善終之概念分析

Good Death: A Concept Analysis

馬瑞菊(Jui-Chu Ma) ； 蔡惠貞(Hui-Chen Tsai)

《馬偕護理雜誌》 6卷2期 (2012/07) Pp. 7-13

https://doi.org/10.29415/JMKN.201207_6(2).0001

摘要

善終及尊嚴的走完生命過程是國人之文化傳統。但病患的善終需求經常被忽略，導因於醫療人員對善終之認知及概念不足。本文以Walker及Avant（2011）提出的步驟，進行善終概念分析。先確立預分析的概念並廣泛查考此概念定義，確定鑑定性特徵，並以模範案例、邊緣案例及相反案例說明之，再確認此概念的前因、後果並列出實證性的參考指標等。經分析顯示善終的鑑定性特徵為：（一）沒有痛苦及症狀困擾，去世之前能維持身體的清潔與舒適。（二）能心平氣和的接受死亡和沒有無意義的生命延長。（三）有充分時間準備做好決定、對家人有交代、道別和選擇死亡場所。（四）符合個人宗教信仰、傳統文化而能坦然面對死亡。希望藉此概念分析，強化善終的整體概念，進而運用於臨床實務中，使家屬免於煎熬，生死二相安。

關鍵字

瀕死病人 ； 善終 ； 概念分析

並列摘要

Good death and dying with dignity are an important culture tradition in Taiwan. However, good death is often neglected by physicians and nurses at the end of patient's lives. Part of the reasons is that a majority of clinical physicians and nurses have no adequate training or practical guidance on caring methods of good death. This paper tried to analyze the concept of good death by the methodology outlined by Walker and Avant(2011). Analytical procedures included reviewing conceptual definitions of good death and identification of defining attributes. We then developed a concept of good death by discussing borderline, contrary case and constructed model and identified antecedents and consequences. Empirical referents were also outlined. Results showed that the definition or features of good death are: (1) death occurs naturally. Patient is comfortable, and feels free from pain or symptoms. (2) Patient gets well-prepared for death, not only prolong life. (3) Patient senses of ending closure, and good preparation of death. The patient autonomously controls over the dying process; has more time with family and say goodbye to friends; dies in a favorite place. (4) The process respects individual culture, tradition, and religion or belief. This analysis is trying to enhance physicians and nurses understanding of good death and utilize the concept in their professional practice.

並列關鍵字

dying patient ； good death ； concept analysis