與淹沒感交戰：一件糖尿病自我照顧的個案研究

Fighting the Overwhelmed: A Case Study of Diabetes Self-care

本研究探討糖尿病對一位病患的意義以及其在面對糖尿病自我照顧的障礙時之掙扎經驗。個案是一位血糖控制不佳的中年華裔美國男性糖尿病患者，在兩次深度訪談時描述其糖尿病自我照顧的經驗，第一次以面對面訪談和第二次電話訪談，訪談後當天立即轉寫為過程紀錄。資料以質性研究詮釋法分析。結果歸類出一個主題一「淹沒感－逃避」，針對糖尿病自我管理的四個項目；用藥、飲食、運動和工作生涯。結果顯示這位血糖控制不佳的病患正經歷一種被自我管理的嚴格和責任感淹沒，使得血糖的控制停滯不前。本個案的情境可引導讀者思維糖尿病照護的新方向：傳統的糖尿病衛教是不夠的，需要增加病患自我照護責任的可近性以及方法的可行性。建立一個新的支持系統對控制不佳的糖尿病人可能較為重要。The purpose of this case study was to explore the meaning of the disease “Diabetes” and the barriers of adherence to self-management that present themselves to sufferers of this affliction. One Chinese-American, middle-aged male patient whose diabetes was under poor controlled was interviewed twice to describe his experience of diabetes. Data were gathered with a tape recorder in the first face-to-face interview, via telephone and the use of written field notes in the second interview for clarification of questions. All information was transcribed immediately after the first interview and upgraded for clarification and greater detail following the second. Data were analyzed according to a hermeneutic phenomenological approach. One major theme overwhelmingavoidance was coded and four aspects of diabetes self-management were categorized: medication, diet, exercise, and working life. The results showed that this patient, with a very poor level to control his diabetes, was undergoing or experiencing a sense of being overwhelmed with the rigors and responsibility of self-care management. This case scenario is important insofar as it helps to suggest or inspire new directions which will make selfresponsibility more accessible, feasible for patients such as this one for whom traditional diabetes education programs have not proven to be adequate. In short, factors other than self-care efficacy that can influence patient adherence to self-care regimen are in need of further investigation. Establishing a new support system for the most vulnerable is very important.