應用行為改變策略改善一糖尿病患者糖化血色素之成效

Effects of Applying Behavior Modification to Improve HbA1C Levels in a Diabetic Patient

糖尿病屬於慢性疾病的一種，為避免及延緩併發症的產生，患者不但需要做好疾病控制，更要學會調整生活習慣。糖尿病患者若具備自我管理的能力，才能進一步建立健康照護行為。文中個案由於無法落實執行飲食、運動控制及驗血糖，在疾病管理的方式總是無法與其日常生活相契合。因此，筆者運用自我調節理論，透過每日自我監測紀錄，使個案能針對所收集到的資料，藉由自我判斷找出無法做好疾病控制的主因，進而設定目標與發展策略，促使個案將疾病控制與日常生活作連結，並於策略執行後引導個案思考無法達成所設定目標之因素，再度修正目標與策略，從旁協助個案從自我調節中，學習行為修正的方法，來達到改善其糖化血色素之目標。臨床護理人員亦可跳脫傳統單向衛教模式，藉此連續性之課程設計，引導糖尿病患者突破血糖控制不佳的窘境，期望未來推廣至更多患者，使其達到自我管理、自我照顧的目標。

Diabetes is a chronic disease. To prevent and delay complications, diabetic patients must adjust their lifestyle as part of a comprehensive approach to disease control. Diabetic patients must be able to self-manage their disease and establish healthy habits in their daily routine. In this study, prior to intervention, the subject was unable to control her diet, do exercise, check sugars properly or integrate disease management effectively into her daily routine. By applying self-regulation theory through the keeping of a diary for sugar and daily activity self-monitoring, she became able to self-assess the causes of poor disease control. Such further facilitated her setting goals and developing strategies to link her habits with disease management. When failing to achieve goals even after execution, she could consider the factors contributing to the failure and modify her behaviors, goals and/or strategies accordingly. We helped this patient learn behavior modification methods in order to achieve her goal of better HbA1C control. This case example may help clinical nursing educators move beyond the confines of the traditional one-way educational model to guide diabetic patients to achieve good sugar control. We hope our findings help many chronic disease sufferers achieve self-management objectives in order to assume greater self-care responsibilities.