Leventhal疾病詮釋概念於臨床之應用

Application of Leventhal 'Illness Representation' in Nursing Practice

Leventhal提出的自我調整模式(self-regulation model)是檢視個人處於健康威脅時所產生之主觀認知及情緒反應，依據此認知與反應採取因應策略，評價因應策略成效後再回饋至原先之認知架構進而修正因應策略的循環過程，這是以病患為中心的理論架構。根據此理論，在面臨健康威脅（疾病刺激）時，個人會經過疾病詮釋(illness representation)、因應(coping)、評價(appraisal)三個階段的自我調整歷程，其中認知層面的疾病詮釋包括五個因子：(1)疾病確認(identity)、(2)疾病原因(causes)、(3)疾病時間性(timeline)、(4)疾病結果(consequences)、(5)疾病可控制性／可治癒性(control/cure)。藉由本文對於「疾病詮釋」(illness representation)概念的的介紹及臨床應用之省思，期望讓護理人員運用此概念於評估病患對於疾病的認知與因應行為之合宜性，提供切合現實及病患需要之資訊及介入措施，修正病患對於疾病的不正確認知，協助病患採取適宜的因應行為、做好疾病的自我管理。

The self-regulation model proposed by Leventhal and colleagues is one theoretical model that addresses how cognitive and emotional factors influence coping behaviours and outcomes. The model depicts a self-regulative system that integrates illness representation (cognitive and emotional), coping procedures used to manage threats, and criteria used by the individual to evaluate coping process outcomes (appraisal). This model describes a system whereby an individual’s cognitive and emotional construction of an illness guides his/her coping, appraisal and ultimate health behaviour. The five components identified in the cognitive illness representation include identity, cause, timeline, consequence and control/cure. The overview and analysis discussed in this paper will help nurses better understand the ”spirit” of illness representation and further apply such in clinical practice to assess correctly illness perception and provide more appropriate interventions to improve illness self-management.