症狀經驗、病因解釋與治療遵從行為——以高血壓病人為例

Symptom Experience, Causal Attribution and Adherence to Therapeutic Regimens: Patients with Hypertension

症狀是病人尋求醫療協助最重要的因素。然而，對於沒有直接生理病理證據的症狀，常容易被歸為情緒或心理因素。症狀是個體對自身生理心理社會功能，知覺或認知改變而反應出來的主觀經驗，在提供合適的症狀護理策略前，護理人員需了解病人的症狀經驗和症狀對病人的意涵。當被診斷有疾病時，個體會依診斷尋求相對應的症狀，當經歷不適的身體症狀時，會尋求症狀代表意義，形成對疾病威脅的一般看法，依此做為接受治療建議的依據。相對的，若個體不遵從治療建議時，也反應所建議的治療與病人對疾病診斷認知或具體症狀經驗感受不一致，影響個體對治療遵從。本文陳述疾病症狀威脅、病因解釋和治療遵從行為的關係，並以高血壓病人為例，說明症狀經驗在治療遵從行為中所扮演的角色，做為後續臨床教育或衛教建議之參考。

Symptoms are the most important factor leading patients to seek medical help from health professionals. However, symptoms not directly supported by physiological and pathological evidence are often classified as being of emotional or psychological origin. Symptoms reflect an individual's subjective experience of physical-psycho-social functions, perception or cognition. Prior to implementing symptom management strategies, nurses should clarify patient symptom experiences and the meaning of such to patients. Individuals naturally seek symptoms based on physician diagnoses. When experiencing uncomfortable physical symptoms, individuals seek to label symptoms and accept medical advice based on their personal illness perception. In light of such, non-adherence to treatment recommendations may reflect inconsistencies between medical advice and patient symptom or illness diagnosis perception. In this paper, the author addresses relationships among symptom experience, symptom/illness attributions and therapeutic regimen adherence. Results identify the significant role that symptom experience plays in adherence to therapeutic regimens in patients with hypertension and suggests recommended revisions to clinical education in order to reflect such.