自我管理之概念分析－－探討氣喘兒童的自我管理

A Concept Analysis of Self-Management of Asthma in Children

氣喘是兒童最常見的慢性病，學習氣喘的自我管理，對兒童及家人而言都是最重要的，可減少氣喘的惡化、發作及死亡率。回顧國內外文獻，發現至今有關氣喘兒童的“自我管理”這個概念，並沒有一致性的術語及一致性的定義，所以本文使用Walker & Avant所提出的概念分析方法進行概念分析，並使用系統性文獻回顧的方式，搜尋了醫學、護理、精神科學和教育領域七個資料庫的文獻。此概念分析的結果，歸納出氣喘兒童自我管理的三項定義性特徵：（1）為一種學習和執行的過程，受認知、生理、行為與環境多面向因素的交互影響，（2）執行預防及處理發作行為的活動，（3）以達到控制氣喘的狀態及減少急性發作的目標，過著正常化的生活。最後，筆者希望未來可根據此概念分析的結果，發展其理論架構及相關的研究問題，建立起理論與知識基礎。

Asthma is a chronic disease commonly seen in children. It is absolutely essential for a child who suffers from the disease, and his/her family members, to learn how to perform self-management to minimize the rate of asthmatic deterioration, attack episodes, and the risk of mortality. Literature review indicates that there is no consistency of definition and terminology as far as the concept of ”self-management” is concerned. This study, therefore, adopts the concept analysis proposed by Walker & Avant, by searching seven health-related databases via systematic review methodology. From the results of the concept analysis it can be concluded that there are three definitive features of self-management among asthmatic children: 1) the learning and performance process factors determined reciprocally by cognition, physiology, behavior, and environment, 2) the prevention and management of sudden asthma attacks, 3) the normalization of the patient's life with proper control of the asthmatic condition and a reduction of asthma attacks. On the basis of this concept analysis, the authors expect to develop a theoretical framework and related research to build up an asthma knowledge base for future care of children with asthma.