運用疾病詮釋模式協助糖尿病腎病變患者之護理

Using the Illness Representation Model to Provide Care for a Patient With Diabetic Nephropathy

當病患面對健康威脅時，會使用知識與經驗來詮釋疾病，疾病詮釋的結果會引導著病患就醫、接受治療的態度及其健康行為，若護理人員能了解病患對疾病的認知及感受，進而提供真正能改變病患自我照顧的介入措施，可引導病患擁有正向的健康行為。本文描述一位糖尿病腎病變患者，其尿量減少、下肢水腫、呼吸喘之症狀為個案帶來身體不適外，也讓個案面臨「洗腎病患」的角色轉換。當個案面對此疾病刺激，對「洗腎」詮釋為「人生就會沒有意義了！不能工作賺錢了！」，而引發的因應行為是「拒絕洗腎」，筆者運用「疾病詮釋」了解個案的疾病感受，根據其個別性，筆者給予個案觀念上之澄清，並強化其症狀與洗腎之間的關聯性，以改變個案對洗腎的疾病詮釋，引導個案接受其洗腎病患之角色，最後，個案評價其洗腎行為可緩解身體不適外，還能維持良好的生活品質。希冀此運用疾病詮釋模式之照護經驗能提供護理人員作為參考，以提升護理品質。

Patients interpret illness through personal knowledge and experience, while illness representation guides patient attitudes with regard to seeing a doctor, accepting treatment and adopting healthy behavior. Nurses who understand the illness representation of patients may be better able to provide intervention in order to enhance patient self-care skills and ultimately improve patient health. This article describes a nurse’s experience providing care to a patient with diabetic nephropathy. He suffered from decreasing urine output, lower limb edema and shortness of breath. He also underwent a role transformation from a healthy individual to hemodialysis patient. He interpreted hemodialysis to be the end of meaning in his life and as preventing his continuing to work and earn money. He thus rejected hemodialysis treatment. The authors applied the illness presentation model to understand the patient’s perception of his illness, then helped the patient to correct his misconceptions about the hemodialysis treatment in order to change his illness representation of hemodialysis and guide him to accept his new role. After one month of care, the patient accepted arterio-venous shunt surgery and accepted that hemodialysis both mitigated his illness and improved life quality. The authors would like to share their report on this case to provide nursing professionals with a reference on one approach to improving healthcare quality.