某醫學中心原醫療團隊對安寧共同照護成效評估

Evaluation of Hospice Shared Care by the Original Medical Team in a Medical Center

蔡麗雲(Li-Yun Tsai) ； 謝瑞坤(Ruey-Kuen Hsieh) ； 楊宜霖(Yi-Ling Yang) ； 蘇文浩(Wen-Hao Su) ； 蔡正河(Cheng-Hu Tsai) ； 張國華(Kou-Hwa Chang) ； 方俊凱(Chun-Kai Fang) ； 李佩怡(Pei-Yi Lee)

《安寧療護雜誌》 10卷3期 (2005/08) Pp. 243-257

https://doi.org/10.6537/TJHPC.2005.10(3).3

摘要

安寧共同照護的發展是為了打破病人與照顧場所的限制，將安寧療護的精神帶至急性病房服務癌症晚期的病人。本研究目的主要是在某醫學中心建立多科合作的安寧共同照護模式，並經由原醫療團隊對共同照護團隊服務滿意的評值結果做為修正之依據。本研究為評價性調查研究設計，針對參與共同照護模式之醫護人員進行問卷調查，共發出600份問卷，回收566份，回收率為94%。問卷內容包括基本資料、對安寧共同照護的認識、對安寧共同照護團隊服務滿意度及對原醫療團隊的協助等四部份。重要研究結果：(1)對安寧共同照護的認識，回答清楚以上者的比例依序為目的(86.1%)、服務對象(84.2%)、服務內容(69.6%)、轉介方式(64.9%)。(2)對安寧共同照護團隊的服務滿意度，回答滿意以上者的比例依序為家屬情緒照顧(91.5%)、病人心理社會問題(91.4%)、整體的團隊運作(90.6%)、與原團隊溝通協調(89.7%)、症狀控制(87%)、轉介流程(85.5%)。(3)原醫療團隊認為安寧共同照護團隊所提供最大幫助之項目，依序為疼痛控制(20%)、家屬心理社會問題(19.1%)、病人心理社會問題(18.8%)、對安寧療護念的認識(12.6%)。(4)不同醫護人員對安寧共同照護的認識與服務滿意度之差異，只有轉介方式與症狀控制有顯著差異。(5)不同醫護人員對安寧共同照護提供最大幫助項目之差異，發現病人心理社會問題、家屬心理社會問題、安寧療護同意書的填寫、出院準備及安寧居家轉介等項目有顯著差異。本研究結果建議安寧共同照護應普遍在急性病房提供服務，未來更朝強化安寧共同照護團隊的角色功能做努力。

關鍵字

安寧共同照護 ； 原醫療團隊 ； 滿意度

並列摘要

The aim of Hospice Shared Care (HSC) is to break through the limitation of patients and care place. It brings the hospice care to acute care units for terminal cancer patients. The purpose of this study is through a satisfactory survey from the original medical team members to modify a multi-cooperation care model of HSC in a medical center. An evaluative survey design was used. All physicians and nurses who work in medical or surgical unit were invited to participate in this study. 566 questionnaires were return from 600 subjects. Return rate was 94%. The content of questionnaire includes demographic, knowing HSC, satisfaction to HSC, and HSC's help to original medical team. Results indicated that (1). In knowing HSC, participants answer very clear and clear in this order: the purpose of HSC (86.1%), service subjects of HSC (84.2%), service content (69.6%), and how to referral (64.9%). (2). In satisfaction to HCS, the answer from satisfy to very satisfy as follows: moodiness care for families (91.5%), psychosocial care for patients (91.4%), integrated Service of HSC (90.6%), communication and cooperation with original medical team (89.7%), symptom control (87%), referral procedure (85.5%). (3). The original medical team members perceived the benefits to patients or families from HSC team were: pain management (20%), families' psychosocial support (19.1%), patients' psychosocial support (18.8%), knowing hospice and palliative care (12.6%). (4). In knowing hospice care and satisfaction, nurses' rating significantly higher than physicians' rating in referral procedure and symptoms control. (5). Original care nurses' perceived the help from HCS team in patients' psychosocial support, families' psychosocial support, to assist patients and families to understand as well as sign hospice palliative care consent, discharge planning, and referral procedure were significantly higher than the original physicians' perceptions. The study suggests that the HSC should be spread to all non hospice units and the role and function of HSC team should more clarify and promote to offer higher quality care to terminal patients and families.

並列關鍵字

hospice shared care ； original medical team ； satisfaction