善別之路　安寧療護中的喪慟關懷臨床指引建構原則之探討

Good Grief: Constructing Principles of Clinical Guideline for Bereavement Care in Palliative Care

蔡佩真(Tsai, Pei-Jen)

《生死學研究》 17期 (2015/02) Pp. 121-149

摘要

善終與善別是安寧療護照顧的目標，喪慟關懷是協助喪親者面對生離死別之痛與生活重建；提供關懷與實質協助，是安寧緩和醫療的延續。然而，臨床上的服務輸送遭遇不少挑戰，包含安寧病房團隊成員經驗不足、缺乏訓練與可依循之模式，加上人力吃緊，增加勞務負荷與挫折無力之感受。因此建構喪慟關懷服務指引，以提供更適切的照顧，成為刻不容緩的議題。喪慟關懷服務指引可以作為醫療團隊臨床的參考與維護服務品質，也有利於讓各醫院安寧病房提供喪慟服務的狀況不會有太大的品質落差。臨床指引是以實證主義為基礎而建構，是整合研究證據以及臨床人員的經驗、並參照服務接受者的價值偏好而制定的照護準則，可用以在面臨特定處境時能做出合適的健康照護決策，進而提供最佳的服務措施，並可作為訓練之參考。本文整理出安寧療護發展良好的英國、澳洲、西班牙等國之安寧療護喪慟關懷臨床指引，希望能作為台灣制定喪慟服務的參考架構，並從服務使用者、服務提供者、服務輸送等三個面向提出反思與討論。

關鍵字

安寧療護 ； 悲傷 ； 喪慟關懷 ； 臨床指引 ； 教育訓練

並列摘要

The ultimate aim of palliative care is to ensure good death and good grief. The purpose of bereavement care is to provide concern and substantial assistance for survivors. Bereavement care is a continuation of palliative care, but service providers encounter challenges including inexperienced hospital team members, a lack of training, and rigid patterns to follow, coupled with a lack of manpower, that only create the feeling of workload and frustration, and inability. The construction of Bereavement Care Service Guidelines provides more appropriate care and has become a topic that cannot be delayed. Bereavement Care Service Guidelines can help clinical reference and maintenance of service quality of a medical team and it is also conducive to the status of the hospital's hospice ward to offer bereavement services, so that there will not be a significant gap in quality. Clinical guidelines are constructed on an evidence-based doctrine to integrate research evidence and clinical staff's care experience. The preference values of patients are used as a reference for the development of care guidelines, which can be used to make the appropriate health care decisions in a particular situation. Thus, the guidelines can provide the best care measures and can be used for training purposes. This study refers to the palliative care and bereavement care clinical guidelines in the UK, Australia, and Spain to provide a reference structure for bereavement services in Taiwan. This study discusses four dimensions: service users, service providers, service content and service procedures, and makes recommendations.

並列關鍵字

Palliative Care ； Grief ； Bereavement Care ； Clinical Guidelines ； Education and Training

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