長照機構照顧服務員生命態度、死亡恐懼與臨終照顧能力之研究

背景：長照機構的臨終照顧日益重要，照服員為主要照顧人力，其臨終照顧能力影響住民照護品質。
目的：探討東部地區長照機構照服員的生命態度、死亡恐懼與臨終照顧能力三者之相關，及臨終照顧經驗、因應方式及其影響。
方法：橫斷式、質量混合研究設計，研究對象為臺東及花蓮縣長照機構165位照服員。使用生命態度、死亡恐懼及臨終照顧能力量表；並針對12位研究對象進行深度訪談。
結果：照服員大多持正向的生命態度，低到中度的死亡恐懼。生命態度與臨終照顧能力呈正相關（r = .426, p < .001）。照服員之臨終身體照顧能力尚好，而提供住民情緒支持的照顧能力較差。死亡恐懼四個分量表、生命態度中之愛與關懷、理想及高中教育程度者為臨終照顧能力的預測因子，解釋量為22.8%。訪談結果歸納為五大主題，並能呼應量化的結果。
結論／實務應用：生命態度、死亡恐懼對照服員的臨終照顧能力有部分影響。建議強化照服員的心靈陪伴之臨終照顧技巧及探索個人對生死意義之在職教育；長照機構透過個案討論、支持團體等關懷及支持照服員。

Background: End-of-life care in long-term care institutions is increasingly important. Nursing assistants are the primary care workforce, and their end-of-life care capabilities affect the quality of care provided to residents as well as residents’physical and mental health.
Purpose: This study was designed to explore the life attitudes, fear of death status, end-of-life care abilities and experience, and coping styles of nursing assistants in long-term care institutions in the eastern region and the effects of these variables on care.
Method: A cross-sectional, mixed-methods research design was used. The study included 165 nursing assistants working in long-term care facilities in Taitung and Hualien counties. The study questionnaire included items covering life attitudes, fear of death, and dying care abilities. In addition, in-depth interviews were conducted with 12 of the participants.
Results: Most of the participants held positive attitudes toward life and reported having a low to moderate fear of death. A significant and positive correlation between life attitude and dying care ability was identified (r = .426, p < .001). Although average ability to provide physical care to residents at end of life was found to be relatively good, ability to provide emotional support and allow residents to express their emotions was generally poor. The scales of fear of death, life attitude toward love and care, ideals, and high school education were identified as significant predictors of dying care ability, together explaining 22.8% of the variance. The interview results were summarized into five major themes that also echoed the quantitative results.
Conclusions/ Implications for Practice: Attitudes toward life and fear of death partially were shown to influence the dying care ability of the nursing assistants in this study. Dying care skills should be strengthened in nursing assistants, and they should be encouraged to explore the meanings of life and death through on-the-job education. Also, long-term care institutions should show concern for and support their nursing assistants by sponsoring case discussions, care experience sharing sessions, and support groups.