安寧緩和護理之教育觀

The Perspectives on Palliative Nursing Education

世界各國老化及慢性病人口日益增多，醫護人員將面臨提供生命末期照護的機會增加，故生命末期醫療照顧之教育議題益形重要。本文參考國外安寧緩和醫護教育的發展歷程，考量文化殊異性，加上國內推展安寧緩和醫療「住院、居家及共同照護」工作模式之經驗，旨在闡述我國臨床常見之末期照護議題、安寧緩和護理正式養成教育與繼續教育之現況發展以及末期照護核心能力的培育，並參考Kern、Thomas和Howard（1998）所提出安寧緩和照護「課程發展六步驟」，簡要說明課程發展每個步驟之注意事項。最後，反思安寧緩和護理課程發展遭遇之「瓶頸、挑戰與反思」，以強化醫護人員實踐醫學人文關懷，提升臨床生命末期倫理思辨能力與照護知能，鼓勵撰寫本土教課書或發展多媒體e化輔助教材，期能提供以「病人為中心、家庭為單位以及社會文化脈絡為導向」的安寧緩和護理，回應台灣社會人口老化、末期病童以及慢性病病人之安寧緩和照護需求。

The numbers of people who suffer from age-related and chronic diseases have been increased worldwide. This has lead to an increased emphasis in the medical community on end of life care. This paper references the processes followed overseas in developing palliative care education programs as well as the domestic experiences promoting the hospitalization, home care, and ＂share care＂ models of palliative care. Particular emphasis is given to considerations of cultural diversity in palliative care. The aim of this paper is to elaborate on the prevalent clinical end-of-life care issues that are faced in Taiwan, to cultivate core capabilities in end-of-life care, to elicit the current status and development of formal nursing education, and to promote continuing education in palliative care. Kern formulated a six-step approach to curriculum development in education and the details has been discussed. Finally, this paper reflects on the current bottlenecks, challenges, and expectations related to palliative care curriculum development in order to help medical professionals further put humanistic and social care into practice, increase ethical reflection in end of life care and nursing competency, and encourage the creation of localized textbooks / multimedia e-teaching materials. The fostering of ＂patient-centered, family unit and the social-cultural contexture＂ for palliative care professionals and the ability to respond to the needs of terminal patients and patients with chronic diseases are critical to increasing the quality of Taiwan healthcare.