多元策略提升加護病房護理人員執行臨終關懷照護完整性

A Multifaceted Strategy to Improve the Hospice Care Completeness of Intensive Care Nurses

背景：近年來國人對於善終的概念日趨進步，重症病人入住加護病房後需承受醫療處置所帶來的痛苦，如何提供尊嚴完善的臨終關懷照護，使病人有尊嚴的善終是很重要的。現況分析發現單位因缺乏照護作業標準、人員不清楚安寧共照小組的功能及缺乏教育訓練等原因，導致加護病房護理人員執行臨終關懷照護完整性僅達46.3%，故引發此專案動機。
目的：提升護理人員執行臨終關懷照護完整性達85.0%。
解決方案制定「臨終關懷照護作業標準」提供人員依循；設計臨終關懷「生心靈，哩丟安」標語小卡，方便人員隨身攜帶並達到提醒之目的；規劃教育訓練及跨團隊工作坊，運用簡易桌上遊戲輔助課程教學，增加參與感及互動性，以提升照護品質。
結果：臨終關懷照護完整性由46.3%提升至88.4%。
結論：專案實施後能有效提升加護病房護理人員執行臨終關懷照護完整性，減輕重症病人末期痛苦並提升尊嚴，協助家屬於悲傷中從容面對，完善重症單位臨終照護品質。

Background & Problems: In recent years, awareness of the need to facilitate death with dignity has advanced significantly in Taiwan. Critically ill patients admitted to intensive care units (ICUs) often endure the pain of medical interventions. Therefore, providing comprehensive end-of-life care that respects patient dignity is crucial. A situational analysis revealed that the ICUs in our hospital lacked standardized care procedures, that ICU staff were unclear about the role of the palliative care team, and that related educational training was deficient. Further investigation showed the completeness rate of ICU nurse implementation of end-of-life care to be 46.3%.
Purpose: This project was developed and executed to increase the end-of-life care completeness rate to 85.0%.
Resolutions: Establish end-of-life care standard operating procedures; design a small portable reminder card featuring the slogan“Physical, Mental, and Spiritual Care”to help prompt nurses while on duty; and plan educational training and cross-team workshops that utilize a simple tabletop game to support course teaching and increase engagement and interactivity.
Result: After full project implementation, the rate of end-of-life care completion was 88.4%.
Conclusions: The developed project effectively improved the integrity of end-of-life care provided by ICU nurses, alleviating the suffering of terminally ill patients and enhancing their dignity. The project also helped families face the grieving process with greater composure, improving the overall quality of end-of-life care provided in our ICUs.