死亡相關經驗對護理人員執行臨終照護能力之探討

Exploring the Death-Related Experience and Ability of End-of-Life Care Among Clinical Nurses

周筱茵(Xiao-Yin Chou) ； 詹瑞君(Jui-Chun Chan) ； 方圓媛(Yuan-Yuan Fang) ； 蔡璧玲(Pi-Ling Tsai) ； 李芸湘(Yun-Hsiang Lee)

《榮總護理》 36卷3期 (2019/09) Pp. 266-276

https://doi.org/10.6142/VGHN.201909_36(3).0006

摘要

「死亡」在課程教育中，不是容易遇到與學習的經驗，但是護理人員透過經歷死亡相關的經驗，則有助於自身的臨終照護能力及面臨照護瀕死病人時之因應與調適。本研究目的為護理人員經歷死亡相關經驗對執行臨終照護能力之探討，進而提出教育策略及方向。研究方法以學者曾於中央研究院學術調查研究資料庫之144份死亡教育對護理畢業學生照護臨終病人的行為調查，分析死亡相關經驗對護理人員臨終照護能力之探討。結果顯示：一、死亡相關經驗中，93.0%參加過葬禮及91.7%曾照護臨終病人。二、臨終照護能力在死亡處理能力項目，以生命省察能力最佳，處理失落能力最差；在臨終照護行為項目中，以臨終祥和處理行為最佳。三、曾修習生死學、參加臨終講習、書寫生前預囑之經驗者，在死亡處理能力的表現皆優於無經驗者且達統計顯著差異（p ＜ .05），且曾書寫生前預囑之經驗者，臨終照護行為項目之臨終祥和處理行為及維護瀕死品質表現較好並達統計顯著差異（p ＜ .05）。建議增加死亡相關知識合併體驗課程，使護理人員在面對臨終病人時，能確實展現合宜的死亡處理能力與臨終照護行為。

關鍵字

死亡相關經驗 ； 臨終照護能力

並列摘要

Death-related issues are difficult to learn in the formal school curriculum; however, personal experiences with death can help nurses to improve their ability to provide end-of-life care and to cope and adapt when caring for an individual approaching the end of life in clinical settings. The purpose of this study was to (1) explore the correlation between end-of-life care ability and personal experiences with death among clinical nurses and (2) propose educational strategies and directions for nurses. Data were gathered from a study of the Research Center for Humanities and the Social Sciences database. A survey of ＂Death Education on Nursing College Students' Attitudes toward Death and Their Nursing Behaviors in Caring for the Dying Patients＂ was completed by144 clinical nurses and analyzed. Results showed that (1) commonly reported death-related experiences included subjects attended funerals (93.0%) and subjects had experience of caring for dying patients (91.7%). The best quality for providing end-of-life care for death competence is self-observation skills, whereas the most difficult quality is coping with grief. In addition, the best end-of-life care behavior is to make end-of-life care as peaceful as possible and (2) death-related experience factors that influenced the ability to provide end-of- life care included obtaining death education from lectures or at school, participating in end-of-life workshops, and drafting living wills. Nurses who had the above experiences had better abilities were more equipped to provide end-of-life care for death competence than those who did not, and this was statistically significant (p ＜ .05). Furthermore, factors that influenced end-of-life nursing care behaviors included participants having drafted living wills; again, this was statistically significant (p ＜ .05). It is recommended that lectures or workshops that include death education and simulation experience be increased, and the appropriate attitude toward death competence and the abilities of end-of-life care behaviors among nursing staff in clinics be improved when caring for dying patients.

並列關鍵字

death-related experience ； end-of-life nursing care

參考文獻

梁天麗、莊夢萍、陳語婷、劉文婷、劉瑗筠、謝佩芸(2011)．護生照護瀕死病患經驗之探討．弘光學報，65，93-108。

陳怡潓、曾煥棠(2017)．加護病房護理人員死亡處理能力之探討．健康科技期刊，4(1)，21-43。

胡文郁、曾建寧、王浴、翁瑞萱(2004)．護理系學生接受安寧緩和醫療臨床實習教育介入之成效．安寧療護雜誌，9(1)，1-20。

邱珍琬(2006)．生死學討論會對準諮商員生命態度影響研究．生死學研究，4 ，119-162。

陳瑞娥、吳讚美(2008)．護理人員死亡恐懼與臨終照護之探討．安寧療護雜誌，13(1)，14-29。