住宿式長照機構跨專業健康照護人員實施安寧療護經驗之質性研究

The Hospice-Care Promotion Experiences of Multidisciplinary Care Providers in Residential Long-Term Care Facilities: A Qualitative Study

背景：長照機構住民是高齡化社會推動安寧療護重要的族群之一，體現在地老化與善終重要的一環。實施五全（全人、全隊、全程、全家、全社區）安寧療護時，機構跨專業健康照護人員在評估、溝通與實施扮演著關鍵角色。目的：了解住宿式長照機構跨專業健康照護人員，實施安寧療護之經驗，作為未來住宿式長照機構實施安寧療護研究之參考。方法：本研究為質性研究設計，收案時間從2019年4月至7月，以半結構性訪談指引，進行一對一深入訪談共收集14位跨專業健康照護人員，平均每位訪談時間約為40－68分鐘，並以內容分析法進行資料分析。結果：歸納五主題為：「缺乏安寧識能與跨專業溝通」、「資源不足難以實施安寧療護」、「理性與內心的矛盾」和「面對瀕死的抉擇與不捨」、「住民與家屬身、心兩安的期待」。結論／實務應用：此經驗強化住宿式長照機構跨專業健康照護人員安寧療護知識的教育訓練、制定住宿式長照機構安寧療護標準作業流程和增加人力及環境設備資源以利實施住宿式長照機構安寧療護的重要性。

Background: In aging societies, residents of residential long-term care facilities (RLTCF) are a population that can significantly influence the success of efforts to promote hospice care and to achieve societal goals of domestic aging in place and good death. Multidisciplinary healthcare providers in RLTCF play vital roles in assessing, coordinating, and implementing the ＂five whole concepts＂ of hospice care. Purpose: To explore multidisciplinary healthcare providers' experiences with implementing hospice care in RLTCF. Study results may be referenced for future research into hospice care in RLTCF. Methods: In this qualitative study, one-on-one interviews were conducted with 14 multidisciplinary healthcare providers working for three hospital-affiliated RLTCFs in Northern Taiwan from April to July 2019. Each interview lasted between 40 and 68 minutes. Data were transcribed and then analyzed using the content analysis technique. Results: The emergent themes derived from participant experiences were ＂lack of hospice care literacy and multidisciplinary communication＂, ＂insufficient resources for hospice care implementation＂, ＂a dilemma between reasonability and sensibility＂, ＂quandary about and bearing from facing family dying＂, and ＂expectation of mental and physical well-being for family and residents＂. Conclusions/Implications for Practice: The experiences of the participants illuminate the importance of strengthening hospice care training for multidisciplinary RLTCF healthcare providers; establishing standard operating procedures; and increasing the manpower, environmental, and equipment resources available for implementing hospice care in RLTCF.