運用賦權協助ㄧ位糖尿病患者面對胰島素治療之護理經驗

本文旨在探討運用賦權協助一位第二型糖尿病患者面對胰島素治療之護理經驗。護理期間自2016年3月3日至7月1日，利用觀察、會談、身體評估、電訪及查閱病歷方式收集資料，運用Gordon十一項健康功能型態進行整體性評估，確立個案主要的護理問題為知識缺失、焦慮及增進健康管理的準備度。護理過程運用賦權策略提供各項護理措施，協助個案願意接受胰島素注射治療，並提供血糖監測原則及低血糖處理方式，減輕個案對自我監測血糖所產生之焦慮，並依照個案接受度，共同討論監測血糖的時間及次數，引導個案執行並融入生活，提升個案對自我健康管理的準備度，最後個案能達到良好的血糖控制。由於門診看診時間有限且就診人數多，賦權需耗費時間與個案溝通與指導，建議可提供諮詢電話及電話追蹤，以及於候診區提供相關衛教海報及影片，宣導血糖控制及施打胰島素時機之正確觀念，提升糖尿病患者對胰島素之正確認知及正向態度，達到良好的血糖控制目標。冀望此護理經驗能提供護理同仁照顧此類個案時，能運用賦權策略，藉由夥伴關係，引發個案的動機，協助由被動轉成主動參與角色，共同參與目標的設定，達到自我健康管理的目的。

This article aims to describe a nursing experience in assisting a patient with type II diabetes to face insulin treatment through the use of empowerment. The primary nursing period was from March 3 to July 1, 2016. The authors assessed the patient's health condition by observation, interview, physical assessment, telephone interview, and review of medical records. The Gordon functional health assessment guide was also used. As a result, deficient knowledge, anxiety, and readiness for enhanced health management were identified. The empowerment strategies were used in the nursing process, such as enhancing the willingness of insulin treatment, and providing the information of blood glucose monitoring and hypoglycemia management in order to reduce anxiety. In addition, time and frequency of blood glucose monitoring was discussed and implemented to increase readiness of selfhealth management for better glycemic control afterwards. As limited time and a large number of patients in the outpatient clinic, it will take time to communicate and teach the individuals when the empowerment strategy is used. It's proposed that a consulting telephone number and telephone follow-up should be provided. The relevant posters and films can be shown in the waiting area to provide the information of glycemic control and insulin treatment. It will contribute to enhance the knowledge and positive attitudes toward insulin treatment and achieve the goal of good glycemic control. By using the empowerment strategy, the partner relationship can be established. The individual is motivated to convert the passive participation role into the active participation role and then the common goal is set up to reach the purpose of self-health management. This nursing experience in this article could serve as a reference for caring patients with diabetes in the future.