台灣專科護理師在安寧居家照護的角色及展望

The Role and Prospective of Hospice Home Care for Nurse Practitioners in Taiwan

安寧緩和醫療是為幫助末期病人達成善終為目標，許多病人期待落葉歸根、在宅善終，因此安寧居家照護視為重要的照顧模式。國內亦發展安寧居家照顧及社區居家安寧照顧模式來協助末期病人完成返家照顧之心願，然而，研究顯示出院返家的病人及家屬對於後續照顧感到擔憂，以及醫師居家訪視之次數或頻率較低，均有可能影響末期病人返家接受居家療護之意願，而無法達成善終目標。臨床上因應癌症專科化的發展，安寧專科護理師的角色應運而生，主要醫療業務是照顧癌症及末期疾病的病人，但尚未參與安寧居家照顧，故本文旨在介紹國外居家安寧之執行及台灣安寧居家的現況與相關規範，以及安寧專科護理師在安寧居家的角色、論述在參與安寧居家緩和醫療前應具備的專業能力，期待培訓安寧專科護理師成為多功能性能獨當一面的居家醫療輔助者，未來若能調整安寧居家規範與給付制度外，讓安寧專科護理師可參與安寧居家訪視，與照護團隊共同合作，以提供末期病人高品質的照護。

 

The aim of palliative medicine is to help end-stage patients have a good death and die at home peacefully.Hospice home care is a specialized care model that achieves this goal. In Taiwan, hospice home care and community home care have been developed to assist end-stage patients in fulfilling their wish to go home and have hospice care at home. However, studies have shown that patients who were discharged from the hospice care unit and their families were concerned about difficulties in care and lower frequencies of physician visits. These factors could affect the willingness of end-stage patients to return home and receive hospice home care; therefore failing to achieve good death. In real world clinical practice, nurse practitioners are an essential part of the cancer specialized care model. Nurse practitioners provide optimized hospice care for end-stage patients in hospitals. However, their role in hospice home care has yet to be determined. This paper introduced the implementation of hospice home care in foreign countries and the situation and regulations of hospice home care in Taiwan. We evaluated the role of nurse practitioners in hospice home care and defined the essentials to providing an optimized hospice home care with the goal of training nurse practitioners to high professionalism.If the regulations and payment systems of the national health insurance for hospice home care were adjusted in the future, the participation of nurse practitioners in the hospice home care team could provide high quality hospice care.