臺灣博碩士論文加值系統

研究背景：近年來，安寧療護已漸受到重視，也知道末期病人早期轉介至安寧療護有許多好處，但卻存在末期病人太晚轉介至安寧療護的狀況。目前已知護理人員對安寧療護的知識與態度，影響病人是否能夠接受及使用安寧療護。因此希望藉此次研究了解護理人員對於安寧療護的知識和態度程度差異，和提供轉介行為之現況。
研究目的：本研究目的為探討不同單位護理人員對於安寧療護的知識和態度程度差異以及轉介安寧療護之現況。
研究方法：採橫斷式結構性網路及實體問卷調查，研究工具為安寧療護知識、態度與環境影響因素量表，以方便及滾雪球取樣方式收集資料，施測時間為107年3月23日~5月14日，回收421份問卷，無效問卷共71份，回收率達83.1%。資料收集完成後使用變異數分析、t檢定、卡方檢定、皮爾森績差相關以及邏輯斯回歸統計法分析。
研究結果：本研究之護理人員有198人(56.6%)在近3個月內曾提供或轉介病人安寧照護經驗，安寧轉介行為與安寧緩和療護態度、個人認知能力呈正相關。影響安寧轉介行為重要因子為「工作期間有無上過安寧療護在職訓練課程」、「有無照顧末期病人經驗」、「安寧療護態度」、「個人認知能力」、「其他病房」及「年齡」等7個變項，共可解釋25.6%變異量，統計檢定力為0.95，其中「有無照顧末期病人經驗」對於護理人員安寧轉介行為佔有最重要的影響力，其次為護理人員「有無參於過在職訓練課程」。本研究「安寧療護知識」總平均分數為14.91，「安寧療護態度」總平均分數為66.37，「環境影響因素量表」中有58.8%護理人員認為末期病人總是太晚轉介至安寧療護。整體而言護理人員對於安寧療護基本知識已十分清楚，也表示願意協助末期病人接受安寧緩和，但在向病人討論安寧轉介上趨向保守，而安寧轉介行為仍受多重其他因素影響，如認為缺乏醫師支持態度與家屬態度對護理人員影響最大。
結論與應用：期望本研究之結果能提供未來護理人員在職教育上與安寧轉介之建議或規劃，使安寧療護的推展利用能更邁進，讓末期病人照護品質可以提升。

Background：In recent years, hospice care has gradually gained attention. Although it is known that several benefits exist in the early referral of terminal patients to hospice care, terminal patients are often referred too late. It is known that the knowledge and attitudes of nurses toward hospice care affect whether patients are able to accept and utilize hospice care. This study hopes to understand differences between the care knowledge and attitudes of nurses as well as the current status of referral behavior.
Objectives：The purpose of this study was to examine differences between the care knowledge and attitudes of nurses from different units and the current status of referrals to hospice care.
Methods：A cross-sectional structured online and paper questionnaire survey was conducted. The research instruments employed were scales for care knowledge, attitude, and environmental factors. Data were collected using convenience and snowball sampling from March 23 to May 14, 2018; 421 responses were received, of which 71 were invalid responses, for a valid response rate of 83.1%. After data collection, ANOVA, t testing, chi-square testing, Pearson’s correlation coefficient, and logistic regression were used for statistical analysis.
Results：A total of 198 nurses in this study (56.6%) had experience providing or referring patients to hospice care in the last 3 months. Hospice care referral behavior was positively correlated with care attitude and individual cognitive ability. Crucial factors that affected referral behavior were “in-service training on hospice care during the working period,” “experience caring for terminal patients,” “attitude toward hospice and palliative care,” “individual cognitive ability,” “other wards,” and “age.” These seven variables explained 25.6% of variance with a statistical power of 0.95, where “experience caring for terminal patients” had the greatest effect on the referral behavior of nurses, followed by the effect of whether nurses “participated in in-service training.” The total mean score for “care knowledge” in this study was 14.91, and that of “care attitude” was 66.37. On the environmental factors scale, 58.8% of nurses believed that terminal patients were consistently referred to hospice care too late. Overall, the nurses were fully clear on the basic knowledge of hospice care and expressed their willingness to assist terminal patients in accepting hospice and palliative care. However, they tended to be conservative in discussions of care referral with patients, and referral behavior remained affected by several other factors, such as the belief that there was a lack of support from physicians as well as the attitudes of family members, which had the greatest effect on nurses.
Conclusion：The results of this study may serve as a reference for nurses in terms of recommendations or planning of in-service education and care referral in the future, enabling the improvement of the promotion and use of hospice care and increasing the care quality for terminal patients.

