提升內科病房生命末期病人善終準備完整率

Improving the Integrity of End-of-Life-Care Preparations for Terminally-Ill Patients in the Medical Ward

10.6386/CGN.202009_31(3).0007

鄭玉伶(Yu-Ling Cheng)；施宥亘(Yu-Hsuan Shih)；林淑麗(Shu-Li Lin)；林怡君(I-Chun Lin)；吳徐慧(Hsu-Hui Wu)

生命末期 ； 善終護理 ； 安寧 ； terminally-ill ； end-of-life care ； hospice

長庚護理

31卷3期（2020 / 09 / 01）

382 - 394

繁體中文

醫療科技的進步雖延長國人平均餘命，控制許多急、慢性病惡化，卻無法避免疾病進展為末期及面臨死亡，因此如何提升末期病人的生活品質，使其有尊嚴、安詳的離世，成為照護此類病人的重要議題。本病房2018年度接受非預期性心肺復甦的末期病人由3位增加為8位，急救成功者僅2位，病人在生命末期時，飽受醫療維生儀器侵入之苦而無法善終，引發改善動機，故專案目的旨在提升內科病房末期病人善終準備完整率。經調查分析原因：護理人員善終照護認知不足、末期照護溝通技巧不足、衛教單張繁瑣、未有系統交班已作項目，且無充足宗教用品。藉由在職教育，製訂衛教單張及溝通語錄，擬訂流程標準化及交班內容，設置善終百寶箱及查核制度，將善終準備完整率由18.2%提升為83.3%，達專案目的。讓善終成為對病人的最後祝福，對家屬的最大慰藉，達生死兩相安。

Death is inevitable no matter how medical technology has been improving. It is important to improve the quality of life in terminally ill patients and help them end their life in peace with dignity. In our ward, the number of patients at the end-of-life receiving cardiopulmonary resuscitation increased from three to eight in 2018, and only two were successfully rescued. The patients usually suffered unnecessary impact of aggressive interventions at the end of life. The purpose of this project was to improve the integrity of end-of-life-care preparations in the medical ward. Five problems were identified in the management of care: (1) lack of knowledge about providing appropriate care to end-of-life patients; (2) insufficient communication between staff members and patient/families on end-of-life care; (3) teaching guidance was too complicated; (4) inadequate systematic hand-off reporting; and (5) lack of sufficient religion related items. A variety of strategies was implemented to improve the integrity of end-of-life care, including providing continuous educational and training programs, creating health education leaflets and communication quotations, and developing a standard of care and hand-off reporting protocol. With the implementation of the project, the integrity of end-of-life careincreased from 18.2% to 83.3%. The hospice is the last blessing to the patient. It provides comprehensive comfort to the family and tranquility to the patient at the end of life.

1. Gaeta, S.,Price, K. J.(2010).End-of-life issues in critically ill cancer patients.Critical Care Clinics,26(1),219-227.
2. 全國法規資料庫=Laws Regulations Database of the Republic of China(2001)。安寧緩和醫療條例。安寧療護雜誌，6(1)，43-45。
3. 李選, S.(1993)。安寧護理模式於臨終護理中之應用。護理雜誌，40(2)，67-72。
4. 孫婉娜, W. N.,蘇靖幃, J. W.,李淑娟, S. X.,何孟修, M. S.,林靖雯, C. W.,林怡初, Y. C.,許心恬, H. T.(2017)。生命末期醫療決策概念分析。高雄護理雜誌，34(3)，59-68。
5. 馬瑞菊, J. C.,蔡惠貞, H. C(2013)。提供重症善終服務：改善加護病房生命末期照護。馬偕護理雜誌，7(1)，7-13。
6. 張嘉容, C. J.,陳瑞貞, J. C.,張嘉琦, C. C.(2017)。運用「臨終照護」概念提升加護病房末期重症病人之照護品質。台灣醫學，21(4)，394-398。
7. 許茹琁, J. H.,張淑敏, S. M.,曾愛倫, A. H.,黃漢倫, H. L.,李維玲, W. L.(2017)。提升加護病房善終準備及照護完整率。健康管理學刊，15(1)，81-94。
8. 陳亭儒, T. R.,胡文郁, W. Y.(2011)。善終之概念分析。長庚護理，22(1)，45-52。
9. 陳學凌, S. L.,羅筱芬, H. F.(2016).死病人護理．內外科護理學.台北市=Taiwan, ROC:華杏=Farseeing.
10. 蔡麗雲, L. Y.,賴允亮, Y. L.,顧乃平,李英芬, N. P.,劉姵妤, I. F.,劉景萍, P. Y.,曾煥堂, H. T.(2018).安寧緩和護理學.華格那=Wagner.

1. (2024)。提升新生兒加護病房護理師執行安寧療護完整率。護理雜誌，71(3)，75-84。