青少年與糖尿病照護

Adolescents and Diabetes Management

此篇文章的目的主要在討論青少年發展特色對於糖尿病健康照護之衝擊，並討論雙親參與青少年糖尿病健康照護上之重要性。青少年血糖控制效果不佳通常導因於其遵從行為不當。青少年發展特色包括自我認識之搜尋、個別化過程之經歷以及「群眾幻想」與「謬想」之產生，而此類青少年發展特色可能為導致遵從行為不佳之潛在原因。雙親參與在青少年糖尿病健康照護上扮演重要角色；然而，當青少年在自我搜尋而欲追求獨立的過程中，親子關係極可能生變。因為親子關係的變化，青少年可能會拒絕雙親參與其糖尿病健康照護。如果雙親沒有考慮青少年的感受與需要而強行參與青少年之糖尿病健康照護，親子間的衝突可能產生。因為青少年與兒童發展特色的差異，為了防止衝突產生，雙親參與青少年與兒童的健康照護的程度也許不應相同。根據青少年發展特色而鼓勵雙親適當程度的參與糖尿病照護過程，為值得鼓勵之對青少年之友善措施。此外，為了防止衝突產生，健康照護者須教導雙親與青少年應該共同參與健康照護的決策過程，並協調適當程度之雙親參與。如此一來，將可有效率改善青少年之血糖控制與遵從行為。The purpose of this paper is to review the impacts of adolescents' developmental characteristics and the importance of parental involvement in adolescents' management of diabetes. Frequently poor glycemic control during adolescence is blamed on non-adherence to diabetes management tasks (DMTs). Adolescent developmental characteristics include the search for a sense of self-identity, the experience of individual process, and the emergence of imaginary audience and personal fable, and these are some of the factors that potentially contribute to a non-adherence to DMTs. Parental involvement in DMTs may be helpful in adolescents' management of diabetes. However, parent-child relationship might change during adolescence, while adolescents strive for independence and explore their personal identity. This changing parentchild relationship may make adolescents refuse the parental involvement in DMTs. If parents try to get involved in adolescents' DMTs, without considering their adolescents' feelings or needs, conflicts may occur between parents and adolescents. Due to the differences of developmental characteristics between adolescents and children, the levels of parental involvement may be somewhat different between adolescents and children, so as to reduce the possible conflicts between parents and their adolescents. Encouraging the appropriate levels of parental involvement in adolescents DMTs, based on adolescents' developmental characteristics, can be considered as an adolescent-friendly intervention provided for adolescents with type 1 diabetes. Furthermore, parents and adolescents should be taught by health care providers to share in decision making regarding DMTs and to negotiate extent of parental involvement in DMTs with each other, in order to avoid the possible conflicts. By doing so, it is expected that adolescents' adherence and glycemic control can be improved effectively.