協助一位第二型糖尿病患者轉換胰島素治療之護理經驗

The Nursing Experiences of Helping a Type 2 Diabetic Patient Switching to Insulin Therapy

本文為運用健康信念模式協助一位第二型糖尿病患轉換胰島素治療的過程，以健康信念模式為評估指引，利用觀察、會談、書寫日誌、行為過程記錄與病歷查閱等方式收集資料，經歸納及分析後完成。結果發現：由拒絕到接受胰島素注射，個案之障礙是多方面的。包括認知偏差、負向態度及能力不足等等。護理過程中重要的是，先瞭解個案生命中有「意義」的人與事物，如兒女及親情，並將其和「健康維護」結合在一起，以加強個案接受注射的動機。衛教指導應加強個案對糖尿病合併症易感性及嚴重度之認知，強調胰島素注射之利益，協助克服障礙，不斷給予鼓勵及支持，使個案能接受並持續執行胰島素注射。希望藉此經驗提供臨床人員，以有系統的策略協助病患及早接受有效治療。

This case study reported an experience of using “Health Belief Model” to assist a type 2 diabetic patient successfully accepting insulin therapy. Data were collected and analyzed through participating observation, direct interview, daily log, and process recording. The results showed that the subject faced difficulties in accepting insulin injection, including misconceptions, negative attitudes, and lack of ability to perform injection. To motivate the patient accepting injection, realization of the most meaningful events among the subject’s current life and had it relating to the necessity of insulin injection was useful. The health education strategies included increasing the subject’s perception of the susceptibility and severity of complications of poor blood sugar control, emphasizing the benefits of insulin injection, overcoming the possible difficulties of injection, and continuing encouragement and reassurance. Finally, the subject accepted the insulin therapy and was willing to use it. This report provides clinical nurses with a strategy to effectively assist a type 2 diabetic accepting insulin therapy.