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

An Experience of Providing Palliative Care in a Long-Term Care Facility: Let Good Death in Place Become a Feasible Reality

隨著人口老化及入住長期照護機構的老人增加，住民在機構內死亡的機會漸增，長期照護機構未來可能成為末期照護主要的場域，因此，提升機構內末期照護品質是當今重要的課題。目前有四類型安寧照護可供末期病人使用，包括醫院內的安寧病房或安寧共照服務及居家或社區安寧照護。但至今，長期照護機構內如何推動緩和照護仍缺乏討論，本文描述於機構照顧一位末期住民的過程，經由推動預立安寧緩和照護指示，連結社區安寧緩和照護團隊、營造溫馨陪伴環境、運用跨團隊服務緩解個案末期症狀、提供心理、社會及靈性支持與陪伴家屬經歷預期性哀傷等處置，協助末期住民尊嚴善終的護理經驗，此案例顯示末期住民留在熟悉的機構在地終老的可行性。

As the number of elderly in long-term care facilities (LTCFs) continues to increase, the number of resident deaths in these facilities is expected to increase. Thus, LTCFs may become a main focus for end-of-life (EoL) care in the future. Therefore, promoting quality EoL care in LTCFs should be a priority issue. Currently, the four types of hospice services include hospice wards and hospice-shareservices in hospitals and home hospice care and community hospice care in patient homes. However, to date, there has been limited discussion regarding promoting palliative care in LTCFs. The present article describes the LTCF nursing process that was used in caring for an EoL resident. Several interventions were used to assist this EoL resident to experience a dignified and peaceful death. These interventions included promoting the advance directive on hospice palliative care, linking community hospice palliative teams, ceating a warm environment, integrating the multidisciplinary team to alleviate the resident's distress symptoms, supporting the resident's psycho-social-spiritual needs, and accompanying family members through the process of anticipatory grief. This experience illustrates the feasibility of maintaining EoL residents in familiar LTCF environs in order to help them experience a good death in place.