運用動機式會談於肥胖糖尿病患者之護理經驗

Nursing Experience Using Motivational Interview Techniques in Caring for an Obese Patient With Type 2 Diabetes

第二型糖尿病患人數不斷的增加。糖尿病患的血糖控制經過實證研究顯示生活型態修正確實可以改善血糖及延緩合併症；其中，肥胖糖尿病患更需藉由行為修正以控制飲食，促使血糖穩定並減輕體重，方可達到健康生活。但臨床常可見缺乏動機的病患，因而提供行為策略往往失效。有鑑於此，本文運用動機式會談技巧，如指出矛盾處、確認其努力、支持自我效能、共同評估損益及會談整理重點等技巧，激發一動機不足之肥胖糖尿病個案，增強其參與健康飲食行為的動機，同時以跨理論模式為基礎，發展行為修正策略協助個案建立健康行為，達到體重減輕及血糖控制的目標。照護期間為2009年4月30日至6月10日，個案體重由原本93.4公斤降至90公斤，血糖也趨於穩定，如此成效，促使其持續執行飲食健康行為。由此可見，動機是為行為修正首要之驅，期望此運用動機式會談及跨理論模式之照護經驗，能提供臨床人員執行照護之參模。

Global prevalence and incidence of diabetes for all age groups are increasing. Research evidence reveals that lifestyle modification can both significantly improve glycemic control and delay complications. Obese patients suffering from type 2 Diabetes Mellitus in particular require food therapy and weight reduction through behavior modification in order to regain a healthy quality of life. This article used motivational interviews and the transtheoretical model to develop a behavioral change strategy to set health behavior as well as to assist the patient to attain weight reduction and glycemic control goals. Over the study period (April 30, 2009 to June 10, 2009), the patient’s weight declined from 93.4kg to 90kg. Also, her blood sugar is gradually stable. Because of the effectiveness of behavior modification, the patient exhibited sustained motivation to continue maintaining diet control, which reflects motivation is an important component for behavior modification. The authors would like to share this case report to provide nursing professionals with a reference for using motivational interview techniques and transtheoretical model.