運用生活創意照護糖尿個案者之護理經驗

The Nursing Experience of Caring a Diabetic Patient Using a Life Creative Method

本篇個案是位勤儉、務實的老年患者，因工作時赤腳，導致左足背於不明物咬傷腫脹入本院急診求治，因血糖及糖化血色素偏高，被診斷為第二型糖尿病及左腳蜂窩性組織炎，護理期間2010年8月11日至8月25日，運用Gordon十一項健康功能評估個案狀況，發現個案有「皮膚完整性受損」、「知識缺失」、「焦慮」之護理問題。筆者除了提供生理、心靈照護外，運用生活創意將家中的巧拼圖、滑鼠軟墊、絲襪…等物品，製成DIY輔具鞋及胰導素注射模型器具，引發個案學習興趣，透過口頭教導、回覆示教、適時提供情緒支持、自我照顧策略等措施，提昇個案對於足部傷口的照護及胰島素注射的技能，以提升糖尿病人返家後自我照顧能力，期盼此護理經驗可提供日後臨床上護理人員在照護此類病人的參考。

This thrifty and practical elderly patient came to the emergency room because of left foot swollen. He was bitten by unknown object while at work with barefoot. Type II diabetes and foot cellulitis were diagnosed according to the high blood sugar, HBA1C, and swollen foot. Gordon Eleven Functional Health Assessment was used for assessment. Major nursing problems found included: impaired skin integrity, knowledge deficit, and anxiety. The period of care was from August 11 to 25, 2010. In addition to provide the physical and psychological care, the authors used home items, such as puzzles, mouse pad, stockings items, to make DIY aid model shoes and insulin injection devices to enhance the patient’s interest in learning. Through provision of multiple teaching methods, timely emotional support, and self-care strategies, foot wound care and insulin injection skills were enhanced. All together, the patient’s diabetes home self-care abilities were improved. The care experience in this article will hopefully provide other nursing personnel with a reference for future clinical care.