應用跨理論模式照護一位糖尿病患飲食之護理經驗

Applying the Transtheoretical Model to a Patient on a Diabetes Control Diet: A Nursing Experience

糖尿病是一典型需要終身自我管理的慢性病，對於一位缺乏糖尿病認知的個案，以跨理論模式來促進個案維護健康的行為，將有助於提昇個案自我照顧能力。個案住院期間，筆者藉觀察及會談法來評估個案於執行糖尿病飲食行為改變過程所遭遇的困難，經由行為改變策略對其飲食控制做個別性的衛教，指導個案依自己每日的12份主食執行飲食代換，再教導自行操作血糖機來監測自己飲食控制的成效，培養個案在行動期對自我照護具有決定的能力，期盼進入維持期後能因自我效能提昇而有信心，相信自己是有能力達成自我照顧行為的信念；從個案出院後電話訪問得知，個案能遵守每日的主食維持在12份，執行血糖監測，測飯前血糖值70－105mg/dl，飯後血糖值110－160mg/dl，飲食控制持續處於行動期，個案也能從血糖值中有效評估自我照顧的缺失，持續執行維護健康的行為。

Diabetes mellitus is a chronic disease that requires lifelong self-management. The author used a transtheoretical model to help improve the self-care abilities of one diabetes mellitus patient who lacked initial appreciation / understanding of self-care needs. During hospitalization, the author employed observation and communication to evaluate subject needs with regard to transforming her dietary behavior in order to better stabilize her medical condition. The author educated the subject on a one-to-one basis in dietary control using change tactics, and recommended that she adjust her 12 portions and food exchange. The patient was instructed to operate the blood sugar machine to monitor the effects of diet control. This method was designed to help the patient build self-care decision-making abilities during the action phase and bolster confidence during the maintenance phase through self-efficacy promotion, and to increase confidence in her self-care abilities. Telephone interview follow-ups demonstrated that the patient was able to self-comply with 12 portion rules and monitor her blood sugar on a daily basis. With blood sugar measurements at 70－105mg/dl and 110－160mg/dl, respectively, before and after meals, her diet control remained in the action phase. The patient was able to self-monitor her personal health status via blood sugar level and conduct personal healthcare maintenance work. Results support the effectiveness of applying the transtheoretical model to self-care strategies for diabetic patients.