一位服藥不遵從之截肢糖尿病病人的護理經驗

Nursing Experience ofNon-Adherence to Medication by a Diabetes Patient With Amputation

本報告運用健康信念模式探討一位中斷服用降血糖藥物、選擇草藥療法之糖尿病截肢患者的服藥不遵從行為，結果發現個案之服藥不遵從導因於自覺罹患糖尿病嚴重程度之認知不足、感覺藥物的療效無法符合個人對治療的期待、感受到長期服用藥物可能損害腎臟功能。於照護期間利用溝通技巧及不批判的態度與個案會談，了解個案不遵從行為背後的故事，並藉由促使個案知覺到疾病合併症的威脅，來引發個案學習的動機，並提昇個案堅信能夠做到醫護囑咐行為的信心程度。臨床上在照顧此類個案時，應完整的評估個案的健康信念，才能有效的改變其行為，減少個案因糖尿病不良控制而反覆入院，本報告可作為臨床上照護此一案例之參考。

This article discusses a diabetes patient who stopped medication to take herbal medicine and washospitalized due to poor healing of a wound. The patient's non-adherence behaviors resulted fromlowerseverity perception, lower benefit perception of taking action, and higher barrier perception in taking action.We gathered information by using communication skills and never criticizing the patient's beliefs.Weinducedmotivation of learning by promoting the patient's perception of possible complications.We alsoimproved the patient's confidence in accomplishing the healthy behaviors. Physicians should assess apatient's health beliefs to change his non-adherence.This will prevent furture hospitalization due to poorcontrol of diabetes.We are glad to share this successful experiencewith others.