癌症末期病人安寧居家的主要照顧議題分析

The Main Care Issues among Terminal Cancer Patients in Hospice Home Care Service

李隆軍(Lung-Chun Lee) ； 胡中傑(Chung-Chieh Hu) ； 黃曉峰(Sheau-Feng Hwang) ； 林鉅勝(Chu-Sheng Lin) ； 張瑛瑛(Ying-Ying Chang)

《安寧療護雜誌》 16卷2期 (2011/07) Pp. 151-167

https://doi.org/10.6537/TJHPC.2011.16(2).2

摘要

研究目的：在瞭解安寧居家病人常見症狀及對護理照顧的需求，以提供更健全的安寧居家照顧方式。材料與方法：本研究以中部某醫學中心安寧居家兩年期間收案之301位癌末病人為研究對象，採回溯性研究調查病歷。研究結果：轉介來源以一般病房安寧共同照護會診為主（43.2％）；主要照顧者身份以配偶居多（33.6％）；往生地點以在家較多（49.2％）。收案平均天數為30.8 天；平均家訪距離為12.3公里；平均家訪次數為4.7次；收案後住院次數平均為每人0.74次，其中住院天數平均為每人每次12.4天。居家訪視中最常見的症狀為疼痛問題（66％），護理服務以口腔護理為主（58.5％）；住院原因以發燒／感染為主（24.5％）。曾經在居家使用緩解性鎮靜方式處置症狀的平均使用天數為7.1天，使用的原因以煩躁最多（57.1％）。結論：本研究可得知安寧居家照顧常見的症狀、護理照顧技巧及住院原因，可提供病人及家屬居家照顧時應注意的事項，並適時的提供相關的護理技巧，以期病人可得到最大的舒適及家屬可安心在家照顧。（安寧療護 2011：16：2：151-167）

關鍵字

安寧居家 ； 癌症 ； 末期 ； 照顧議題

並列摘要

Purpose: To deliver hospice home care service in a more comprehensive way, the common symptoms and the needs of nursing care of patients receiving hospice home care service are reviewed. Material and Method: A total of 301 patients enrolled were cancer patients in a tertiary center referred to the hospice home care service in a two-year period. The medical records were reviewed for analysis. Results: The enrolled patients were mainly referred to the home care service from ordinary medical wards (43.2%); the majority of the primary caregivers were female (76.4%), and their relationship with the patients were mostly spouses(33.6%), children or grand-children(31.9%), and some of the caregivers were paid care-aide (27.9%). In patients of whom the reason to end home care service was death, about half of them (49.2%) died at home. The average length of home care was 30.8 days; the average distance from the hospital to the patients's home was 12.3 km; the average number of home visits were 4.7 times. The average number of admissions after enrolled were 0.74 times per person. The most common reasons of re-admission were fever or infection (22.5%). And average hospital stay was 12.4 days. During home visits, the most common symptom was pain (64%), and the most common nursing activity were oral care (60.4%). A total of 35 patients used palliative sedation at home in order to alleviate difficult symptoms. The average length of day on sedation was 7.1 days, and the majority of patients were given sedation because of agitation (57.1%). The common regimen used was Haloperidol alone (37.2%). Conclusion: In this study, by reviewing the common symptoms, practical nursing activities provided and the reasons of admission to in-patient ward, the members in the health care teams are more prepared about the knowledge and skills needed in the home care setting. By understanding the needs of the patients and their families, health-care professionals are more capable of providing timely and skilled care, of instructing the patients and family carers about the specific attention and skills needed at home, and of helping patients to receive maximal quality comfort care. As a result, they are able to provide the patients and their family a sense of security at home.(Taiwan J Hosp Palliat Care 2011：16：2：151-167)

並列關鍵字

hospice home care ； cancer patient ； terminal illness ； care issue