非安寧病房護理人員照護生命末期病人之經驗

The Nurse Experiences for Caring End of Life Patients in Non-Hospice Wards

目的：現今國內安寧療護發展日益茁壯，但生命末期病人死於醫院仍有逐年上升趨勢，如何提升高品質生命末期照護，已是很重要的議題。因此，本研究目的旨在深入瞭解非安寧病房護理人員照護生命末期病人之經驗。方法：本研究藉由詮釋現象學方法，透過立意取樣訪談中部某區域教學醫院之非安寧病房15位護理人員，以Colaizzi主張的描述及詮釋現象學之「整體－部分－整體」原則分為七大階段，並書寫反思日誌進行資料分析，本研究執行前，通過人體試驗委員會審查，遵守研究倫理基本四項原則，並將記錄資料分析、編碼、歸類完整保存，以供日後審核管道之依據。結果：研究發現，非安寧病房護理人員照護生命末期病人之經驗，有六個主題：（1）基本舒適照護，（2）照護的助力與阻力，（3）對生命末期病人照護的認知差異與溝通，（4）護理人員逆境的轉折，（5）感受主要照顧者的疲憊與家屬的矛盾，（6）生命末期靈性需求。結論：非安寧病房護理人員照護生命末期病人之經驗中，共同的目標是提供基本的舒適照護。但當護理人員、醫師和家屬對生命末期治療立場與觀念的不同，無形中增加照護負荷，且與家屬溝通說明生死問題，過程也潛藏疲憊感與情緒壓抑，此時的支持及如何自我調適是很重要的。

Purpose: Nowadays, the hospice care development in Taiwan is growing stronger. However, the number of end of life patients dying in hospitals are still raising annually. Therefore, improving the quality of end-of-life care has become a crucial topic in Taiwan, particularly because the number of patients receiving hospice care in non-hospice wards has been increasing. This study explored the experience of nurses caring for end of life patients in non-hospice wards. Methods: Hermeneutic phenomenology and purposive sampling were adopted in this study. In total 15 nurses were recruited at a regional teaching hospital in central Taiwan. They were interviewed and data were analyzed by using the“complete-partial-complete”principle of the seven-step descriptive phenomenological data analysis method proposed by Colaizzi（1979）. In addition, reflective journals were written for data analysis. This study obtained institutional Review Board（IRB）approval before conducting data collection, follow research ethic four principles, keep data analysis, coding and grouping data in records for future audit. Results: Six themes were emerged from the nurse's experience of providing for the nurse caring end of life care for patients in non-hospice wards:（1）Basic comfort care,（2）Care-related catalysts and obstacles,（3）Different understanding of end of life care and Communication message,（4）Nurses’adversity and turning point,（5）Sense the fatigue of the main caregivers and the conflict of family members, and（6）Spiritual care needs in end-of-life. Conclusions: The experience of nurses caring for end of life patients in non-hospice wards, their common goal is to provide basic comfort care. However, when nurses, doctors and family have different expectations to end of life treatment, it may increase the care burden. In addition, when nurses communicate life and death issues with family, the potential fatigue and emotional distress may occur. Support system and how to self-adjustment are very crucial at this stage.