運用羅氏適應模式於初次接受胰島素注射糖尿病個案之護理經驗

The Nursing Experience of Initiating Insulin Treatment in the Type 2 Diabetes Patient

本文旨在分享照護一位第二型糖尿病個案之護理經驗。個案長期口服降血糖藥物，卻無法有效控制血糖，經醫師建議個案學習施打胰島素注射，引發個案身體及心理產生極大的焦慮並出現抗拒行為，筆者於2012年12月05日到2013年6月28日護理期間以觀察、身體評估、會談、傾聽等專業技巧及查閱病歷收集資料，並運用羅氏護理適應模式針對個案在生理、自我概念、角色功能及相互依賴進行護理評估，歸納健康問題為焦慮、營養狀況改變：多於身體需要、無效性健康維護能力。筆者在護理過程中運用傾聽、陪伴及同理心，給予個案及家屬支持及持續性照顧，並提供護理專業知識、病友團體經驗分享、飲食衛教及自我照顧技巧等措施，使個案能面對注射胰島素之治療、減輕焦慮及提升自我照顧能力，讓個案能成功適應注射胰島素的新生活。筆者期望能藉由本文照護經驗提供護理人員在照護類似個案的參考與運用。

This paper aimed to share experiences of caring a case with type 2 diabetes. The patient has taken long-term oral hypoglycemic agent, but failed to effectively control her blood sugar. Her physician recommended shifting medications to insulin injections, which in turn aroused her anxiety and resistance. Between December 5th 2012 and June 28th 2013, the author collected data via observation, physical assessment, conversations, listening and reviewing medical records. We performed nursing assessments using Roy Adaptation Model on the patient’s physical condition, self-concept, role-function and inter-dependence. We concluded that her health problems were anxiety, altered nutritional state (increased needs in catabolic state), and incapability in health maintenance. We supported the patient and her families and provided ongoing care with attentive listening and empathy. We also offered caring expertise, encouraged experience-sharing in groups from different patients, provided nutrition education and skills about self-care. With these measures, we have ensured that the patient has accepted insulin injection, her anxiety ameliorated and self-care skills enhanced. Eventually, the patient successfully adapted to her life with insulin injections. In this article, we wish to provide our nursing experience, which serves as a reference for those who care similar cases. (Tzu Chi Nursing Journal, 2015; 14:3, 62-72)