善終之概念分析

Concept Analysis of Good Dying

「善終」是生命末期照顧之主要目標，但善終概念相當複雜，涵蓋層面廣泛，使得對善終的看法與應用也相當分歧。本文藉由Walker和Avant(2004)所發展之概念分析架構，進行善終之概念分析。從文獻歸納出其主要屬性為：舒適、保有控制感、維持身體之完整性、生命統整、完成、良好之溝通與關係、減少對他人造成負擔、作出貢獻，並建構各式案例作說明。善終之前置因素為：溝通與預立指示、生命末期照顧品質；後果為：病人安詳尊嚴地逝世於理想地點或環境、家屬較能調適悲傷、健康照顧者專業滿意度增加。基於對善終概念的了解，有助於專業人員評估末期病人及其家屬之需求、發展照顧計畫，以提升善終服務與末期照顧品質。

“Good dying” is the primary goal in end-of-life care. The concept of good dying is very complicated and broad. There were many different perspectives and applications. The purpose of this article is to clarify the concept of good dying. The analysis of this concept has been guided by Walker and Avant’s framework of concept analysis. The literature was reviewed to identify all uses regarding “good dying”. The defining attributes of good dying were identified as being comfortable, being in control, integrity, awareness or peace with impending death, completion, affirmation, good relationships with others, burden minimized, and contribution to others. Advance directives, communication, and quality of care in end of life were the antecedents of good dying. When good dying occurs, it leads to peaceful and dignified death, family satisfaction, positive bereavement process, and work satisfaction for care professionals. Knowing the concept of good dying would enable health professionals to assess the needs of the terminally-illed patients and their families, and to develop care plans to improve the quality of care at the end of life.