運用多元方案提升安寧居家護理師執行在宅善終準備完整率

A Complex Program to Enhance Preparation Completeness of Patients Receiving Home Hospice Care for Good Death at Home

台灣南部文化多期望在宅善終，將在宅善終視為一種福報，本院安寧居家護理師執行在宅善終準備完整率僅75.3%，與病人心願違背，故引發之動機。本專案旨在提升安寧居家護理師執行在宅善終準備完整率，經現況分析原因為護理師管案天數短來不及指導、依個人經驗衛教、缺乏交班工具、無法掌握住出院動態、無專科課程、無規定收案時間及查核機制、家屬不知瀕死階段處理、擔心死亡診斷書不易取得、住所之限制、鄰居輿論之壓力，經執行對策含教育訓練、制定監控稽核、愛的叮嚀寶貝袋、電子交班日報表、LINE即時聯繫、轉介3天內完成收案、雙軌訊息提示住出院動態，改善後在宅善終準備完整率75.3%提升至90.1%，在宅善終率41.4%提升67.9%達目標。在宅安寧療護圓滿末期病人在宅善終心願，達高品質之善終。

Having good death at home is considered as a good fortune to most people in Southern Taiwanese culture. However, in the Hospital, only 75.3% of patients having home hospice care had good death at home. In other words, most of the patients are not able to have good death at home as they wish. Such occurrence gives the author a motivation to design and conduct this program, whose purpose is to enhance the preparation of the patients having home hospice care to receive good death at home. After analysis of the cause, the author found out the reason leading to the low preparation were mainly insufficient days of case management for nurses to give the instruction, provision of health education based on merely personal experience, lack of instruments for shift exchange, unable to understand and handle patients’status after discharge, none of specific courses and training for such domain, none of standards and regulations for case enrollment and checking mechanism, family members’lack of cognition to deal with the patients during the agonal stage, family members’concern about unable to obtain death diagnostic report, limitation of residence, as well as stress coming from neighbors’opinion. To improve the above-mentioned factors, this program includes several measures including educational training, checking and inspection mechanism, an instruction of health educational purpose, electronic daily report of shift exchange, mobile messaging app to contact with patients and family members, a regulated mechanism of case enrollment within three days, as well as two-way message notification of patient’s admission and discharge. After conduction of the program, the preparation completeness of home based hospice nurse for good death at home is increased from 75.3% to 90.1%, and the rate of patients’good death at home is also increased from 41.4% the planned target of 67.9%. Home hospice care can fulfill patients’wish of good death at home, and let them end of their lives in a higher quality.