提升安寧病房在宅善終護理指導完整率

Improving Complete Rate of Good Death at Home for Nursing Staff in Hospice Ward

在落葉歸根的華人文化下，在宅善終的議題備受國人重視，但主要照顧家屬往往欠缺提供臨終病人照護所需的認知和技巧，若能提前於安寧病房住院期間接受完整的臨終護理指導，可讓家屬對死亡及末期臨終照顧有所準備，進而達到生死兩無憾之善終。本專案主旨在提升安寧病房在宅善終護理指導完整率。經查檢單位發現主要問題有：(1)缺乏在宅善終指導教材；(2)缺乏在宅善終指導的標準流程；(3)家屬對於在宅善終流程概念不清且衛教內容無法吸收。透過製作多元化衛教方式與在宅善終相關護理技術影片，讓家屬的學習無受限。制訂在宅善終護理指導標準流程及檢核表，讓醫療團隊了解末期病人臨終意願、在宅善終護理指導的進度及主要照顧者的學習成效。發展在宅善終家屬版流程圖，讓家屬更能一目了然下一步可能即將面臨的與因應方法。向客觀性結構式臨床測驗中心借用模擬人，讓家屬能實做練習。透過上述，在宅善終護理指導完整率由50%提升到96.7%，達到此專案目的。

Under the Chinese culture, the issue of good death at home is highly valued by Taiwanese, but the primary family caregivers of the patient often lack the knowledge and skills required to provide end-of-life care. If complete nursing education can be given first, the primary family caregivers can be more aware of death and the end of life. The main purpose of this project is to improve complete rate of nursing education for the good death at home. The main problems found by the inspection unit are: (a) Lack of guidance materials for good death at home; (b) Lack of standard procedures for good death guidance at home; (c) Family members have unclear concepts about the good death process at home and cannot understand the contents of nursing education. Through the production of diversified health education methods and nursing technology videos related to hospice at home, family members can learn without restriction. Develop standard procedures and checklists for good death at home, so that the medical team can understand the end-of-life wishes of terminal patients, the progress of home care guidance, and the learning effectiveness of the main caregivers. Develop the good death at home flow chart for the family members, so that the family members can understand what they may be facing next and how to deal with it. Borrow a simulator from the objective structured clinical testing center so that family members can practice. Through the above, the good death at home rate was increased from 50% to 96.7%, achieving the purpose of this project.