運用資訊科技照顧一位糖尿病個案不遵從之護理過程

Approaches Using Information Technology to Care for a Noncompliant Diabetic Patient

本文主旨為探討一位37歲男性因反覆糖尿病足感染，接受數次清創手術後，仍面臨截肢之照護經驗，護理期間自2019年5月28日至6月15日，運用Gordon十ㄧ項功能性健康型態評估，藉由會談觀察、行為過程紀錄、身體功能評估、病歷查閱等技巧收集資料，確立健康問題有組織完整性受損、不遵從、知識缺失、焦慮。照護期間利用護理專業知識結合通訊軟體和健康應用程式於護理過程中，協助個案利用Line個人群組行血糖紀錄並將衛教資訊放置在群組記事本內及運用「講糖」App行飲食衛教及控制，住院期間提供血糖控制趨勢圖，讓個案瞭解規則用藥的重要性，並運用傾聽、鼓勵及同理心，引導個案表達傷口癒合不佳及面臨截肢之感受，並教導放鬆技巧減輕焦慮產生。期許藉由健康應用程式結合日常生活，可增加個案方便性與遵從性，此經驗提供日後個案照護參考。

"This report shares the experience of caring for a 37-year-old man who needed to be amputated after several debridement procedures due to recurrent diabetic foot infection. During the period of care from May 28 to June 15, 2019, Gordon’s functional health patterns was used to assess the patient’s health condition; data were collected through interview, observation, process recording, measures of physical function, and medical record review. The major health problems identified were impaired skin integrity, non-compliance, lack of knowledge, and anxiety. With the nurse’s professional knowledge in combination with health apps, the patient was capable of self-monitoring his blood glucose by routinely recording blood sugar levels on the LINE Group chat and accessing health education information in the NOTES; using the Talkabout DM app, he learned how to improve diet and eating habits. By looking at his blood glucose trend graph during hospitalization, the patient was aware of the importance of adhering to regular medication to control blood glucose level. Using empathic listening and encouraging the patient to clarify his concerns, nurses found that the patient was worried about poor wound healing and amputation and, therefore, taught relaxation techniques to reduce his anxiety. We share this approach of integrating health apps into care for the improvement of patient compliance in the hope to help other nurses."