目錄
致謝 i
中文摘要 iii
Abstract iv
目錄 vi
圖目錄 viii
表目錄 ix
附錄目錄 x
第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 4
第三節 研究問題 5
第四節 研究假設 6
第五節 名詞界定 7
第二章 文獻查證 9
第一節 台灣安寧療護在台灣發展歷程及理念 9
第二節 台灣安寧療護照護模式 12
第三節 護理人員對安寧療護的知識與態度 18
第四節 台灣安寧療護轉介現況與困境 28
第三章 研究方法 31
第一節 研究設計 31
第二節 研究架構 32
第三節 研究場域與研究對象 33
第四節 研究工具與信效度檢定 34
第五節 研究步驟 36
第六節 研究倫理 37
第七節 資料處理與分析 38
第四章 研究結果 39
第一節 研究對象基本屬性 39
第二節 護理人員安寧轉介行為之現況 44
第三節 護理人員對安寧緩和療護知識程度 46
第四節 護理人員對安寧緩和療護之態度 49
第五節 環境影響因素量表測驗結果 52
第六節 護理人員人口學背景對於安寧緩和療護知識、態度和轉介行為之差異 55
第七節 安寧、腫瘤與其他病房護理人員安寧緩和療護之知識、態度與安寧轉介討論行為的差異性 62
第八節 護理人員對安寧療護知識、態度、環境影響因素與安寧轉介行為之相關性 71
第九節 護理人員安寧轉介行為之重要預測因子 73
第十節 開放性問題結果 75
第五章 討論 95
第一節 研究方法 95
第二節 護理人員安寧緩和療護轉介行為之現況 97
第三節 安寧緩和療護的知識、態度及環境影響因素之探討 99
第四節 影響護理人員安寧緩和療護知識、態度與轉介行為的因素 103
第五節 安寧緩和療護知識、態度與環境影響因素對轉介行為之影響 105
第六節 安寧、腫瘤與其他病房護理人員安寧療護之知識、態度與轉介討論行為的差異分析 107
第七節 開放性問題討論 109
第六章 結論、建議、研究優勢與限制 116
第一節 結論 116
第二節 研究應用與建議 120
參考文獻 125

圖目錄
圖3-1 護理人員對安寧療護知識、態度、轉介行為研究架構 32
圖3-5 網路收案流程 36
圖3-6 研究流程 37
圖5-7 護理人員在執行安寧轉介的困難 114
圖6-1 依研究結果整理出護理人員安寧轉介過程中之困境 119

表目錄
表2-1安寧緩和醫療條例三次修法內容 12
表2-2-1 安寧緩和療護團隊常見成員介紹 16
表2-2-2 五全照護內容 17
表2-3 安寧療護知識與態度國內外相關研究 23
表4-1 護理人員基本屬性之分布(N=350) 41
表4-2 護理人員安寧轉介行為(N=350) 45
表4-3護理人員於安寧緩和療護知識得分情形(N=350) 47
表4-3-1護理人員於安寧緩和療護知識各題項得分情形(N=350) 47
表4-3-2不同單位護理人員於安寧緩和療護知識得分情形(N=350) 48
表4-4 護理人員於安寧緩和療護態度得分情形(N=350) 50
表4-4-1護理人員於安寧緩和療護態度各題項得分情形(N=350) 50
表4-4-2不同單位護理人員於安寧緩和療護態度得分情形(N=350) 51
表4-5 護理人員安寧緩和療護之環境影響因素之測驗結果(N=350) 53
表4-6 護理人員人口學特性與安寧緩和療護知識之差異(N=350) 55
表4-6-1 護理人員人口學特性與安寧緩和療護態度之差異(N=350) 58
表4-6-2 護理人員人口學特性與安寧轉介行為之差異(N=325) 60
表4-7 護理人員於知識答對率的差異性(N=350) 63
表4-7-1護理人員於態度得分的差異性(N=350) 66
表4-7-2 安寧與非安寧專科護理人員與安寧討論行為之差異(N=325) 69
表4-7-4 腫瘤專科與非腫瘤專科護理人員與安寧討論行為之差異(N=252)
69
表4-7-5 非安寧專科護理人員之安寧討論行為的差異(N=252) 70
表4-8 安寧療護知識、態度、環境影響因素與安寧轉介行為之相關矩陣(N=350) 72
表4-9 護理人員安寧轉介行為之二項式邏輯斯迴歸分析表(N=350) 74
表4-10 開放性問題整理表格(N=168) 87
表4-10-1 開放性問題逐字稿資料(N=168) 88

附錄目錄
附錄一 研究問卷初稿 138
附錄二 研究工具專家效度名單 143
附錄三 專家效度修正結果 144
附錄四 護理人員對安寧緩和療護知識、態度、轉介行為之研究問卷 148
附錄五 附錄五探討不同單位護理人員安寧緩和療護知識、態度、轉介行為之差異之研究甘特圖 154
附錄六 人體研究暨倫理委員會審查同意書 155

中文部分
中華民國護理師護士公會全國聯合會(2018年06月04日)･台閩地區護理人員統計表･取自http://www.nurse.org.tw/publicUI/H/H10201.aspx?arg=8D5CA3386401F3E058
何紜緹(2013)･另一個善終的選擇：安寧共同照護･生命雙月刊，118，3-7。
宋佳霖(2014)･護理之家工作人員對安寧療護知識、態度及相關因素的探討･未發表碩士論文，臺中科技大學：台中市。
周嘉惠(2014)･探討加護病房護理人員對安寧患和療護認知與態度的相關性･未發表碩士論文，輔英科技大學：高雄市。
許禮安(2012)･安寧療護概論･安寧緩和療護(一版，頁2-17)･台北：華杏。
陳佳佳(2014)･生命盡頭的尊重･全民健康保險雙月刊，111，10-15。
陳雅莉(2017)･非安寧病房護理人員對安寧緩和醫療決策行為意向相關影響因素之探討･未發表碩士論文，國立台北護理健康大學：台北市。
楊克平(2012)･安寧與緩和療護理念･安寧與緩和療護學(二版，頁23-29)･台北：華杏。
臺灣安寧緩和護理學會(2018)･教育課程･取自http://www.hospicenurse.org.tw/
臺灣安寧照顧協會(2017年1月31日)･全國安寧療護資源現況分佈･取自http://www.tho.org.tw/xms/toc/list.php?courseID=16
臺灣安寧照顧基金會(2017)･安寧療護理念問題･取自http://www.hospice.org.tw/2009/chinese/qa-2.php.
