護理之家實施安寧療護服務措施之研究

Service measures of hospice care in nursing homes in Taiwan

目標：目前國內護理之家面對疾病末期與瀕死階段住民提供之相關服務，尚有待進一步探討。本研究目的企圖建構護理之家安寧療護之服務措施，以供相關單位、機構與實務專業人員參考。方法：依地理區域於全國舉辦四場次焦點團體會議，參加對象為立案且經衛生福利部評鑑為甲等（含）以上護理之家的實務工作者，共計34人參與。結果：建構護理之家安寧療護服務措施包含三個面向與十二個措施：(一)解決人力資源不足：建立機構內的照護團隊、完善的教育訓練、機構間之跨團隊合作、提升對安寧的認知；(二)建立良好制度：解決死診開立問題、簽署DNR措施、結合相關政策、設立安寧療護專區；(三)面對死亡的藝術：安寧接案考量、促進有效溝通、全人照護面向、往生後事與悲傷輔導。結論：應先了解推行安寧療護服務措施面臨的困境，再者評估現有的資源，從人力資源與制度建立進行改善。最後，建議從政策面、機構面與人員面解決所面臨的困境，以利安寧療護實施於護理之家。 Objectives: In Taiwan, the services currently available for terminally ill nursing home residents require further discussion. This study established service measures of hospice care in nursing homes for the reference of related units, facilities, and practicing professionals. Methods: Four focus group meetings were convened in Taiwan according to geographic location. Thirtyfour practicing professionals from registered nursing homes with accreditation of A or higher by the Ministry of Health and Welfare attended the meetings. Results: The establishment of service measures of hospice care in nursing homes comprised 3 aspects, with a total of 12 measures: (1) resolving labor shortages (establishing caregiving teams within the facility, providing comprehensive education and training, and promoting interfacility teamwork and hospice care knowledge), (2) establishing an appropriate system (resolving problems concerning the issuing of death certificates and DNR promotion, incorporating related policies, and establishing designated areas for hospice care), and (3) confronting death (considering hospice admission, facilitating effective communication, implementing holistic health care, assisting in funeral affairs, and providing grief counseling). Conclusions: To facilitate the implementation of service measures for hospice care in nursing homes, the procedure should be started by considering the difficulties associated with implementation, followed by the evaluation of current resources, improvement of the system and human resources situation, and finally, addressing of the dilemma faced by the relevant policymakers, organizations, and personnel.