運用個案管理協助一位車禍截肢後，初次診斷糖尿病患者自我照護經驗

Case Management Experience for Assisting in Self Care of an Initial Diagnosed Diabetes after Amputation Due to Car Accident

本文旨在探討運用個案管理協助一位55歲車禍截肢後患者自我照護經驗，患者因否認罹病，血糖控制不佳，傷口照護不當而造成反覆感染，缺乏自我健康管理，引發筆者探討動機。護理期間自2019年8月14日至12月11日，藉由Gordon十一項健康功能型態為評估工具，運用溝通、觀察、身體評估及病歷查閱方式收集資料，並藉由電話及通訊軟體進行追蹤，確立個案主要的護理問題為無效性健康管理、肥胖及組織完整性受損。經由糖尿病個案管理的照護流程，針對個案的護理問題提供個別化的措施，透過主動關懷、傾聽、同理及鼓勵個案表達內心感受及想法，協同營養師的飲食衛教、釐清個案對施打胰島素錯誤觀念及擔憂、衛教體重過重對血糖控制及傷口癒合之影響，以及提供傷口照護知識與技能，逐漸引導個案透過生活型態改變，提昇個案自我健康管理能力，最終達到良好的血糖控制及促進傷口的癒合，建議個管師的角色能在後續的回診中能持續提供關懷與支持，適時評估衛教成效，強化病人自我管理能力。冀望藉此護理經驗能提供護理人員照護此類病患之參酌。

"This article describes a case management experience for a 55-year-old patient who was initial diagnosed diabetes after amputation due to care accident assissting whom self-care. The nursing care period was from August 14 to December 11, 2019. The author used Gordon’s functional health pattern to collect data through the methods of communication, observations, physical examination, and chart review and followed up by telephone and application software. The identified main health problems were ineffective health management, obesity, and impaired tissue integrity. According the workflow of case management for diabetes, provided individualized interventions such as attitudes of active caring, listening, empathy, and encouraged patient to express inner feelings and ideas, instructing dietary knowledges with nutritionist, to clarify patient’s misconception of insulin injection and alleviate her worries, teaching impacts of overweight on blood sugar control and wound healing, as well as to enhance abilities of self-health management and guide patient through changes in lifestyle gradually. Finally, the patient got blood sugar well control and healing wound. Therefore, we suggested that case manager should be able to provide concern and support during OPD visits, to evaluate the effect of health education and strengthen self-health management. The author hopes that this nursing experience can serve a reference for other nurses who were caring similar patients in the future."