臺灣安寧緩和醫學學會(2013)･安寧緩和醫療理論與實務･台北：合記。
衛生福利部(2014年3月25日)･104-105年度推廣安寧緩和醫療社區照護模式試辦計畫･取自http://www.mohw.gov.tw/news/531953263。
衛生福利部中央健康保險署(2015年08月03日)･安寧共同照護･取自https://www.nhi.gov.tw/Content_List.aspx?n=57EF6EC5BCAB7609&topn=D39E2B72B0BDFA15
衛生福利部台灣病人安全資訊網(2016年11月21日)･醫病共享決策簡介･取自http://www.patientsafety.mohw.gov.tw/Content/Messagess/Contents.aspx?SiteID=1&MmmID=710351317675351145
衛生福利部中央健康保險署(2017年03月21日)･安寧療護(住院、居家、共照及社區)網路查詢服務･取自https://www.nhi.gov.tw/Content_List.aspx?n=D8386FD9AD1B49D3&topn=D39E2B72B0BDFA15
衛生福利部國民健康署(2014年08月06日)･全民健康保險安寧療護觀摩會･取自http://www.nhi.gov.tw/Information/newsdetail.aspx?menu=9&menu_id=544&No=1198
衛生福利部國民健康署(2016)･健康主題癌症防護安寧療護･取自http://www.hpa.gov.tw/Bhpnet/Web/HealthTopic/Topic.aspx?id=200804090002
衛生福利部統計處(2014年09月04日)･102年度死因統計･取自http://dep.mohw.gov.tw/DOS/np-1784-113.html
衛生福利部醫事司(2017年12月18日)･保障病人自主，病人自主權利法三讀通過･取自https://www.mohw.gov.tw/cp-2651-19687-1.html
衛生福利部醫事司(2017年03月27日)･安寧緩和醫療業務･取自https://dep.mohw.gov.tw/doma/cp-2708-7460-106.html
蕭麗雯(2009)･中彰地區長期照護機構工作人員對安寧療護之知識、態度及行為之探討･未發表碩士論文，亞洲大學：台中市。
鍾昌宏(2014)･安寧療護面面觀･聲洋防癌之聲，146，147-110。

英文部分
Abu Hasheesh, M. O., Al-Sayed AboZeid, S., Goda El-Zaid, S., & Alhujaili, A. D. (2014). Nurses' characteristics and their attitudes toward death and caring for dying patients in a public hospital in Jordan. Health Science Journal, 7(4), 384-394.
Aghdam, A. M., Aghaei, M. H., Hassankhani, H., & Rahmani, A. (2015). Awareness and attitude of nurses in regard to providing hospice care. Asian Pacific Journal of Cancer Prevention, 16(16), 6941-6945. doi: 10.7314 / APJCP.2015.16.16.6941
Al-Kindi, S. G., Zeinah, G. F. A., & Hassan, A. A. (2014). Palliative care knowledge and attitudes among oncology nurses in Qatar. American Journal of Hospice and Palliative Medicine, 31(5), 469-474. doi: 10.1177/1049909113489874
Amano, K., Tatara, R., Katayama, H., Uno, T., & Takagi, I. (2015). Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of end of life care: An investigation of cancer decedents in a cancer-designated hospital in Japan. 18(3), 270-273. doi: 10.1089/jpm.2014.0132
An, A. R., Lee, J. K., Yun, Y. H., & Heo, D. S. (2014). Terminal cancer patients’ and their primary caregivers’ attitudes toward hospice/palliative care and their effects on actual utilization: A prospective cohort study. Palliative Medicine, 28(7), 976-985. doi: 10.1177/0269216314531312
Artnak, K. E., McGraw, R. M., & Stanley, V. F. (2011). Health care accessibility for chronic illness management and end-of-life care: A view from rural America. The Journal of Law, Medicine & Ethics 39(2), 140-155. doi: 10.1111/j.1748-720X.2011.00584.x
Ayed, A., Sayej, S., Harazneh, L., Fashafsheh, I., & Eqtait, F. (2015). The nurses' knowledge and attitudes towards the palliative care. Journal of Education and Practice, 6(4), 91-99. doi: 10.13140/RG.2.1.1382.8960
Azami-Aghdash, S., Jabbari, H., Bakhshian, F., Shafaei, L., Shafaei, S., Kolahdouzan, K., & Mohseni, M. (2015). Attitudes and knowledge of Iranian nurses about hospice care. Indian Journal of Palliative Care, 21(2), 209-213. doi: 10.4103/0973-1075.156505
Bailey, C. J., Murphy, R., & Porock, D. (2011). Dying cases in emergency places: Caring for the dying in emergency departments. Social Science & Medicine, 73(9), 1371-1377. doi: 10.1016/j.socscimed.2011.07.036
Bakanic, V., Singleton, M., & Dickinson, G. E. (2016). Hospice attitudes of physicians and nurses: A pilot study. American Journal of Hospice and Palliative Medicine, 33(1), 34-40. doi: 10.1177/1049909114552124
Beckstrand, R. L., Rohwer, J., Luthy, K. E., Macintosh, J. L., & Rasmussen, R. J. (2017). Rural emergency nurses’ end-of-life care obstacle experiences: Stories from the last frontier. Journal of Emergency Nursing, 43(1), 40-48. doi: 10.1016/j.jen.2015.08.017
