加護單位護理人員照顧病人及家屬於瀕死的過程中會因情感衝突與臨床困境，影響病人的照護品質，甚至威脅身心健康。本研究目的為呈現加護單位護理人員照護瀕死病人時的經驗，協助護理人員透過敘說回顧自己經驗並賦予意義。採敘說研究法，以立意取樣選取南部某醫學中心10位加護單位護理人員，並使用半結構式訪談大綱引導訪談。研究顯示護理人員照顧經驗包括，『看見受苦，內心不捨』護理人員看見病人與家屬於積極治療中，承受生心理兩方面的苦痛，感到內心不捨，因此引發動機，希望提供更好的照顧；『瀕死陪伴，生死兩安』除基本的生理照顧，瀕死期的照顧過程，護理人員更期許自己可提供更多情感支持與心靈陪伴；『衝突掙扎，身心疲憊』照護過程中，護理人員經歷自我情感衝突與臨床困境掙扎，因而只能無奈的面對自己的無能為力，導致於身心疲憊以及出現熱情消減的狀況；『豁達態度，規劃人生』出現情緒的低潮期後，護理人員反思自我，對於人生的態度出現轉變，自己應該要豁達且正向的面對人生，並且提早規劃；『同感支持，期許未來』雖然照護過程中面臨許多困難與挫折，但身旁仍持續有來自於同仁及家屬的支持，讓護理人員獲得能量，更期許自己未來可更精進。透過整體敘說故事的呈現，加護單位護理人員照顧病人及家屬於瀕死期的經驗能被看見，並透過教育、行政或支持系統方面提供幫助，以提升照護能力。

The ICU nurses experience reluctance, emotional conflict and exhaustion due to the suffering of patients and their families during the dying process. This affects the quality of care and the health of the ICU nurses. The purpose of this study is to explore the experiences of the ICU nurses caring for patients and their families during the dying process and to help them define the meaning of these experiences. A narrative inquiry was conducted for ten ICU nurses in a southern Taiwan medical center. A semi-structure interview guide was used for collecting data during the interview. Results from this study show five main experiences: 1) “Seeing the suffering and feeling reluctant”- the ICU nurses saw the suffering of the patients and families during the aggressive treatment procedures. They feel reluctant and are moved to provide better care for the dying patients. 2) “Being there to accompany the dying, bringing peace and relief ” - the ICU nurses wish they can provide more emotional and spiritual care for the patients and families. 3) “Feeling conflict, struggle and exhaustion” - The ICU nurses felt emotional conflict, struggle, powerlessness and exhaustion during the caring process. 4) “Having a positive attitude and reorganizing life” - After the feeling of depression, self-reflection helped the ICU nurses change their attitudes and reorganize their lives. 5) “Getting support and looking to the future” - There was a lot of support from colleagues and relatives which helped the ICU nurses get power to look to the future. From presenting the stories of ICU nurses in context, their experiences can be heard, providing information for the improvement of education, administration and support systems in the future

全國法規資料庫(2002，12月11日)‧安寧緩和條例‧2008年10月15日取自http://law.moj.gov.tw/Scripts/Query1A.asp?no=1L0020066&K1=安寧緩和&KeyWordID=&KCDate=
李日斌 （2009）‧先秦儒家殯葬倫理思想‧輔仁宗教研究，18，149-182。
阮平英、黃珊（2004）‧外科加護單位護理人員照顧瀕死病患之行為及其相關因素‧新臺北護理期刊，6（1），33-45。
呂佩佩、丁興祥、陳美伶、唐婉如（2005）‧學術洪流中護理研究的定位－從質性研究與量化研究之源流談起‧護理雜誌，52（6），76-81。
周雅容（2008）‧象徵互動論與語言的社會意涵‧胡幼慧主編，質性研究（二版，61-80頁）‧台北：巨流。
曾美珠、李燕蕙（2006）‧非安寧病房護理人員面對遺體護理之心理歷程探討‧中華心理衛生學刊，19（4），395-415。
陳玉黛、林佩芬（2004）‧影響加護單位護理人員面對瀕死病患態度之因素探討‧慈濟護理雜誌， 3（4），49-60。
陳雅惠（2005）‧中部某醫學中心之護理人員的臨終兒童照護經驗‧未發表的碩士論文，台北：國立臺灣大學護理學研究所。
許禮安（1998）‧心蓮心語-安寧療護與生死學‧台北市：慈濟文化志業中心。
馮雅芳（2002）‧加護病房醫護人員對疾病末期病人醫療決策行為意向及其影響因素之研究‧未發表的碩士論文，台北：國立臺灣大學護理學研究所。
趙可式（2007）‧安寧伴行 ‧台北市：天下遠見。
趙可式（2009）‧台灣安寧療護的發展與前瞻‧護理雜誌，56（1），5-10。
蔡昌雄、蔡淑玲、劉鎮嘉（2006）‧死亡焦慮下的自我照顧-以安寧護理人員為例‧生死學研究，(3)，133-164。
Angus, D. C., Barnato, A. E., Linde-Zwirble, W. T., Weissfeld, L. A., Watson, R. S., Rickert, T., et al. (2004). Use of intensive care at the end of life in the United States: an epidemiologic study. Critical Care Medicine, 32(3), 638-643.
