引導一位高血糖高滲透壓糖尿病患正向接受注射胰島素治療之照護經驗

The Nursing Experience of Guiding a Diabetic Patient with Hyperosmolar Hyperglycemic State to Receiving Insulin Injection Therapy Positively

本篇為探討一位高血糖高滲透壓糖尿病患者正向接受注射胰島素治療之照護經驗。照護期間自2021年5月26日至2021年9月2日，運用Gordon十一項功能性健康型態進行整體性評估，在過程中以訪視、觀察、病歷查閱、回覆試教、電訪方式來收集資料，確立病人主要健康問題包括：現存性傷害／與糖尿病合併高血糖高滲透壓狀態有關、無力感／面臨施打胰島素技術學習能力不足有關、知識缺失／與缺乏血糖監測及糖尿病飲食控制相關認知有關等。並運用主動關懷、同理心技巧來與個案建立治療性人際關係，同時運用圖文並茂且色彩鮮豔的圖片（如：糖尿病管理七巧板）、多媒體影音教材及注射模型等多元衛教工具及結合家屬的力量，更容易評估病人的理解程度和常見的迷思，也可引發個案學習自我照護的動機，藉由醫護即時互動回饋，適時調整與加強個別衛教內容，並與醫師、營養師等跨領域的合作方式提供個別化的衛教指導，促使個案增加對糖尿病的了解、自我照護方式（施打胰島素的信心、注射技巧、自我血糖監測等），以預防及延緩糖尿病的合併症發生，幫助個案回歸良好的生活型態，期望藉由分享此照護經驗，提供臨床同仁對於照護此類個案之參考。

This article discusses the nursing experience of a diabetic patient with Hyperosmolar Hyperglycemic State (HHS) to receiving insulin injection therapy positively. The patient during the nursing period, from May 26, 2021 to September 2, 2021. We applied approaches such as observation, interview, medical record review and phone calls to collect data, and a comprehensive assessment model (Gordon's 11 Functional Health Patterns) to determine the patient's problems (including the existing damages：existing injuries/related to the diabetes combined with Hyperosmolar Hyperglycemic State, feeling of powerlessness/related to insufficient learning ability to insulin injection techniques, lack of knowledge/related to lack of cognition blood sugar monitoring and diabetes diet control). Use active care and empathy skills to establish a therapeutic interpersonal relationship with the case. At the same time, use multiple health education tools such as richly illustrated and colorful pictures (For example: Diabetes Management Tangram), multimedia audiovisual teaching materials and injection models, and combine the power of family members, it is easier to assess the patient's understanding and common confuse, and it can also trigger the motivation of the case to learn self-care. By the real-time interactive feedback of doctors and nurses, timely adjustment and strengthening of individual health education content, and cross-disciplinary cooperation with doctors, nutritionists. The cooperation method provides individualized health education to promote patients to increase their understanding of diabetes and self-care methods (confidence in administering insulin, injection skills, self-monitoring of blood sugar, etc.), as to prevent and delay the occurrence of diabetes complications and help patients return Good lifestyle. This case report is for nursing colleagues' future references while caring patients with similar conditions.