應用行為改變策略及激發自我效能促進一位長期臥床截肢患者下床活動成效評價

The Effects of Applying Behavioral Change Strategy and Self-Efficacy Elevation on Facilitating an Amputation Patient from Bed to Walk

本個案研究主要在評價行為改變策略及激發自我效能理論應用在促使一位長期臥床截肢患者下床走路之成效。研究對象為一位老年女性糖尿病居家患者，一年前因傷口惡化而截肢。民國90年3月至5月間，經四次家庭訪視及五次電話訪視，藉身體評估、觀察，與患者及其家庭成員會談收集資料，整理資料後歸納分析並評價成效。結果顯示，初期她無法下床執行復健活動及義肢穿戴，主要是缺乏動機，因此採用行為改變策略及自我效能理論做為介入計劃擬訂之內容依據。在行為改變策略應用過程之準備期，透過身體評估將結果讓她面對截肢的事實，並運用刺激控制策略與其討論生理的限制，激發她的意願。執行期時經單張圖示衛教、實際練習及回覆示教、透過評價性支持如讚許，來塑造她正確執行復健運動及義肢穿戴之行為。維持期運用口頭教導及討論、並鼓勵家屬參與，教導減輕穿戴義肢疼痛方法，以激發自我效能，使她規律執行復健及義肢穿戴。經一連串的介入與引導下，她能主動聯繫義肢公司，由坐至站，每日練習穿戴義肢，時間逐漸增加且步伐穩健。希望藉此個案研究能提供醫護人員照護此類個案的參考。

This case study was to evaluate the effects of applying behavioral change strategy and self-efficacy elevation on facilitating the rehabilitation of an amputation patient from bed to walk. The subject was a female diabetic patient whose left leg was amputated one year ago. Data was collected through telephone interview and home visit from March to May of 2001. After initial assessment, lacking motivation influenced her refusing to wear prosthetic and execute rehabilitation. The intervention process was designed as three stages. The first preparation stage was a stimulation control strategy for promoting motivation. The second stage was an action stage in which correct exercises were promoted and executed. Education about wearing prosthetic properly was also given at this stage by providing pictures and opportunity of practicing. Behavioral modeling and psychological supports were provided in the process. The third stage was the maintenance period in which education and assistance were applied to help the patient in managing pain and releasing discomfort. Family's participation was an important support factor in this stage. After the intervention, the patient decided to contact the prosthetic company and perform rehabilitation. This case study could provide a reference for nurses in caring similar patients.