Beckstrand, R. L., Wood, R. D., Callister, L. C., Luthy, K. E., & Heaston, S. (2012). Emergency nurses' suggestions for improving end-of-life care obstacles. Journal of Emergency Nursing, 38(5), e7-e14. doi: 10.1016/j.jen.2012.03.008
Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. doi: 10.1001/jamainternmed.2014.5271
Boyd, D., Merkh, K., Rutledge, D. N., & Randall, V. (2011). Nurses’ perceptions and experiences with end-of-life communication and care. Oncology Nursing Forum, 38(3), 229-237. doi: 10.1188/11.ONF.E229-E239
Carpenter, J. G., McDarby, M., Smith, D., Johnson, M., Thorpe, J., & Ersek, M. (2017). Associations between timing of palliative care consults and family evaluation of care for veterans who die in a hospice/palliative care unit. Journal of Palliative Medicine, 20(7), 745-751. doi: 10.1089/jpm.2016.0477
Center for Advanced Palliative Care. (2017). Definition of palliative care. Retrieved from https://www.capc.org/about/palliative-care/.
Chang, H. J., Hsieh, S. I., Hsu, L. L., Chu, T. L., & Yu, W. P. (2015). [The needs assessment for nurses receiving the inservice education program in palliative care]. Chang Gung Nursing, 26(2), 125-136. doi: 10.3966/102673012015062602001
Chang, H. T., Lin, M. H., Chen, C. K., Chou, P., Chen, T. J., & Hwang, S. J. (2016). Trends of do-not-resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A hospital-based observational study. Medicine, 95(46), 1-6. doi: 10.1097/MD.0000000000005394
Chang, Y. J., Kwon, Y. C., Lee, W. J., Do, Y. R., Lee, K. S., Kim, H. T., . . . Yun, Y. H. (2013). Burdens, needs and satisfaction of terminal cancer patients and their caregivers. Asian Pacific Journal of Cancer Prevention, 14(1), 209-215. doi: 10.7314/APJCP.2013.14.1.209
Chao, C. S. C. (2009). [Development and prospects of hospice palliative care in Taiwan]. The Journal of Nursing, 56(1), 5-10. doi: 10.6224/JN.56.1.5
Chao, C. S. C. (2015). [Hospice palliative care is a universal value and the essence of nursing]. The Journal of Nursing, 62(2), 5-12. doi: 10.6224/JN.62.2.5
Chen, C. H., & Chen, M. J. (2016). [Home-based paliative care: Attitude in living-alone elderly cared under hospital-based accountable family physicians system]. Taipei City Medical Journal, 13(2), 130-140. doi: 10.6200/TCMJ.2016.13.2.03
Chen, C. Y., Hsu, T. F., & Pei, J. (2016). [Knowledge, attitudes, and behaviors of nurses toward the life-sustaining treatment choices of terminally ill patients]. Journal of Healthcare Management, 17(3), 169-187. doi: 10.6174/JHM2016.17(3).169
Chen, L. F., Chang, C. M., & Huang, C. Y. (2015). Home-based hospice care reduces end-of-Life expenditure in Taiwan: A population-based study. Medicine, 94(38), e1613. doi: 10.1097/MD.0000000000001613
Chen, M. M., Chou, C. C., Hsu, K. Y., Yen, Y. F., Yang, Y. T., & Huang, H. L. (2017). [An experience of providing palliative care in a long-term care facility: Let good death in place become a feasible reality]. The Journal of Nursing, 64(2), 130-135. doi: 10.6224/JN.000032
Chen, R. C. (2015a). [Hospice palliative care policy in Taiwan: Past developments and future perspectives]. The Journal of Nursing, 62(2), 13-17. doi: doi:10.6224/JN.62.2.13
Chen, R. C. (2015b). [Hospital should promote patient's right of peaceful dying according to the hospice palliative care act]. Hospital, 48(1), 7-12. doi: 10.6224/JN.62.2.13
Chen, S. T., Shen, H. Y., Huang, S. F., Lin, X. F., Lin, S. F., Lin, Q. L., . . . Hsiao, S. H. (2015). [Withdrawal of life sustaining treatment for a peaceful death]. Taipei City Medical Journal, 12(Suppl.), 57-67. doi: 10.6200/TCMJ. 2015.12.SP.07
Chen, Y. C., Liu, Y. F., Tsai, H. S., Lin, Y. S., & Fan, C. T. (2016). [Deliberations and review on the hallmarks of the hospice palliative care act in Taiwan]. Journal of Medicine and Health, 5(1), 25-34.