Badger, J. M. (2005). Factors that enable or complicate end-of-life transitions in critical care. American Journal of Critical Care, 14(6), 513-522.
Beckstrand, R. L., Callister, L. C., & Kirchhoff, K. T. (2006). Providing a "good death": critical care nurses' suggestions for improving end-of-life care. American Journal of Critical Care, 15(1), 38-46.
Beckstrand, R. L., & Kirchhoff, K. T. (2005). Providing end-of-life care to patients: critical care nurses' perceived obstacles and supportive behaviors. American Journal of Critical Care, 14(5), 395-403.
Beckstrand, R. L., Smith, M. D., Heaston, S., & Bond, A. E. (2008). Emergency nurses' perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care. Jouranl of Emergency Nursing, 34(4), 290-300.
Brosche, T. A. (2003). Death, dying, and the ICU nurse. Dimensions of Critical Care Nursing, 22(4), 173-179.
Buauchamp, T. L., & Childress, J. F. (2009) Principles of biomedical ethics. New York: Oxford University press.
Cambridge University Press. (2005). Cambridge advanced learner's dictionary. Cambridge: Cambridge University Press.
Campbell, M. L. (2006). Palliative care consultation in the intensive care unit. Critical Care Medicine, 34(11), S355-358.
Chen, Y. C., Lin, S. F., Liu, C. J., Jiang, D. D., Yang, P. C., & Chang, S. C. (2001). Risk factors for ICU mortality in critically ill patients. Journal of the Formosan Medical Association, 100(10), 656-661.
Clarke, E. B., Curtis, J. R., Luce, J. M., Levy, M., Danis, M., Nelson, J., et al. (2003). Quality indicators for end-of-life care in the intensive care unit. Critical Care Medicine, 31(9), 2255-2262.
Curtis, J. R., & Engelberg, R. A. (2006). Measuring success of interventions to improve the quality of end-of-life care in the intensive care unit. Critical Care Medicine, 34(11), S341-347.
Dunn, G. P., & Mosenthal, A. C. (2007). Palliative care in the surgical intensive care unit: where least expected, where most needed. Asian Journal of Surgery, 30(1), 1-5.
Dunn, K. S., Otten, C., & Stephens, E. (2005). Nursing experience and the care of dying patients. Oncology Nursing Forum, 32(1), 97-104.
Evans, M. J., & Hallett, C. E. (2007). Living with dying: a hermeneutic phenomenological study of the work of hospice nurses. Journal of Clinical Nursing, 16(4), 742-751.
Esponosa, L.,Young, A., Symes, L., Haile, B., & Walsh, T. (2010). ICU nurses' experiences in providing terminal care. Critical Care Nursing Quarterly, 33(3), 273-281.
Espinosa, L., Young, A., & Walsh, T. (2008). Barriers to intensive care unit nurses providing terminal care: an integrated literature review. Critical Care Nursing Quarterly, 31(1), 83-93.
Gross, A. G. (2006). End-of-life care obstacles and facilitators in the critical care units of a community hospital. Journal of Hospice & Palliative Nursing, 8(2), 92-102.
Halcomb, E., Daly, J., Jackson, D., & Davidson, P. (2004). An insight into Australian nurses' experience of withdrawal/withholding of treatment in the ICU. Intensive & Critical Care Nursing, 20(4), 214-222.
Hansen, L., Goodell, T. T., Dehaven, J., & Smith, M. (2009). Nurses' perceptions of end-of-life care after multiple interventions for improvement. American Journal of Critical Care, 18(3), 263-271.
Heyland, D. K., Rocker, G. M., O'Callaghan, C. J., Dodek, P. M., & Cook, D. J. (2003). Dying in the ICU: perspectives of family members. Chest, 124(1), 392-397.
Hodde, N. M., Engelberg, R. A., Treece, P. D., Steinberg, K. P., & Curtis, J. R. (2004). Factors associated with nurse assessment of the quality of dying and death in the intensive care unit. Critical Care Medicine, 32(8), 1648-1653.
