隨著高齡化、少子化及家庭結構改變，高齡者臨終階段醫療照護需求明顯增加，醫院亦逐漸成為臨終照護的重要場域。對第一線醫院照顧服務員（以下簡稱照服員）而言，在複雜的醫療照護情境中，除需照顧高齡者、回應家屬需求，亦需與醫療團隊密切合作，共同面對高齡者的臨終歷程。然而，現行照服員培訓仍以基礎照護技能為主，臨終照護相關訓練及支持資源相對有限，面對病況惡化、家屬溝通、死亡衝擊與情緒負荷等情境時，可能面臨多重挑戰。由於不同照服員之個人背景、臨終照護經驗及照護情境有所差異，其對臨終照護之理解、感受與因應方式亦不盡相同。目前國內外臨終照護相關研究多聚焦於醫師或護理師，對醫院照服員角色的描述與探討相對不足，故本研究將了解醫院照服員照護臨終高齡者經驗。
本研究採質性研究設計，於南部兩家教學醫院進行收案，收案條件為任職於醫院、具備一年（含）以上照服員工作經驗，且於過去6個月內曾照顧臨終高齡住院病人之照服員。藉由半結構式訪談，了解醫院照服員照護臨終高齡者之經驗。以質性內容分析法進行資料分析。共18位受訪者接受訪談，研究結果共歸納三個主題：一、走進臨終照護承擔多重角色，次主題包含：提供臨終身心靈照護、連結多方臨終照護關係；二、面對臨終照護的多重考驗，次主題包含：身處複雜照護情境、承受臨終照護內在負荷；三、在臨終照護中學習與適應，次主題包含：累積臨終照護實務經驗、從死亡經驗中調適與反思。
研究顯示，醫院照服員於高齡者臨終照護情境中扮演重要的支持角色。面對高齡者因老化、身體功能退化及疾病影響而產生的複雜照護需求，照服員透過細心觀察與儀器監測，即時察覺其狀況變化，提供舒適照護，維護其臨終尊嚴。同時依個別生命歷程與宗教信仰，回應其此生未竟心願與靈性需求。此外，協助高齡者、家屬與醫療團隊傳遞照護訊息，部分照服員亦會主動參與照護討論；當家屬面對親人即將離世時，亦提供心理撫慰與支持。然而，醫院急性照護環境中的臨終病程具有高度複雜性與不確定性，照服員除需因應高齡者多重疾病與病情變化，亦須面對家屬不同的照護期待與意見衝突，以及反覆經歷死亡所造成的身心耗損；當缺乏系統性的教育與支持時，亦可能加深照服員對自身照護能力不足的感受。儘管如此，照服員仍在每次陪伴高齡者走向生命終點的過程中，逐漸看見高齡者於晚年支持系統薄弱的處境。隨著照護經驗的累積，照服員持續學習與調適，部分照服員逐漸將終老與死亡視為生命自然歷程的一部分，重新思考生命與死亡的意義，並從反覆的臨終照護經驗中獲得生命體悟，以更為從容的態度面對臨終照護。
整體而言，醫院照服員照護臨終高齡者是一段「提供照護、面對挑戰、學習與適應」的動態歷程。醫院急性照護環境中的高齡者病情變化快速、更為複雜，且照服員需頻繁與跨專業團隊互動，構成臨終經驗的重要脈絡。未來建議規劃醫院照服員臨終照護相關培訓課程、建立醫院照服員情緒支持機制，將有助於提升高齡者臨終照護品質。

With population aging, declining birth rate, and changing family structures, hospitals have become important settings for end-of-life (EOL) care for older adults. Hospital care assistants (HCAs) provide supportive care, respond to family needs, and collaborate with health professionals, yet their experiences remain underexplored. This study aimed to explore HCAs’ experiences of caring older adults at EOL, including the challenges they encountered and how they responded. Participants were recruited from two teaching hospitals in southern Taiwan. Data were collected through semi-structured interviews and analyzed using qualitative content analysis. Eighteen participants were recruited. Three major themes emerged: taking on multiple roles in EOL care; facing multiple challenges in EOL care; and learning and adapting through EOL care. HCAs observed changes in patients’ conditions, provided comfort care, maintained dignity, responded to spiritual needs and unfinished wishes, facilitated communication among older adults, families, and healthcare professionals, and supported families facing impending death. They also faced challenges related to rapidly changing conditions among older adults, family expectations and conflicts, repeated exposure to death, and inadequate preparation for EOL care. Through their clinical experience, team support, self-adjustment, and reflection, HCAs learned to adapt, gained a deeper understanding of older adults’ later-life circumstances, and approached death with greater acceptance. These findings highlight the need for hospital-based EOL care training and professional and emotional support systems to strengthen HCAs’ preparedness and improve EOL care quality for older adults.

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