Cheng, S. Y., Chen, C. Y., & Chiu, T. Y. (2016). Advances of hospice palliative care in Taiwan. Korean Journal of Hospice and Palliative Care, 19(4), 292-295. doi: 10.14475/kjhpc.2016.19.4.292
Chih, A. H., Su, P., Hu, W. Y., Yao, C. A., Cheng, S. Y., Lin, Y. C., & Chiu, T. Y. (2016). The changes of ethical dilemmas in palliative care a lesson learned from comparison between 1998 and 2013 in Taiwan. Medicine, 95(1). doi: 10.1097/MD.0000000000002323
Chuang, R. B. (2005). [Introduction of hospital-based palliative shared care program]. Taiwan Journal of Hospice Palliative Care, 10(1), 39-43. doi: 10.6537/TJHPC.2005.10(1).4
Clara, G. C., & Arlene, H. (2012). Concept analysis of good death in terminally ill patients. American Journal of Hospice and Palliative Medicine, 29(8), 632-639. doi: 10.1177/1049909111434976
Dionne Odom, J. N., Azuero, A., Lyons, K. D., Hull, J. G., Tosteson, T., Li, Z., . . . Akyar, I. (2015). Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: Outcomes from the ENABLE III randomized controlled trial. Journal of Clinical Oncology, 33(13), 1446. doi: 10.1200/JCO.2014.58.7824
Facts, N. (2012). Figures: Hospice care in America. National Hospice and Palliative Care Organization, 3.
Feng, R. C., Yu, K. H., & Wu, M. P. (2015). [Demand of hospice care in potential end-of-life patients]. Taipei City Medical Journal, 12(Suppl.), 68-85. doi: 10.6200/TCMJ. 2015.12.SP.08
Freeman, S., Heckman, G., Naus, P. J., & Marston, H. R. (2013). Breaking down barriers: Hospice palliative care as a human right in Canada. Educational Gerontology, 39(4), 241-249. doi: 10.1080/03601277.2013.750930
Fu, H. Y., Li, C. L., Huang, T. H., Hsieh, S. I., & Wang, H. M. (2014). [Service analysis of hospitalized patients in the hospice ward at a district hospital of Taoyuan]. Chang Gung Nursing, 25(4), 375-388. doi: 10.3966/102673012014122504001
Gallagher, A., Bousso, R. S., McCarthy, J., Kohlen, H., Andrews, T., Paganini, M. C., . . . Arber, A. (2015). Negotiated reorienting: A grounded theory of nurses’ end-of-life decision-making in the intensive care unit. International Journal of Nursing Studies, 52(4), 794-803. doi: 10.1016/j.ijnurstu.2014.12.003
Gill, F., & Duffy, A. (2010). Caring for cancer patients on non-specialist wards. British Journal of Nursing, 19(12), 761-767. doi: 10.12968/bjon.2010.19.12.48654
Glass, A. P., Chen, L. K., Hwang, E., Ono, Y., & Nahapetyan, L. (2010). A cross-cultural comparison of hospice development in Japan, South Korea, and Taiwan. Journal of Cross-Cultural Gerontology, 25(1), 1-19. doi: 10.1007/s10823-009-9108-8
Gomes, B., Calanzani, N., Curiale, V., McCrone, P., Higginson, I. J., & de Brito, M. (2016). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Sao Paulo Medical Journal, 134(1), 93-94. doi: 10.1590/1516-3180.20161341T2
Gopal, K. S., & Archana, P. S. (2016). Awareness, knowledge and attitude about palliative care, in general, population and health care professionals in tertiary care hospital. International Journal of Scientific Study, 3(10), 31-35. doi: 10.17354/ijss/2016/07
Graham, M. J. (2015). Rural healthcare providers' behavioral intentions with hospice referrals: Attitudes, knowledge, beliefs, benefits, and barriers. (Doctoral Dissertation), Gardner-Webb University:Boiling Springs, NC.
Hales, S., Chiu, A., Husain, A., Braun, M., Rydall, A., Gagliese, L., . . . Rodin, G. (2014). The quality of dying and death in cancer and its relationship to palliative care and place of death. Journal of Pain and Symptom Management, 48(5), 839-851. doi: 10.1016/j.jpainsymman.2013.12.240
Hartogh, G. d. (2017). Suffering and dying well: On the proper aim of palliative care. Medicine, Health Care and Philosophy, 20(3), 413-424. doi: 10.1007/s11019-017-9764-3
Higginson, I. J., Finlay, I. G., Goodwin, D. M., Hood, K., Edwards, A. G., Cook, A., . . . Normand, C. E. (2003). Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? Journal of Pain and Symptom Management, 25(2), 150-168.
