230.
   連結：
2. 周琬琳, W.(2019)。突然「不想死」錯了嗎？－從尊重自主原則到尊重自主死亡權利的道德疑慮。應用倫理評論，67，125-139。
   連結：
3. 林艷君, Y.-C.,胡文郁, W.-Y.(2016)。社區高齡者預立醫療自主計畫之介入與推展。護理雜誌，63(4)，13-18。
   連結：
4. 洪一文, Y.-W.,陳純純, C.-C.,王英偉, Y.-W.,謝至鎠, J.-G.,江淑莞, S.-W.,張智容, C.-J.,王淑貞, S.-C.,吳淑貞, S.-C.(2016)。長照機構執行安寧緩和照護介入之成效初探。安寧療護雜誌，21(3)，245-257。
   連結：
5. 胡伊婷, I.-T.,潘湘如, H.-J.,陳如意, R.-Y.(2020)。漸凍人病人接受安寧療護之個案報告。安寧療護雜誌，24(2)，153-163。
   連結：
6. 陳冠綸, K.-L.,黃獻樑, H.-L.(2021)。心臟衰竭病人的安寧療護。台灣家庭醫學雜誌，31(2)，87-95。
   連結：
7. 陳柏安, B.-A.,鄭綺, C.(2019)。作為中間人的克服和協調：轉送長照機構住民至急診的護理經驗。新臺北護理期刊，21(2)，39-51。
   連結：
8. 陳銘渼, M.-M.,周春珍, C.-C.,許貴英, K.-Y.,顏永豐, Y.-F.,楊雅婷, Y.-T.,黃秀梨, H.-L.(2017)。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。護理雜誌，64(2)，130-135。
   連結：
9. 黃郁珊, Y.-S.,黃淑鶴, S.-H.(2017)。台灣居家安寧療護面臨困境之探討。安寧療護雜誌，22(2)，180-191。
   連結：
10. 萬宣慶, S.-C.,周盈邑, Y.-Y.,張冠民, G.-M.,董鈺琪, Y.-C.(2020)。癌症與非癌生命末期病人使用安寧療護對照護利用及費用的影響。台灣公共衛生雜誌，39(2)，187-201。
    連結：
11. 龍紀萱, C.-H.,李依臻, I.-J.(2018)。護理之家實施安寧療護服務措施之研究。台灣公共衛生雜誌，37(6)，638-650。
    連結：
12. 安寧緩和醫療條例，總統華總一義字第11000003571號令修正（2021，1月20日）。[Hospice Palliative Care Act, Hua-Zong-Yi-Yi-Tzu No.11000003570 amended. (2021, January 20).] https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020066
13. Anstey, S.,Powell, T.,Coles, B.,Hale, R.,Gould, D.(2016).Education and training to enhance end-of-life care for nursing home staff: A systematic literature review.BMJ Supportive & Palliative Care,6(3),353-361.
14. Chen, B.-A.,Chien, H.-H.,Chen, C.-C.,Chen, H.-T.,Jeng, C.(2019).Patient transfer decision difficulty scale: Development and psychometric testing of emergency department visits by long-term care residents.PLOS ONE,14(2),Article e0210946.
15. Chen, B.-A.,Lai, F.-C.,Tsao, L.-I.,Chien, H.-H.,Chen, C.-F.,Jeng, C.(2021).Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study.Journal of Advanced Nursing,77(6),2728-2738.
16. Chiang, S.-W.,Wu, S.-C.,Peng, T.-C.(2021).The experience to implement palliative care in long-term care facilities: A grounded theory study of caregivers.Asian Nursing Research,15(1),15-22.
17. Fernando, G.,Hughes, S.(2019).Team approaches in palliative care: A review of the literature.International Journal of Palliative Nursing,25(9),444-451.
18. Golafshani, N.(2003).Understanding reliability and validity in qualitative research.The Qualitative Report,8(4),597-606.
19. 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.
20. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Sage Publications.
21. Obermeyer, Z.,Makar, M.,Abujaber, S.,Dominici, F.,Block, S.,Cutler, D. M.(2014).Association between the medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer.JAMA,312(18),1888-1896.
22. Ten Koppel, M.,Onwuteaka-Philipsen, B. D.,Van den Block, L.,Deliens, L.,Gambassi, G.,Heymans, M. W.,Kylänen, M.,Oosterveld-Vlug, M. G.,Pasman, H. R. W.,Payne, S.,Smets, T.,Szczerbińska, K.,Twisk, J. W.,van der Steen, J. T.(2019).Palliative care provision in longterm care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE).Palliative Medicine,33(9),1176-1188.
23. Tsai, H.-H.,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.
24. Vaismoradi, M.,Jones, J.,Turunen, H.,Snelgrove, S.(2016).Theme development in qualitative content analysis and thematic analysis.Journal of Nursing Education and Practice,6(5),100-110.
25. Wang, Y.-T.,Yang, W.-S.(2019).Changes and trends in family structure in Taiwan, 1990 to 2010.Journal of Family Issues,40(14),1896-1911.
26. Worldwide Palliative Care Alliance. (2014). Global atlas of palliative care at the end of life. https://bit.ly/3vuZTBu
27. Xiong, B.,Freeman, S.,Banner, D.,Spirgiene, L.(2019).Hospice use and one-year survivorship of residents in long-term care facilities in Canada: A cohort study.BMC Palliative Care,18(1),Article 100.
28. 侯春梅, C.-M.,陳雅芳, Y.-F.,黃勝堅, S.-J.,楊文理, W.,蔡衣帆, Y.-F.(2015)。醫院與長照機構推動社區安寧整合性服務。北市醫學雜誌，12，130-148。
29. 梁淑媛, S.-Y.,莊宇慧, Y.-H.,吳淑芳, S.-F.(2012)。內容分析技巧在護理質性資料之初步應用。護理雜誌，59(5)，84-90。
30. 黃肇明, C.-M.,施華菁, H.-C.,劉嘉仁, C.-J.,黃勝堅, S.-J.,黃遵誠, T.-C.(2015)。臺北市立聯合醫院安寧療護現況及未來需求分析。北市醫學雜誌，12，9-20。
31. 鄒淑萍,陳秀卿,于宗梅, T.-M.(2021)。推動機構式安寧照護。北市醫學雜誌

1. 吳宏蘭(2023)。後疫情時代長照機構之安寧緩和照護溝通－護理人員的角色。護理雜誌，70(2)，14-19。
2. (2024)。長照機構照顧服務員生命態度、死亡恐懼與臨終照顧能力之研究。護理雜誌，71(5)，58-69。