後疫情時代長照機構之安寧緩和照護溝通──護理人員的角色

Hospice Palliative Care Communications in Long-Term Care Facilities in the Post-Pandemic Era: The Role of Nurses

在大流行時期COVID-19的高傳染性、重症與死亡嚴重地影響民眾。嚴格的防疫管控與限制措施，亦影響個案安寧緩和與生命末期照護的討論及家屬的哀傷撫慰。在疫情期間，提供清晰、簡明與正確的照護訊息是有效緩解個案與家屬焦慮與恐懼的良方。在疫後時代，長照機構的護理人員在安寧緩和照護的溝通，應該積極扮演促進者、支持者、代言者及協調者的角色。本文提出U-R-PEACE之方法，透過理解（understanding）、尊重（respect）、計畫（plan）、表達（expression）、行動（act）、照護（care）、教育（education）等方式，儘早開啟安寧緩和照護的溝通，瞭解住民與家屬的期望與偏好，促進他們與醫師共同討論照護計畫，並尊重其決定，以維護個案最佳的生活與死亡品質，達成生死兩相安的全人、全家及全程照護的目標。

The high infectivity, severity, and mortality of COVID-19 led to the devastating impact this disease has had on people’s lives during the pandemic. The related strict infection controls and restrictions affected how palliative and end-of-life care could be discussed with clients and how family members could deal with their grief afterward. However, the provision of concise and accurate information by healthcare providers was found to help ease anxiety and fear during the COVID-19 pandemic. In the post-pandemic era, nurses should actively facilitate, support, advocate for, and coordinate palliative care communications with long-term care facility residents. Thus, the Understanding, Respect, Planning, Expression, Act, Care, and Education (U-R-PEACE) communication strategy is introduced and suggested in this article for this purpose. Palliative care communications should be commenced by nurses as early as possible. Moreover, nurses may help residents optimize their quality of life and death by understanding their and their family members’expectations and preferences, encouraging them to discuss their care plan with doctors, and respecting their decisions. The care goals of achieving a good death and relief of suffering may also be promoted through care that is delivered using a holistic, person/family-centered care approach.