Higginson, I. J., Sarmento, V. P., Calanzani, N., Benalia, H., & Gomes, B. (2013). Dying at home--Is it better: A narrative appraisal of the state of the science. Palliative Medicine, 27(10), 918-924. doi: 10.1177/0269216313487940
Hoel, H., Skjaker, S. A., Haagensen, R., & Stavem, K. (2014). Decisions to withhold or withdraw life‐sustaining treatment in a Norwegian intensive care unit. Acta Anaesthesiologica Scandinavica, 58(3), 329-336. doi: 10.1111/aas.12246
Hou, S. Y., & Lee, R. P. (2009). [Nurses’ knowledge, attitudes and behavior intentions in the care of terminal stage cancer]. The Journal of nursing, 56(3), 46-56. doi: 10.6224/JN.56.3.46
Hu, W. Y., Chiu, T. Y., Lue, B. H., Chen, C. Y., Hsieh, C. Y., & Chen, Y. C. (2001). [An educational need to natural death act in Taiwan]. Journal of Medical Education, 5(1), 21-32.
Huang, L. H., & Wei, S. E. (2013). [End of life medical decision-making in intensive care unit: An analysis for do-not-resuscitate (DNR) designation]. Journal of Life Education, 5(1), 25-56. doi: 10.3966/207466012013060501002
Huijer, H. A. S., Abboud, S., & Dimassi, H. (2009). Palliative care in Lebanon: Knowledge, attitudes and practices of nurses. International Journal of Palliative Nursing, 15(7), 346-353.
Jack, B. A., Mitchell, T. K., Cope, L. C., & O'brien, M. R. (2016). Supporting older people with cancer and life‐limiting conditions dying at home: A qualitative study of patient and family caregiver experiences of hospice at home care. Journal of Advanced Nursing, 72(9), 2162-2172. doi: 10.1111/jan.12983
Kao, C. Y., Hu, W. Y., Chiu, T. Y., & Chen, C. Y. (2014). Effects of the hospital-based palliative care team on the care for cancer patients: An evaluation study. International Journal of Nursing Studies, 51(2), 226-235. doi: 10.1016/j.ijnurstu.2013.05.008
Kassa, H., Murugan, R., Zewdu, F., Hailu, M., & Woldeyohannes, D. (2014). Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC Palliative Care, 13(1), 1-11. doi: 10.1186/1472-684X-13-6
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755. doi: 10.1056/NEJMra1404684
Khader, K. A., Jarrah, S. S., & Alasad, J. (2010). Influence of nurses characteristics and education on their attitudes towards death and dying: A review of literature. International Journal of Nursing and Midwifery, 2(1), 1-9. doi: 10.11124/jbisrir-2015-1809
Laging, B., Ford, R., Bauer, M., & Nay, R. (2015). A meta‐synthesis of factors influencing nursing home staff decisions to transfer residents to hospital. Journal of Advanced Nursing, 71(10), 2224-2236. doi: 10.1111/jan.12652
Lancaster, G., Kolakowsky-Hayner, S., Kovacich, J., & Greer-Williams, N. (2015). Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel. Journal of Nursing Scholarship, 47(3), 275-284. doi: 10.1111/jnu.12130
Lau, S. C., Shen, L. C., Chiang, W. Y., & Wang, C. C. (2006). [A pilot study of public attitude to hospital hare]. The Journal of Nursing, 11(3), 242-251. doi: 10.6537/TJHPC.2006.11(3).2
Lee, L. C., Hu, C. C., Hwang, S. F., Lin, C. S., & Chang, Y. Y. (2011). [The main care issues among terminal cancer patients in hospice home care service]. Taiwan Journal of Hospice Palliative Care, 16(2), 151-167. doi: 10.6537/TJHPC.2011.16(2).2
Lee, S. Y., Chen, C. H., Huang, G. C., Ku, H. C., Shih, S. C., Wu, C. L., . . . Ho, Y. H. (2015). Factors associated with attitude and knowledge toward hospice palliative care among medical caregivers. International Journal of Gerontology, 9(2), 98-102. doi: 10.1016/j.ijge.2015.05.007
Lin, I. C., Lu, C. C., Lin, Y. L., Hsu, H. C., & Yang, P. Y. (2011). [A comparison of hospice development in Japan and Taiwan]. Taiwan Journal of Hospice Palliative Care, 16(2), 133-150. doi: 10.6537/TJHPC.2011.16(2).1
