運用健康信念模式於一位糖尿病個案戒菸與血糖控制之照護經驗

The Nursing Experience of Smoking Cessation and Blood Sugar Control in a Diabetic Patient by Using the Health Belief Model

本文旨在運用健康信念模式於一位糖尿病個案戒菸與血糖控制之照護經驗。個案曾戒菸失敗，又因血糖控制不佳尋求協助而引起筆者探討動機。2021年1月4日至12月15日照護期間，透過觀察、訪談、身體評估與查閱病歷等方式收集資料，以健康信念模式(Health Belief Model, HBM)確立個案健康問題為：增進健康識能的準備度、增進決策的準備度及潛在危險性不穩定血糖濃度。筆者藉由關懷與心理支持等方式與個案建立良好信任關係，應用醫病共享決策與跨領域團隊合作，增進個案的自覺罹患性與自覺嚴重性，提升其戒菸信念與健康識能，並強化其決策信心，使其獲得全方位照護；戒菸過程中面臨藥物回收之行動障礙，再次使用醫病共享決策與個案討論戒菸方式，並定期電訪給予個案關懷與鼓勵，促進其自我效能。適逢疫情期間使個案生活型態改變，增加個案行動利益與行動線索，促使其成功戒菸與血糖控制趨於穩定。建議未來除常規血糖衛教外，應將個案的生活型態，如戒菸、戒酒等列入衛教重點，藉醫病共享決策與個案討論出最合適之治療選項，並適時提供跨領域團隊合作，提升醫療品質與成效。

This article aims to apply the Health Belief Model (HBM) to the nursing experience of a diabetic patient in smoking cessation and blood sugar control. The patient had failed to quit smoking and sought help because of poor blood sugar control, which motivated the author to investigate. During the nursing period from January 4, 2021 to December 15, 2021, data were collected through observation, interviews, physical assessment, and review of medical records. Based on the HBM, the health problems of the patient were established as: readiness for enhanced health literacy, readiness for enhanced decision-making, and risk for unstable blood glucose control. The authors established trust with the patient through caring and psychological support. Involving the patient in shared decision-making (SDM) and interdisciplinary teamwork increased the patient’s the perceived susceptibility and the perceived severity, enhanced his belief in smoking cessation and health literacy, and strengthened his confidence in decision-making. In the process of smoking cessation, faced with the action barrier of drug recycling, the decision-making sharing between the author and patient was used again to discuss smoking cessation methods, and regular phone calls were made to encourage the patient and promote his self-efficacy. During the pandemic, the lifestyle of the patient changed, and the interests and action clues of the patient were increased to maintain the successful smoking cessation and stable blood glucose control. The authors suggest that in addition to routine blood glucose health education, the individual's lifestyle, such as smoking cessation and quitting drinking, should be included in the focus of health education, and the most suitable treatment option should be discussed with the patient through SDM to provide quality and effective interdisciplinary medical care.