提供重症善終服務：改善加護病房生命末期照護

Providing A Good Death: Improve Care for ICU Critical Patients at the End of Life

馬瑞菊(Jui-Chu Ma) ； 蔡惠貞(Hui-Chen Tsai)

《馬偕護理雜誌》 7卷1期 (2013/01) Pp. 7-13

https://doi.org/10.29415/JMKN.201301_7(1).0001

摘要

隨著醫藥科技不斷的進步，急重症加護技術的發展，使得重症病患的生命得以延長。愈來愈多的重症病人可能在加護病房進入生命末期階段。但因加護病房首重急重症疾病之救護，因此病患、家屬、醫護人員對醫療的期待不同，又面臨倫理與法律種種之困境，所以無效醫療隨之而生。雖然2011年1月10日已三讀通過安寧緩和醫療條例修正案，新增條文包含可以終止或撤除末期病人原先已使用的心肺復甦術，讓臨終病人免除無意義的痛苦。但因法規限制繁複，臨床實務工作中執行不易，在以往病人往生前多為家屬隨伺在側，曾幾何時變成醫療儀器隨伺在側，使得重症病人『善終』成為空談。故本文以文獻查證方式提出加護病房醫療人員面對生命末期病患該有之作為，除重視病患身體善終、心理善終、靈性善終、社會善終之外，亦針對如何提供完善的加護病房生命末期照護提出討論，期望藉由此份報告協助醫療人員面對末期病患時有所依循，並能符合病人自主、家屬安心、醫療人員亦無遺憾之全人照護。

關鍵字

加護病房 ； 重症病人 ； 善終 ； 生命末期照護

並列摘要

Following continuous progress of medical technology, the life of critical illness could be prolonged via development of intensive care for acute and critical illness. In addition, there are increasing critical patients probably stay in ICU at the end of life. However, the ICU mostly emphasizes on care of acute and critical illnesses, while the patients, family members and medical people have different expectation to the treatment. Besides, there are various dilemmas as facing moral the legal issues, and medical futility is created accordingly. The amendment of Hospice Palliative Care Act has been passed on January 10, 2011, and the cardio pulmonary resuscitation for critical patients used originally could be terminated or cancelled in newly added article to eliminate the nonsense pain of critical patients. However, it is really difficult to implement at clinical practices due to complicated regulations and the situation that patient was accompanied by medical instruments not by family members at his/her end of life. It makes peaceful ”good death” merely prate. Therefore, the article discussed how medical personnel to avoid medical futility in addition to paying attention to physical, mental, spiritual and social good death of critical patients. It is expected that this report may be the references for medical personnel as providing integrated care satisfying autonomy of the patient, ease of family members and no regret of medical personnel as facing critical patients.

並列關鍵字

ICU ； Critical Illness ； good death ； End of Life Care