運用跨理論模式於一位心衰竭病患的飲食行為修正

Application of the transtheoretical Model on Eating Behavior Modification of a Patient with Congestive Heart Failure

本文探討以跨理論模式，協助一位心衰竭病患進行飲食行為修正。筆者運用跨理論模式，融合理論中之自我效能與決策平衡之概念，根據個案行為以跨理論分析個案經歷動機期、準備期與行為期等三種行為改變階段，依據不同之行為階段，設定目標，並運用意識覺醒、情感喚起、自我再評價與社會解放等四種認知改變策略及自我解放、強化處置、協助關係、條件抵銷與剌激控制等五種行為改變策略，進行個案之飲食修正，讓個案能長期且有效的執行低鈉飲食，減少疾病惡化並提升其健康和生活品質。由此案例發現，跨理論模式可清楚的判斷個案之行為階段，藉由認知與行為改變策略，可提供個別性之護理措施，建議發展個案管理師並推廣此理論模式於心衰竭病患之飲食行為修正。This article describes a successful application of the transtheoretical model on eating behavior modification of a patient with congestive heart failure. First, the concepts of self-efficacy and decisional balance are integrated into the process of eating behavior modification. Then three different stages of change-contemplation, preparation, and action- are identified according to the transtheoretical model. Different goals are set in different stages and different activities including covert and overt activities are utilized during the process. Covert activities include consciousness raising, dramatic relief, self-reevaluation, and social liberation. Overt activities include self-liberation, reinforcement management, relationship building, counterconditioning, and stimulus control. These approaches enable the case to comply with low-sodium diet that contributes the reduction of heart failure exacerbation and the enhancement of life quality. In conclusion, the transtheoretical model can be applied to identify the stages of change. Covert and overt activities can be used effectively to provide individualized and timely nursing intervention during the process of eating behavior modification. Therefore, the transtheoretical model is effective in life style modification for patients with congestive heart failure. Case manager system can be developed along with the utilization of the transtheorectical model on patients with congestive heart failure in order to improve their eating behavior modification.