自我效能諮商技巧訓練於糖尿病衛生教育之運用

The Application of Self-Efficacy Counseling Skills to Health Education in Patients with Diabetes

隨著糖尿病人數的增加，授權病患自我照顧責任越來越被重視。自我效能（self-efficacy）能激發人們執行特定行為，得到預期的結果。強化醫護人員自我效能諮商技巧為落實病患自我照護之有效方式，可改善傳統糖尿病衛教之不足，避免病患急、慢性併發症。自我效能諮商技巧提升策咯包括：提出問題、從病人之議題開始、擬定個人化之治療計畫、定義問題、一步一步達成目標、定期訪問追蹤執行情形，持續與病人保持聯絡、將問題排序、腦力激盪、評估過去成功及失敗之努力、再次評估自信、最後處理自我效能有關的行為改變，這些諮商技巧經由結構式諮商課程訓練便可獲學習。本文以文獻分析法說明糖尿病衛生教育合併自我效能諮商技巧作法；再以案例分析，具體呈現健康諮商師應用自我效能提升策略，引導患者建立自我照顧活動的自我信心及作法。是兼顧病患身心照護的發展趨勢，期許誰動更多護理措施應用心理諮商技能於臨床護理實務。

As the incidence of chronic disease increases, empowerment of patients with chronic disease to adopt self-care responsibilities becomes paramount. Self-efficacy is a belief in one's ability to perform a task that will lead to the desired outcome. Utilizing self-efficacy counseling skills is an effective way to enhance patients' compliance with self-care activities. The development of such skills can compensate for the lack of traditional health education provided for diabetes patients and plays a significant part in the prevention of acute and chronic complications. Self-efficacy counseling strategies involve: asking questions; focusing on patient's agenda; planning personal treatment schedules; defining problems; setting goals (taking a step-by-step approach); regular follow-up and contact with patients; scaling questions; brainstorming solutions; considering past efforts, successes and failures; reassessing confidence; and finally checking behavior changes. Self-efficacy counseling skills can be learned through structured training courses in counseling skills. The aims of this report were twofold: (1) to undertake a literature review on self-efficacy and counseling skills used as the theoretical framework in a health education training program for diabetes; (2) to analyze cases when a counseling guide based upon a self-efficacy framework was used by health counselors to help patients improve their self-confidence and self-care ability. This report reveals it is important to promote the application of counseling skills in nursing interventions in the clinical practice field.