居家安寧療護的挑戰──在宅善終

A Challenge for Home-Based Hospice Care: Good Death at Home

台灣人口結構快速老化，推估2065年將正式邁入超高齡社會。雖然進步的醫療科技可以讓重症病人延續生命，但是無法醫治其疾病，因此增加病人承受治療的痛苦與浪費醫療成本。安寧療護的理念與服務已經普及化，但是家屬與病人最擔憂的則是後續銜接的照顧問題。善終，是人生的最後一哩路，在宅善終是生命末期病人的最大心願，但是針對在宅善終，國內尚未有完善的指引與支持，在推廣與執行上，面臨限制與困境。本文藉由四個層面的探討：（一）臨終關懷的重要性；（二）臨終地點的選擇；（三）瀕死護理的教育需求；（四）在宅善終之挑戰與策略，包括「家庭面—與家屬的連結」和「教育面－護理教育的推行」，協助生命末期的病人可以在家安逝，家屬對於臨終末期病人不再擔憂與徬徨無助，達到在家往生的目標，讓人們安居其處，逝者適得其所。

Taiwan is expected to become a “super-aged” nation in 2065. Modern medical advancements, while extending the average human lifespan, has led to higher incidence of patient suffering and greater medical expenses due to chronic disease and terminal illnesses. As the concept and services of hospice and palliative care have become increasingly accepted by the public, the issue of final care for a good death has become a priority concern for both patients and their families. Experiencing a good death at home is a common last wish for terminal patients. However, guidelines for good death at home are still unavailable in Taiwan. The promotion of this concept thus remains a challenge with many limitations. This article aims to explore: (1) the importance of hospice care; (2) the selection of a proper location for good death; (3) the requirements for nursing education in the care of dying patients; and (4) the challenges and strategies of a good death at home, including “the family dimensionconnections with the family members” and “the education dimension-promotion of home-based dying in nursing education”. The goal is to help terminal patients experience a good death at home, to assist family members embrace the good death of their loved ones, and, eventually, to facilitate peaceful and successful home-based dying for both the patient and their family members.