運用Orem理論照護一位第1型糖尿病青少年之護理經驗

Application of Orem's Theory to Nursing Care for a Patient with Type I Diabetes

本報告描述一位18歲青少年初次診斷第1型糖尿病，運用Orem自我照顧理論，協助個案學習自我照顧技能及適應疾病造成心理衝擊之護理過程。於2012年4月3日至11日護理期間，應用Orem自我照顧理論，以會談、觀察、直接照護等方式收集資料，確立主要問題包括健康維護能力改變、不遵從、無望感。筆者運用主動傾聽、關懷、 支持性陪伴、同理心等技巧建立信任關係，以胰島素注射訓練模型示教個案胰島素施打及測血糖方式，並請其回示教；深入探討個案不遵從飲食控制之因素，針對其問題共同討論，尋找適切解決辦法；以分享小故事、介紹成功案例、提供支持團體、引導朝正向思考等，解決無望感的危機，終使個案對第1型糖尿病有正確認知，且以正向態度坦然面對罹病事實，提升自我照顧技能，正確操作胰島素注射及血糖自我監測，配合遵循糖尿病飲食計劃，使血糖獲得有效控制。糖尿病是慢性病，需與病共存，除了急性期照護外，讓個案了解疾病並提升照顧能力進而改善生活品質，期望以此照護經驗提供同仁參考。

This article describes how to apply Orem's Self-Care Theory in caring for an adolescent patient with type I diabetes. The author assisted the patient in learning self-care skills and coping strategies to overcome the impact the disease had imposed on him. During the caring period of 4/3/2012 to 4/11/2012, with application of Orem's Self-Care Theory, the author collected data by means of face-to-face interview, observation, and direct patient care. The three identified major health problems were lack of ability of self-care for health maintenance, noncompliance with diet control, and feelings of hopelessness. The author built a therapeutic relationship with the patient through attentive listening with empathy and caring and supportive presence. The patient learned how to monitor blood glucose levels and inject insulin via an insulin injection training model with demonstration. The author probed the factors causing the patient’s non-compliance of dietary control. The author attempted to find available solutions to these factors with the patient. Through story-telling of successful cases and having a supportive group, the patient received support with positive thinking about the disease without feeling hopeless. The patient was ultimately able to effectively control his blood glucose level using learned self-care skills including correct blood sugar monitoring, insulin injection, and an adequate diabetic diet plan. Diabetes is a chronic disease. Besides care during the acute stage, patients with diabetes need to learn how to cope with and learn self-care skills to further promote their quality of life. The author shares this care experience as a reference for nurses taking care of similar cases.