Hopkinson, J. B., Hallett, C. E., & Luker, K. A. (2003). Caring for dying people in hospital. Journal of Advanced Nursing, 44(5), 525-533.
Iranmanesh, S., Dargahi, H., & Abbaszadeh, A. (2008). Attitudes of Iranian nurses toward caring for dying patients. Palliative and Supportive Care, 6(4), 363-369.
Iranmanesh, S., Haggstrom, T., Axelsson, K., & Savenstedt, S. (2009). Swedish nurses' experiences of caring for dying people: a holistic approach. Holistic Nursing Practice, 23(4), 243-252.
Luce, J. M., & Wachter, R. M. (1994). The ethical appropriateness of using prognostic scoring systems in clinical management. Critical Care Clinics, 10(1), 229-241.
Luce, J. M., & White, D. B. (2007). The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States.[see comment]. American Journal of Respiratory & Critical Care Medicine, 175(11), 1104-1108.
Mak, J. M., & Clinton, M. (1999). Promoting a good death: an agenda for outcomes research--a review of the literature. Nursing Ethics, 6(2), 97-106.
McMillen, R. E. (2008). End of life decisions: nurses perceptions, feelings and experiences. Intensive & Critical Care Nursing, 24(4), 251-259.
Meltzer, L. S., & Huckabay, L. M. (2004). Critical care nurses' perceptions of futile care and its effect on burnout. Am Journal of Critical Care, 13(3), 202-208.
Mosenthal, A. C. (2002). Managing Death in the Intensive Care Unit: The Transition from Cure to Comfort. Journal of Pain and Symptom Management, 23(1), 83-84.
Mosenthal, A. C. (2005). Palliative care in the surgical ICU. Surgical Clinics of North America, 85(2), 303-313.
Mularski, R. A. (2006). Defining and measuring quality palliative and end-of-life care in the intensive care unit. Critical Care Medicine, 34(11), S309-316.
Nelson, J. E. (2006). Identifying and overcoming the barriers to high-quality palliative care in the intensive care unit. Critical Care Medicine, 34(11), S324-331.
Nelson, J. E., & Danis, M. (2001). End-of-life care in the intensive care unit: where are we now? Critical Care Medicine, 29(2), N2-9.
Pattison, N. (2006). A critical discourse analysis of provision of end-of-life care in key UK critical care documents. Nursing in Critical Care, 11(4), 198-208.
Prendergast, T. J., & Luce, J. M. (1997). Increasing incidence of withholding and withdrawal of life support from the critically ill.[see comment]. American Journal of Respiratory & Critical Care Medicine, 155(1), 15-20.
Riessman, C. K., (2000). Analysis of personal narratives. In J. F. Gubrium and J. A. Holstein (Ed.), Handbook of Interview.(1 st ed., 695-710). Thousand Oaks, CA: Sage.
Riessman, C. K., (2002). Narrative Analysis. In A.M. Huberman and M. B. Miles (Ed.), The Qualitative Researcher's Companion. (1 st ed., 217-220). Thousand Oaks, CA: Sage.
Shanafelt, T. D., Bradley, K. A., Wipf, J. E., & Back, A. L. (2002). Burnout and self-reported patient care in an internal medicine residency program. Annals of internal medicine, 136(5), 9.
Stapleton, R. D., Engelberg, R. A., Wenrich, M. D., Goss, C. H., & Curtis, J. R. (2006). Clinician statements and family satisfaction with family conferences in the intensive care unit. Crit Care Med, 34(6), 1679-1685.
Sorensen, R., & Iedema, R. (2007). Advocacy at end-of-life research design: an ethnographic study of an ICU. Int J Nurs Stud, 44(8), 1343-1353.
Treece, P. D., Engelberg, R. A., Crowley, L., Chan, J. D., Rubenfeld, G. D., Steinberg, K. P., et al. (2004). Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Critical Care Medicine, 32(5), 1141-1148.
Vejlgaard, T., & Addington-Hall, J. M. (2005). Attitudes of Danish doctors and nurses to palliative and terminal care. Palliative Med, 19(2), 119-127.
Walter, T. (2003). Historical and cultural variants on the good death. British Medical Journal, 327(7408), 218-220.
Weigel, C., Parker, G., Fanning, L., Reyna, K., & Gasbarra, D. B. (2007). Apprehension among hospital nurses providing end-of-life care. Journal of Hospice & Palliative Nursing, 9(2), 86-91.
WHO. (n.d.). WHO Definition of Palliative Care. Retrieved February 1, 2009, from http://www.who.int/cancer/palliative/definition/en/
Wu, H. L., & Volker, D. L. (2009). Living with death and dying: the experience of Taiwanese hospice nurses. Oncology Nursing Forum, 36(5), 578-584.