護理之家護理人員照護生命末期住民之經驗探討

背景：台灣社會人口結構改變，加及少子化的影響，初估2020年將會進入超老化國家。因此，家中若有失能者則無人可以照顧，現已開始從住家養老的場域，轉往護理之家，並於此地渡過餘生，住民於生命末期時，護理人員是主要兼具照護住民、機構管理和家屬協調的職責，所以護理人員被賦予重責，是需要被重視及探討之對象。研究目的：瞭解任職於護理之家的護理人員，在照護生命末期住民時的經驗。研究方法：本研究以質性研究法為基礎，使用內容分析法做為資料分析。共有7位護理人員參與本研究，藉由半結構面對面深度訪談作為資料收集的方法，訪談中使用錄音方式進行的資料蒐集。研究結果：護理之家護理人員在照護生命末期的經驗中，共有三大主題及七項次主題：(一)守護生命末期住民：給予生命末期住民的照護、處理住民發生死亡之程序；(二)難以承受的重：承擔心理社會層面的衝擊、承受身體上的疲憊感、衝擊靈性層面的影響；(三)重新調適再出發：厚實專業應變能力、強化全方位自我調適。結論與建議：本研究結果發現護理人員在照護生命末期住民上的真實感受，以及面對沉重的情緒負荷，期盼能在護理之家實務中：推廣住民預立遺囑，以及安寧共照之提供，減輕護理人員在與家屬討論不施行心肺復甦術(DNR)以及照護住民上之困難，提供護理人員哀傷輔導機制，可應用於自身承重的情緒處理；於護理教育上，增強護理人員對於生命末期住民之疼痛評估，以及運用臨床技能訓練測試(OSCE)訓練，增進住民急救能力培訓；於護理政策上，推廣護理之家臨終安息室之設置，免於護送末期住民往返急診奔波，以及配合醫院協助護理之家死診開立之程序；於護理研究上，建議護理人員利用實證搜尋，可運用於生命末期住民評估與照護。本研究結果，期許可以提供給未來護理之家護理人員，在實務上、教育研究以及政策上作為供給資源之依據。關鍵字：護理人員、生命末期、住民

關鍵字

住民；生命末期；護理人員

並列摘要

Background： Due to changes in the population structure and the sub-replacement fertility in Taiwan, it is estimated that by 2020, Taiwan will become a super-aged country. There will be a lack of family care for the disabled elderly at home. Therefore, instead of staying at home, an increasing number of older people have now moved to nursing homes to live the rest of their lives. When residents are near the end of their lives, nurses have the primary responsibility to care for them, manage the institutions, and cooperate with their family members. The profound significance of such a role is what makes the nurses important subjects worthy of investigation. Purpose： To understand the experience of nurses working at nursing homes in caring for end-of-life residents. Method： Based on a qualitative research method, this study used in-depth interviews for collecting data and content analysis for analyzing data. Seven nurses participated in this study. Information was collected through face-to-face in-depth interviews, during which the nurses’ responses were recorded. Findings： There were three core topics and seven sub-topics regarding the experience of the nurses at nursing homes in caring for end-of-life residents： (1) safeguarding end-of-life residents： care provided for them and the procedure for handling their deaths; (2) unbearable burdens： substantial psychosocial impact, physical fatigue, and spiritual repercussions endured by the nurses; (3) re-adapting and starting over： reinforcement of the abilities to deal with emergencies professionally and to adjust oneself comprehensively. Conclusion and Suggestions： Results revealed the nurses’ actual feelings and their immense emotional load when caring for end-of-life residents. This study suggests adopting the following practices in nursing homes： encouraging residents to draw up a will and the provision of hospice shared care; alleviating the difficulties nurses face in discussing DNR decisions with family members and caring for the residents; and providing the nurses with a grief counseling mechanism that can be applied to managing their own emotional burdens. In terms of nursing education, this study suggests improving the nurses’ skills in assessing the pain of end-of-life residents and development of their first aid skills with OSCE training. In terms of nursing policies, hospice care rooms should be established in nursing homes to save the nurses from the trouble of escorting end-of-life residents to and from emergency departments; hospitals should also assist in the nursing homes’ procedure for issuing death certificates. In terms of nursing research, studies about nurses should employ empirical research to apply to their assessment and care of end-of-life residents. Keywords： Nurses, End-of-life , Residents ,Caring