運用跨理論模式於一位血液透析老人血磷控制之護理經驗

Application of the Transtheoretical Model to Help an Elderly Hemodialysis Patient Control His Hyperphosphorus

本篇是運用跨理論模式協助一位長期血液透析老人藉由飲食及藥物控制血磷濃度之護理經驗，護理期間自2016 年9 月17 日至2017 年10 月14 日。筆者藉由整體性評估、觀察、個別訪談及查閱病歷等方式收集資料，並以跨理論模式為架構，評估個案當下行為改變階段，確認個案護理問題為血磷控制不佳／缺乏正確認知及血磷管理行為。依據不同行為階段設定不同目標，並運用意識提升、情緒解除、環境再評價、自我再評價、社會開放、自我承諾、強化處置、協助關係、條件抵銷、刺激控制等策略，提升自我效能和決策權衡，讓個案能確實改變行為，執行低磷飲食及正確服用降磷藥物。希望藉此經驗分享，能提供護理人員照顧類似個案之參考。

 

This article describes the successful application of the transtheoretical model on diet control and medicine in-take behavioral modification for an elderly hemodialysis patient; the nursing period was from September 17, 2016 to October 14, 2017. We have collected the data and made a comprehensive nursing assessment through observation, interview and the patient’s medical records. Major issues included poor control of blood phosphorus/ lack of correct awareness and management. Different goals were set for different stages and different strategies including consciousness raising, emotional release, self-reevaluation, environmental reevaluation, social-liberation, assisting relationships, counter-conditioning, reinforced management, stimulus control, self-commitment were utilized to improve the self-efficacy and decision-making trade-off of the patient. These approaches enabled the case to comply with the low-phosphorus diet and the in-take of the anti-phosphate agent. In conclusion, the transtheoretical model can be applied to identify the changes of the patient. By sharing this experience, the author hopes to provide other medical personnel with an example on how the transtheoretical behavioral modification can be used to care forthis type of elderly patient.