運用健康信念模式協助接受經皮冠狀動脈血管成型術後之患者執行規律運動之護理經驗

Nursing Experience of Using Health Believe Model to Assist a Patient Who Had Undergone Percutaneous Coronary Intervention Performing Regular Exercise

本文為協助一位冠心症病患於接受經皮冠狀動脈血管成型術後執行規律運動的護理過程。筆者以相關文獻查證及健康信念模式為護理過程的指引，運用觀察、會談、電訪、行為過程記錄及病歷查閱等方式進行資料收集。結果顯示，個案在執行規律運動的過程中所遇到的障礙分為知識、生理及心理三方面。知識部分，對血管再阻塞的可能性及運動對疾病保健重要性的認知不足；生理障礙為疲倦感及膝關節酸痛，心理障礙是擔心運動會導致心臟病復發。也因為心理之擔心而使運動自我效能比發病前減少許多。為除去上述執行規律運動之障礙，筆者執行以下護理措施：(1)加強病患對疾病及運動利益之認知；(2)協助病患處理生理障礙；及(3)提供個別性的安全運動計畫以除去心理恐懼，強化自我效能。護理過程中最重要的是不斷地給予鼓勵及肯定，以增進病患執行運動時的信心。

This case report described the nursing experience of assisting a patient with coronary heart disease (CAD) after percutaneous coronary intervention (PCI) therapy to form a habit of regular physical exercise. Based on the Health Believe Model and the results of literature reviews, a model was established to guide the nursing process. Data was collected through medical records, observations, interviews, and phone calls. The results indicated that there were three major obstacles preventing patients from regular exercise. Firstly, the patient did not know the possibility of the re-occlusion of the coronary artery and the necessity of maintaining regular physical exercise. Secondly, the patient perceived physical limitations by fatigue and arthritis. Thirdly, in the psychological aspect, the patient was afraid of heart attack caused by physical exercise. This fear reduced the patient’s perception of selfefficacy in physical exercise after PCI therapy. To overcome these obstacles, the following nursing interventions were suggested: (1) to enhance patients’ understanding of the risk of relapse of CAD and the benefits of the physical exercise; (2) to assist patients in managing their physical limitations; and (3) to promote patient’s self-efficacy in physical exercise by providing personal guidelines to ensue safety during physical exercise. Moreover, it is important to encourage and recognize the patient’s achievements continuously in order to enhance the patient’s confidence in performing exercise.