運用跨理論模式協助一位酮酸中毒青少女血糖控制之護理經驗

Nursing Experience of Using Transtheoretical Model to Glycemic Control in an Adolescent with Diabetic Ketoacidosis

本個案報告主要運用跨理論模式協助一位酮酸中毒青少女血糖控制之護理經驗。本文個案因罹患第一型糖尿病且已反覆因酮酸中毒入院四次，實際護理期間自2007年3月19日至3月25日，後續追蹤其糖化血色素(HbA1c)至2008年8月4日。筆者藉由整體性護理評估、參與性觀察、個別訪談、門診與電話訪視及查閱病歷，結果分析顯示個案正處於行為改變的「準備期」階段，發現個案對血糖及飲食控制概念常以過去習慣方式看待，糖化血色素值高達11.5％，過去雖已採取施打胰島素及飲食控制行動，也曾參加糖尿病衛教課程，但常出現故態復萌現象，漸進引發血糖控制不良。故筆者以行為改變跨理論模式為基礎，提供不同階段的認知行為修正方案及相關策略後，個案已從行為改變的準備期進步到「行動期」，最終能達到「維持期」，經長期追蹤顯示其後續的糖尿病控制成效佳，建議未來兒科護理人員可結合運用跨理論模式的行為改變於糖尿病照護中。

This article reported the nursing experience of using transtheoretical model of health behavior change to glycemic control in an adolescent with diabetic ketoacidosis (DKA). The patient had four times hospitalization due to recurrent DKA. The patient was under our care from March 19 to March 25 in 2007 and HbA1c follow-up till August 4 in 2008. Holistic nursing assessment, participant observation, individual interview, outpatient consultations, telephone interviews, and medical chart review were used to collect data. An analysis of results showed the case to be in “preparation stage” of behavior change. We found the patient had specific diabetic knowledge deficiency. Her HbA1c value was 11.5%. She had used injected insulin, on diet control, and also received diabetic education program. However, several relapses often occurred, inducing poor glycemic control gradually. We utilized transtheoretical model of health behavior change and provided cognitive-behavior modification interventions and related strategies based on different behavior stages. The patient had changed from “preparation stage” up to “action stage” and to “maintenance stage” eventually. Finally, the patient could attain promotion of illness cognition and cultivate self-care health behavior. The blood sugar of this patient had been in good control through long-term follow-up. We recommend pediatric nurses could incorporate transtheoretical model of health behavior change into diabetic care.