家屬照顧者運用安寧療護經驗探討

A Study of Family caregivers experience for the Hospice Care

劉曉恬(Xiao-Tian Liu)

指導教授 ： 陳斐虹

朝陽科技大學/人文暨社會學院/社會工作系/碩士(2014年)

摘要

在台灣，癌症造成的死亡率仍佔十大死因中的第一，許多癌症末期病人飽受病痛折磨，往往到了生命末期，無法獲得好的生活品質，因此，癌症末期病人需要更人性化的照顧與對待，是故推動安寧療護的照顧模式，可增進末期病人的福祉。本研究旨在探討生命末期病人運用安寧療護中安寧病房的照顧經驗，藉由家屬照顧者的視角，來了解運用安寧療護的經驗、對於安寧療護的態度與看法、知覺安寧療護團隊社會工作者的協助與角色為何。本研究以質性研究方式，採立意取樣，取得6位研究參與者，1位男性及5位女性，平均年齡分佈於39-60歲，病人入住安寧病房最長一個月，最短為三天。
研究結果分別以「家屬照顧者運用安寧療護的經驗」、「家屬照顧者對安寧療護的態度與看法」、「家屬照顧者知覺安寧療護團隊中社會工作者的協助與角色」三部分呈現，研究者依據研究結果加以討論並提出實務上的建議，其研究結果發現：
一、 家屬照顧者運用安寧療護的經驗：描述家屬照顧者在親身經歷病人入
住安寧病房時的情景，其經驗分為「生命末期的抉擇：進入安寧的理由」、「安寧療護的開展：在安寧病房的照護」、「曲終人散：感恩與告別」。
二、 家屬照顧者對安寧療護的態度與看法：討論家屬照顧者切身運用安寧療護的照顧後，對於安寧療護的態度與看法產生的差異，其結果分為「安寧療護的訊息來源」、「運用安寧療護前對安寧的認知」、「運用安寧療護後對安寧態度與看法之轉變」。
三、 家屬照顧者知覺安寧療護團隊中社會工作者的協助與角色：描述家屬照顧者在安寧病房中，知覺社會工作者提供的協助及扮演的角色，其結果分為「角色模糊型」、「角色明確型」。
關鍵詞：安寧療護、安寧緩和醫療、家屬照顧者

關鍵字

家屬照顧者 ； 安寧緩和醫療 ； 安寧療護

並列摘要

In Taiwan, the mortality resulted from cancer still occupies the first rank in the top-10 leading causes of death. Numerous terminal cancer patients suffer to the fullest extent from the torture of illness indisposition and often cannot obtain their good living qualities when entering into the end of life. Therefore, the terminal cancer patients need to be given a more humanized care and treatment; hence, the promotion of hospice caring mode can increase the welfares of terminal cancer patients. This study was aimed to investigate the utilization of caring experiences in hospice wards during the hospice period of terminal cancer patients, as well as to understand the utilization of palliative care experiences, the attitudes and views to hospices, and to perceive what the assistances and playing roles of social workers in the hospice team are via the view angles of family caregivers. Based on the quality research method, this study adopted the purposive sampling. It obtained 6 research participants as 1 male and 5 female in them with their average range of age distributed with 39 – 60 years old. The patients were transferred into the hospice wards by 1 month for longest period and by 3 days for shortest term.
The study results were presented by the three portions of ‘Family caregivers utilized the palliative care experiences’, ‘Attitudes and views of family caregivers to the hospices’, and ‘Perceptions of family caregivers to the assistances and roles of social workers in the hospice team’, respectively. The researchers discussed and proposed the practical recommendations according to the study results. The findings are as below:

(1) Family caregivers utilized the palliative care experiences: It described the circumstances when the family caregivers personally experienced the patients transferred into the hospice wards; and, their experiences can be divided as: ‘Choice about the end of life: the reason(s) to enter hospices’, ‘Development of hospices’, and ‘Final end: acknowledgement and farewell’.

(2) Attitudes and views of family caregivers to the hospices: It discussed the generated differences about the attitude and views to hospices after the personal utilizations of palliative cares by the family caregiver. And, its results can be divided into: ‘Information sources of hospices’, ‘Utilization of hospice perceptions before the hospices’, and ‘Change of attitude and views to hospices after the utilization of hospices’.

(3) Perceptions of family caregivers to the assistances and roles of social workers in the hospice team: It described the perceptions of family caregivers to the assistances and playing roles of social workers. And, its results can be divided into: ‘Vague-type about roles’ and ‘Clear-type about roles’.

Keywords: Hospice caring, palliative care, family caregivers.

並列關鍵字

family caregivers ； palliative care ； Hospice caring

參考文獻

王素真(2007)。民眾對安寧療護的認知程度及選擇考慮因素之探討。安寧療護雜誌，12(1)，440-55。

方慧芬、張慧玉、林佳靜(2009)。末期病人面臨預立醫囑、生前預囑之現況及與生命自決之倫理議題。護理雜誌，56(1)，17-22。

台灣安寧緩和醫療學會(2013)。安寧緩和醫療-理論與實務。新北市：合記。

石世明(2000)。對臨終者的靈性照顧。安寧療護雜誌，5(2)，41-56。

朱思盈、林明慧、陳曾基、黃信彰(2008)。影響臺灣死亡地點的臨床與心理社會因子。北市醫學雜誌，5(5)，22-32。