Lin, W. C., & Li, P. Y. (2015). [The last piece of the palliative care team puzzle: The function and the role of psychologists]. Taiwan Journal of Hospice Palliative Care, 20(2), 133-144. doi: 10.6537/TJHPC.2015.20(2).3
Lin, W. H., & Lee, C. L. (2017). [The role of pharmacists in a palliative care team]. Taipei City Medical Journal, 14(1), 123-127. doi: 10.6200/TCMJ.2017.14.1.13
Lin, W. Y., Chiu, T. Y., Ho, C. T., Davidson, L. E., Hsu, H. S., Liu, C. S., . . . Lin, C. C. (2014). Hospice shared-care saved medical expenditure and reduced the likelihood of intensive medical utilization among advanced cancer patients in Taiwan: A nationwide survey. Supportive Care in Cancer, 22(7), 1907-1914. doi: 10.1007/s00520-014-2168-5
Liu, M. Y., Liu, H. E., Wan, H. M., Tsay, P. K., Jane, S. W., & Lin, Y. H. (2015). [The efficacy of a hospice shared-care model on the care overload of primary caregivers of terminal-stage cancer patients]. Journal of Nursing and Healthcare Research, 11(4), 257-266. doi: 10.6225/JNHR.11.4.257
Love, A. W., & Liversage, L. M. (2014). Barriers to accessing palliative care: A review of the literature. Progress in Palliative Care, 22(1), 9-19. doi: 10.1179/1743291X13Y.0000000055
Lusardi, P., Jodka, P., Stambovsky, M., Stadnicki, B., Babb, B., Plouffe, D., . . . Montonye, M. (2011). The going home initiative: Getting critical care patients home with hospice. Critical Care Nurse, 31(5), 46-57. doi: 10.4037/ccn2011415
Lysaght Hurley, S., Barg, F. K., Strumpf, N., & Ersek, M. (2015). Same agency, different teams: Perspectives from home and inpatient hospice care. Qualitative Health Research, 25(7), 923-931. doi: 10.1177/1049732314554091
Lysaght Hurley, S., Strumpf, N., Barg, F. K., & Ersek, M. (2014). Not quite seamless: Transitions between home and inpatient hospice. Journal of Palliative Medicine, 17(4), 428-434. doi: 10.1089/jpm.2013.0359
Ma, J. C., Cheng, W. J., Li, C. H., Lin, P. X., & Su, M. I. (2015). [Withdrawal of endotracheal tube for patients at end-of-life in intensive care unit]. Taiwan Journal of Hospice Palliative Care, 20(2), 120-132. doi: 10.6537/TJHPC.2015.20(2).2
Mahon, M. M., & McAuley, W. J. (2010). Oncology nurses' personal understandings about palliative care. Oncology Nursing Forum, 37(3), 141-150. doi: 10.1188/10.ONF.E141-E150
Miller, S. C., Lima, J. C., Looze, J., & Mitchell, S. L. (2012). Dying in U.S. nursing homes with advanced dementia: How does health care use differ for residents with, versus without, end-of-life medicare skilled nursing facility care? Journal of Palliative Medicine, 15(1), 43-50. doi: 10.1089/jpm.2011.0210
Mills, T. (2017). Hospice and African American referrals: Perceptions of non-physician medical providers. (Doctoral Dissertation), Grand Canyon University: Phoenix, AZ.
Park, K. S., & Yeom, H. A. (2014). Factors influencing Korean nurses’ attitudes towards hospice care. International Nursing Review, 61(4), 563-569. doi: 10.1111/inr.12135
Peng, J. K., & Hung, S. H. (2011). [Establishing end-of-life care program in the community: Yun-Lin experience]. Formosan Journal of Medicine, 15(1), 48-55. doi: 10.6320/FJM.2011.15(1).08
Phua, J., Joynt, G. M., Nishimura, M., Deng, Y., Myatra, S. N., Chan, Y. H., . . . Arabi, Y. M. (2015). Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Internal Medicine, 175(3), 363-371. doi: 10.1001/jamainternmed.2014.7386
Prokip, S., Pawłowska, I., Hromovyk, B., & Pawłowski, L. (2014). Pharmacist’s role in the system of palliative and hospice care in Ukraine and Poland. Journal of Medical Science, 83(4), 282-287.
Schulman-Green, D., McCorkle, R., Cherlin, E., Johnson-Hurzeler, R., & Bradley, E. H. (2005). Nurses' communication of prognosis and implications for hospice referral: A study of nurses caring for terminally ill hospitalized patients. American Journal of Critical Care, 14(1), 64-70.
