充能訓練對糖尿病患者糖化血色素、自我效能和照護之成效

The Effectiveness of Empowerment Training on the HbA1c, Self-Efficacy and Self-Care among Diabetes Patients

本研究之目的旨在探討糖尿病患者於充能訓練後對糖化血色素、充能、自我效能和自我照顧之成效。研究以台灣北部某教學醫院新陳代謝科之門診病患為對象。選案條件包括：(1)經醫師診斷為第二型糖尿病；(2)患病時間不超過十年；(3)能自行照護者；(4)無DSM-Ⅳ診斷中所有之精神疾病者；(5)年齡於十八歲以上；(6)意識清楚；(7)能以國、台語溝通無障礙者。研究採實驗型設計，研究對象共67位，以簡單隨機方式分派至實驗組和控制組。實驗組患者接受為期八週，每週二小時之充能訓練，而控制組則僅接受一般的門診照護。研究工具包括糖尿病充能量表、糖尿病自我效能量表、糖尿病自我照顧量表。資料蒐集分別於前測、後測及三個月後之後後測。研究資料以SPSS 10.0套裝軟體進行建檔及統計分析。統計方法包括次數分配、百分比、平均數、標準差、皮爾遜積差相關檢定、獨立及成對樣本t檢定、共變數分析ANCOVA及重複測量repeat measure ANOVA。研究結果顯示大多數糖尿病患者之自我照顧行為欠佳。充能與糖化血色素呈負相關，與自我效能、自我照顧呈正相關；自我效能與自我照顧呈正相關。此外，研究結果亦顯示糖尿病充能訓練對患者之充能、自我效能和自我照顧有顯著的提昇（p＜0.05），且對糖化血色素值亦有顯著的影響（p =.03）。本研究結果可提供臨床護理人員照顧第二型糖尿病患者之護理模式，期能藉由充能訓練措施，提升患者之自我效能與自我照顧能力。

The purpose of this study was to examine the effectiveness of an empowerment training program (ETP) on HbA1c, empowerment, self-efficacy and self-care among diabetes. Sampling criteria includes：(1) diagnosed TypeⅡ diabetes with in ten-years ; (2) able to self-care by oneself ; (3) no DSM-Ⅳ diagnoses ; (4)more than eighteen years old ; (5) clear consciousness ; and (6) able to communicate. The study was an experimental design. Sixty seven TypeⅡ diabetes were randomly assigned into the experimental group(n = 34)and control group (n = 33 ). Subjects in experimental group have received two hours per week for 8 weeks of empowerment training. The control group subjects have only received the routine clinical care. Main measures included HbA1c of blood, Diabetes Empowerment Scales (DES), Diabetes Self-Efficacy Scale, and Diabetes Self-Care Scales. Data were collected on three timepoints: the pretest, posttest and 3 months follow-up after ETP. The statistical analyses included frequency, percentage, mean, standard deviation, Pearson’s product-moment correlation, t-test, analysis of covariance ANCOVA and repeat measure ANOVA. Results of this study showed that the scores of empowerment, self-efficacy and self-care were at medium level. There were a negative relationation between empowerment and HbA1c, positive relationship between empowerment and self-efficacy and self-care. After empowerment training, there were significant improvements in HbA1c, empowerment, self-efficacy and self-care in the experiement group than the control group(P<.05).In conclusion, this study provided an interventional model for nurses to taking care TypeⅡ diabetes patients. Implementation the ETP can promote patient，s empowerment, perceived self-efficacy and self-care.