提昇居家護理臨終照護指導完整性

Improve the Comprehensiveness of Home Hospice Care Guidance

根據內政部2010年統計65歲以上老年人口比為10.74%，其中罹患慢性疾病佔75.9%，十大死因中，以慢性病惡化而死亡占最多，本單位為某醫學中心居家護理單位，照顧的個案多為高齡長者且併有多種慢性疾病，日常生活照顧需依賴他人提供，身體功能隨著時間逐漸退化，死亡已是無法避免的過程。臨床發現居家護理師提供個案臨終照護指導內容及時機並不一致，人員對臨終照護指導認知僅70%，臨終照護指導記錄完整性僅65%，為提昇臨終照護品質，期望透過事前的臨終照護指導討論及準備，以避免家屬因應個案突發狀況慌亂，故進行專案改善，透過設立「居家護理臨終照護指引」提供一致性指導標準、明訂指導時機、辦理相關在職教育等改善措施，以確保臨終照護指導品質。專案實施後發現，護理人員對臨終照護認知由70%提昇至100%，臨終照護指導紀錄完整性由65%提昇至100%，實際觀察護理人員執行臨終照護指導的完整性達100%，確實有效提昇人員執行臨終照護指導的完整性，家屬對於臨終指導滿意度達97.6%，家屬也常感謝護理師事先的提醒指導，讓家屬們能有時間充分討論及準備臨終事宜，以達個案善終，生死兩相安的目的。

According to the Ministry of Interior, elders age 65 and above composited 10.74% of total population in 2010, with 75.9% of them suffer from chronic conditions which the worsen of chronic conditions are amongst the top ten causes of death. A home care unit from undisclosed medical center, most of our cases is elderly co-morbid with multiple chronic conditions. Along with the eventually decline of functional abilities, most of their activities of daily living have to rely on others and the process towards death become inevitable. Clinically found that the hospice care guidance provided by home care nurses is not consistent and not timely. Their knowledge in the hospice care is only 70% while the comprehensiveness of the guide record is 65%. In order to improve the quality of hospice care, we intended to provide the families with guidance and preparation to prevent the panic caused by unexpected situation. Through a specific project, the ‘Guidelines of home hospice care' was established and the unity standard and timing of the guidance were set. Besides, the related continuing education was also adopted in order to assure the quality of hospice care guidance. After the project implied, knowledge of nurses in hospice care and the comprehensiveness of guide record increased to 100% from 70% and 65% respectively, while the completeness of hospice care guidance in practical observation was also 100%. The families' satisfaction on the hospice guidance was 97.6% and they were grateful for allowing them more time and preparation before deathbed.