運用自我效能理論，處理食道癌晚期個案呼吸道清除失效問題

Using Self-Efficacy Theory to Manage Ineffective Airway Clearance in a Client With Advanced Esophageal Cancer

本文呈現運用自我效能理論協助一位自我效能低落的食道癌晚期個案的護理經驗。護理期間為2020年12月3日至12月23日，筆者透過病歷查閱、觀察、會談評估，發現個案因呼吸道清除功能失效多次出入院，導致個案有自我效能低落的護理問題。運用自我效能理論的四大面向（生心狀態、言語說服、替代經驗、執行經驗）為評估及訂定護理方向，再以文獻充實護理措施內涵。於照護期間，與個案建立良好的治療性關係，從各個面向為個案規劃個別性的護理措施， 包括給藥、姿位引流、拍痰等技巧改善個案的生心狀態；讓個案重要他人共同參與醫療照護，並以衛教、言語支持等方式提升個案之言語說服資源；利用其他病友之故事增加病人處理健康問題的替代經驗；運用比較的方式，使個案能夠透過資料感受到身體的變化以改善執行經驗，在增加個案處理健康問題的自我效能後，個案的呼吸道狀態獲得改善。期望本文能提供護理人員運用自我效能理論之參考，透過不同的資源增進個案的自我效能，讓個案恢復信心，提升個案和醫療團隊之間的關係，更進一步增加照護品質。

This nursing experience describes the application of “self-efficacy theory” to a patient with low self-efficacy who was diagnosed with advanced esophageal cancer. The nursing period was from December 3rd, 2020 to December 23rd, 2020. Medical records, interview assessment, and observation showed that the patient had ineffective airway clearance, which caused him to be in and out of the hospital several times, resulting in lower self-efficacy. In addition to applying the “self-efficacy theory”, the authors referenced the patient’s physiological and affective states, vicarious experiences, and performance experiences and used verbal persuasion techniques to assess the patient for nursing and interventions. During the nursing period, we established a good therapeutic relationship with the patient. We provided him with personalized nursing interventions to improve his physiological and affective states. These interventions included the administration of medication, posture drainage, and sputum percussion. We also sought the help of people who were close to the patient as participants in the medical care process. We improved self-efficacy by means of verbal persuasion through education and mental support; increased vicarious experience through verbal encouragement and sharing the experiences of other patients; and used a comparative approach to enable the patient to observe changes in his physical status over time. The interventions also improved his performance experience. The patient’s airway status improved after his self-efficacy had been enhanced. Based on the results, it is hoped that this study will be a helpful reference on the theory of self-efficacy for nursing staff. It is also hoped that the results will better enable nurses to enhance the self-efficacy of patients using different means such as restoring patient confidence and enhancing the patient - the medical team relationship to further enhance the quality of patient care.