安寧緩和醫療近數十年來已儼然成為全球性的公共議題，以及各國積極推行的政策。本研究旨在初步探討長期照護機構提供安寧緩和照護措施的因應，瞭解不同型態長照機構執行安寧緩和照護服務的現況，和長期照護機構人員對於「安寧療護」的知能，以及接受安寧培訓相關照護課程訓練的情形，並探究長照機構配合政府推動安寧緩和照護落實社區化的因應情形。
本研究採質性深度訪談的方式，對南部地區八家長照機構，包含護理之家、養護中心、以及居家護理所，為求收案樣本之多樣性，又將收案對象分為獨立型及附設型態，並且依據訪談的結果，比較其差異性。
本研究之結果，長照機構服務之對象，因為老化伴隨的慢性疾病，與安寧療護健保給付之十類疾病之診斷多有重疊，其中以失智症、其他大腦變質、心臟病、慢性腎衰竭、腎衰竭診斷疾病比率較為高，此類疾患病程多為不可逆，而且伴隨年齡之增長病情會越溢嚴重，最終將成為安寧服務的目標對象，所以長照機構未來對於安寧療護的需求情形是可以預見的。
目前長照安寧政策發展為社區模式，鼓勵居家安寧照護方式，藉由安寧緩和措施介入，除了可以提升末期個案的生命品質、也可以落實在地終老的理念，並且可以節省社會照護成本與醫療支出，但是社區安寧的服務提供，尚存有諸多的問題，包含: 普遍長照機構人員的安寧專業素養，呈現不足的狀態，再則，社區安寧居家服務也多存窒礙，安寧居家服務輸出缺乏有效的因應機制，以至於安寧居家(乙類)照護服務成效不彰，另外，長照安置型態的機構對於安寧服務的提供，也存在許多的限制，有待多方解決並改善。

Palliative care has become a global public health concern, prompting countries to actively promote relevant policies. This is a pilot study on the coping measures of long-term care institutions when providing palliative care. The objective is to determine the current implementation status of palliative care services in various types of long-term care institutions, the palliative care expertise of long-term care staff, and the outcome of receiving relevant palliative care training programs. This study also explores the implementation of community-based palliative care in long-term care institutions in response to the government’s promotion of the topic.
This study conducted in-depth interviews at 8 long-term care institutions in southern Taiwan, including nursing homes, health maintenance centers, and home care institutions. To pursue sample variety, the participating institutions were divided into independent and affiliated types. The variation among these institutions was compared through the outcomes of interviews.
For patients in long-term care institutions, the majority of chronic diseases associated with aging overlap with the 10 diseases covered by the national health insurance, including several highly diagnosed diseases: dementia, cerebral degeneration, heart disease, chronic renal failure, and renal failure. Most of these diseases are irreversible, and patients’ conditions only deteriorate with age. Because these patients will eventually become the target audience of palliative care services, the palliative care demands of long-term care institutions must be assessed.
At present, long-term palliative care policy has become community-focused to encourage home-based palliative care. The intervention of palliative care measures improves the life quality of patients with late-stage diseases, embodies the concept of aging in place, and reduces the cost of social care and medical expenses. However, the provision of community palliative care still contains numerous problems, such as the inadequate palliative care professionalism of long-term care personnel and the obstacles of home-based palliative care (category B) induced by ineffective service output that engenders unfavorable outcome. Additionally, numerous restrictions still exist in the palliative care services provided by long-term institutions, requiring collaboration among multiple parties for resolutions and amelioration.

目錄
論文審定書 i
致謝 ii
中文摘要 iii
ABSTRACT v
目錄 vii
表次 x
第壹章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 6
第四節 名詞解釋 7
第貳章 文獻探討 8
第一節 安寧療護的定義 8
第二節 我國安寧緩和療護政策推動發展及現況困境 10
第三節 世界安寧療護的發展 18
第四節 長期照護機構服務及2.0計畫之安寧緩和推動政策 19
第五節 長照機構施行安寧緩和療護探討 21
第參章 研究方法 27
第一節 研究設計 27
第二節 研究工具 29
第肆章 研究結果 30
第一節 各機構基本資料 30
第二節 訪談結果 32
第伍章 討論與建議 107
第一節 討論 107
第二節 研究貢獻 127
第三節 研究限制 127
第四節 後續研究建議 128
參考文獻 129
附錄一 安寧療護病房設置標準 143
附錄二 安寧居家設置規範 144
附錄三 安寧居家療護/醫事人員教育訓練資格分為甲、乙兩類 146
附錄四 安寧居家療護服務條件及內容 147
附錄五 訪談大綱 148
附錄六 各機構逐字稿 152
A 機構 152
B 機構 175
C 機構 190
D 機構 210
E 機構 227
F 機構 242
G 機構 253
H 機構 265
表次
表4-1 各機構基本資料 30
表4-Q1 訪談結果 32
表4-Q2 訪談結果 34
表4-Q3 訪談結果 35
表4-Q4 訪談結果 38
表4-Q5 訪談結果 39
表4-Q6 訪談結果 42
表4-Q7-1 訪談結果 44
表4-Q7-2 訪談結果 46
表4-Q7-3 訪談結果 48
表4-Q7-4 訪談結果 51
表4-Q7-5 訪談結果 54
表4-Q8-1 訪談結果 57
表4-Q8-2 訪談結果 60
表4-Q8-3 訪談結果 62
表4-Q9-1 訪談結果 66
表4-Q9-2 訪談結果 68
表4-Q10 訪談結果 71
表4-Q11-1 訪談結果 73
表4-Q11-2 訪談結果 76
表4-Q11-3 訪談結果 77
表4-Q12-1 訪談結果 80
表4-Q12-2 訪談結果 81
表4-Q13 訪談結果 84
表4-Q14 訪談結果 86
表4-Q15-1 訪談結果 88
表4-Q15-2 訪談結果 91
表4-Q16 訪談結果 95
表4-Q17 訪談結果 99
表4-Q18 訪談結果 104

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