Shanley, C., Whitmore, E., Conforti, D., Masso, J., Jayasinghe, S., & Griffiths, R. (2011). Decisions about transferring nursing home residents to hospital: Highlighting the roles of advance care planning and support from local hospital and community health services. Journal of Clinical Nursing, 20(19‐20), 2897-2906. doi: 10.1111/j.1365-2702.2010.03635
Shepperd, S., Gonçalves‐Bradley, D. C., Straus, S. E., & Wee, B. (2016). Hospital at home: Home‐based end‐of‐life care. Cochrane Database of Systematic Reviews, 2. doi: 10.1002 / 14651858.CD009231
Shih, T. C., Chang, H. T., Lin, M. H., Chen, C. K., Chen, T. J., & Hwang, S. J. (2017). Trends of do-not-resuscitate orders, hospice care utilization, and late referral to hospice care among cancer decedents in a tertiary hospital in Taiwan between 2008 and 2014: A hospital-based observational study. Journal of Palliative Medicine, 20(8), 838-844. doi: 10.1089 / jpm.2016.0362
Smith, H. (2014). Giving hope to families in palliative care and implications for practice: While parents of children with life-limiting may not be in denial, Helen Smith suggests they will need time to come to terms with the inevitable, and nurses are crucial to conveying information sensitively and involving them in decisions. Nursing Children and Young People, 26(5), 21-25. doi: 10.7748/ncyp.26.5.21.e412
Smith, S., Brick, A., O’Hara, S., & Normand, C. (2014). Evidence on the cost and cost-effectiveness of palliative care: A literature review. Palliative Medicine, 28(2), 130-150. doi: 10.1177/0269216313493466
Spencer, L. (2015). Hospice to home: A patient-centric multiprofessional community approach. International Journal of Palliative Nursing, 21(5), 245-250. doi: 10.12968/ijpn.2015.21.5.245
Tang, V. L., French, C. J., Cipher, D. J., & Rastogi, P. (2013). Trends in hospice referral and length of stay at a veterans hospital over the past decade. American Journal of Hospice and Palliative Medicine, 30(5), 432-436. doi: 10.1177/1049909112453642
Tapley, M. P., Pilling, L., Jolley, D., Daniels, A. M., & El-Mahmoudi, B. (2013). Hospice transfer for patients at the end of life: part 1. Nursing Standard, 28(8), 42-48. doi: 10.7748 / ns2013.10.28.8.42.e7756
Tedder, T., Elliott, L., & Lewis, K. (2017). Analysis of common barriers to rural patients utilizing hospice and palliative care services: An integrated literature review. Journal of the American Association of Nurse Practitioners, 29(6), 356-362. doi: 10.1002/2327-6924.12475
Thorn, H., & Uhrenfeldt, L. (2017). Experiences of non-specialist nurses caring for patients and their significant others undergoing transitions during palliative end-of-life cancer care: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(6), 1711-1746. doi: 10.11124 / JBISRIR-2016-003026
Tien, L. C., Wu, Y. L., Liu, C. N., Lin, S. F., Chen, C. L., Lin, H. Y., . . . Wang, S. C. (2015). The role of social workers in community palliative care. Taipei City Medical Journal, 12(Suppl.), 35-45. doi: 10.6200/TCMJ.2015.12.SP.05
Torres, L., Lindstrom, K., Hannah, L., & Webb, F. J. (2016). Exploring barriers among primary care providers in referring patients to hospice. Journal of Hospice & Palliative Nursing, 18(2), 167-172. doi: 10.1097/NJH.0000000000000233
Tsai, H. H., Tsai, Y. F., & Huang, H. L. (2016). Nursing home nurses’ experiences of resident transfers to the emergency department: No empathy for our work environment difficulties. Journal of Clinical Nursing, 25(5-6), 610-618. doi: 10.1111/jocn.13084
Ueng, R. S., Hsu, S. H., Hung, S. L., Liu, H. H., Lee, P. H., Hung, Y. C., . . . Shih, C. Y. (2013). [Is it possible for people to die peacefully at home in Taiwan ?--Home death issues of terminal patients]. Taiwan Journal of Hospice Palliative Care, 18(3), 320-329. doi: 10.6537/TJHPC.2013.18(3).6
Wang, S. C. (2007). [People's recognition tendency and concerned factors in hospice care]. The Journal of Nursing, 12(1), 44-55. doi: 10.6537/TJHPC.2007.12(1).4
Weng, C. E., Chin, S. H., Liao, M. N., & Wang, C. H. (2005). [Nurses toward hospice care in non-hospice ward]. Chang Gung Nursing, 16(1), 12-22.
Wessel, E. M., & Rutledge, D. N. (2005). Home care and hospice nurses' attitudes toward death and caring for the dying: Effects of palliative care education. Journal of Hospice & Palliative Nursing, 7(4), 212-218.
Wilson, O., Avalos, G., & Dowling, M. (2016). Knowledge of palliative care and attitudes towards nursing the dying patient. British Journal of Nursing, 25(11), 600-605. doi: 10.12968/bjon.2016.25.11.600
World Health Organization. (2014). Programs and management: Palliative care. Retrieved from http://www.who.int/ncds/management/palliative-care/introduction/en/#.
World Health Organization. (2017). Definition of palliative care. Retrieved from http://www.who.int/cancer/palliative/definition/en/.
Wu, F. L., Chen, C. Y., & Hsieh, B. S. (2011). [Death care planning in the community]. Formosan Journal of Medicine, 15(1), 22-31. doi: 10.6320/FJM.2011.15(1).05
Yamagishi, A., Morita, T., Kawagoe, S., Shimizu, M., Ozawa, T., An, E., . . . Miyashita, M. (2015). Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home. Supportive Care in Cancer, 23(2), 491-499. doi: 10.1007/s00520-014-2397-7
Yao, C. A., Hu, W. Y., Lai, Y. F., Cheng, S. Y., Chen, C. Y., & Chiu, T. Y. (2007). Does dying at home influence the good death of terminal cancer patients? Journal of Pain and Symptom Management, 34(5), 497-504.
Zerwekh, J. V. (2005). Nursing care at the end of life: Palliative care for patient and families. Philadelphia, PA: F.A. Davis Company.
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., . . . Tannock, I. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730. doi: 10.1016/S0140-6736(13)62416-2