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1 ~ 陳淑玲黃秋玲 * 中文摘要本篇報告在於分享改變, 對 2 照期間民國 95 年 5 月至 9 月, 藉由觀察會談電訪及電子郵件方收集資料, 評估顯示個案是處於改變準備期階段 ; 筆者 Marcus 等人根據所提出策略, 包括自我承諾自我再評價強化管替代選擇找出社會支持力量及環境線索的佈置等策略, 促進個案執的措施下, 進入動期階段由以上的介入措施後, 個案能自擬訂計畫, 記錄日誌, 並逐日, 協同家人起執健康的, 因此筆者期望藉此個案報告, 能提供醫人員以改變照此類個案參考 ( 志, 2009; 8:1, ) 關鍵詞 : 2 前言 %100 (Chuang et al., 2006) ( 2006) (2004) (2002) ( 1998), ( 2006) 高雄市立聯合醫院大同院區加房師阮綜合醫院衛教師 * 受文日期 :96 年 12 月 10 日改日期 :97 年 1 月 9 日接受刊載 :97 年 4 月 21 日通訊作者地址 : 黃秋玲 807 高雄市三民區鼎昌街 88 號 4 樓電話 :(07) 轉 2371 電子信箱 :metaedu_lab@yahoo.com.tw 八卷期 105

提供醫人員以改變照此類個案參考 ( 志, 2009; 8:1, 105-112.) 關鍵詞 : 2 前言 2 20792 5.8%100 (Chuang et al.

2 文獻查證 2 2 (2003) 2060% 5-15% 3-5( 2002) 2 25%16%( 2002) 的 2 (2004) ( 1998) (Jones et al., 2003) (2006) 三改變 (transtheoretical model, TTM) (Burbank, Padula, & Nigc, 2000) ( 2003; Burbank, Padula, & Nigc, 2000) (1)(precontemplation) (2) (contemplation) (3)(preparation) 106

3 (4)(action) (5) (maintenance) (Prochaska & Diclemente, 1983) Marcus(1992) (1) (consciousness raising) (2) (dramatic relief) (3) (self-liberation) (4)(selfreevaluation) (5)(social liberation) (6) (environmental reevaluation) (7)(stimulus control)(8) (helping relationships) (9)(counter conditioning) (10) 75 歲高血壓 57 歲 55 歲公司主管 32 歲科技圖家族圖譜 68 歲肺癌 52 歲家管 28 歲貿易秘書 53 歲 (contingency management) (Marcus, Rossi, Selby, Niaura, & Abrams, 1992) 過程個案簡介 55 疾史三評估 () 生層面 : % 八卷期 107

relationships) (9)(counter conditioning) (10) 75 歲高血壓 57 歲 55 歲公司主管 32 歲科技圖家族圖譜 68 歲肺癌 52 歲家管 28 歲貿易秘書 53 歲

4 ,7002,400 () 心層面 : () 社會層面 : () 靈性層面 : (5/15-6/30) (1) (2) 評值 :5/17 5/20 (7/1-9/20)

5 2. (1) (2) 1, (3) (4) () (5) 95/7/5 55mg/dl 50 (6) 評值 :7/5 7/20 8/8 9/1 八卷期 109

6 110 討 ( ) (7.4% 6.8%) 結 ()(/) 參考文獻 (2002) 45(4)27-30 (1998) 2(1)8-16 (1998) 6(1)31-41 (2006) (2006) 56(4)83-87 (2003) 32(2)7-12 (2004) 1(3)

7 (2004) (2002) (7-10) (2003) (13-24) Burbank, P. M., Padula, C. A., & Nigc, C. (2000). Changing health behavior of older adults. Journal of Gerontological Nursing, 6(3), Chuang, L. M., Soegondo, S., Soewonde, P., Young-Seol, K., Mohamed, M., Dalisay, E., et al. (2006). Comparisons of the outcome on control, type of management and complication status in early onset and late onset type 2 Diabetes in Asia. Diabetes Research Clinical Practice, 71(2), Jones, H., Edwards, L., Vallis, T. M., Ruggiero, L., Susan R., Rossi, S. R. (2003). Changes in diabetes self-care behaviors make a difference in glycemic control. Diabetes Care, 26(3), Marcus, B. H., Rossi, J. S., Selby, V. C., Niaura, R. S., & Abrams, D. B. (1992). The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychology, 11, Prochaska, J. O., & DiClemente, C. C., (1983). Stages and processes of self change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 自己除了要培養善念的心, 還要不斷推廣, 讓愛的種子在每個人的心裡萌芽, 成就美好的淨土 ~ 證嚴法師靜思語 ~ It is not enough to nurture goodness only in our own hearts we must moreover nurture the seeds of love in everyone s heart, so as to let our world become a better place. ~ Dharma Master Cheng Yen ~ 八卷期 111

Comparisons of the outcome on control, type of management and complication status in early onset and late onset type 2 Diabetes in Asia. Diabetes Research Clinical Practice, 71(2), 146-155. Jones, H.

8 An Experience of Diet and Behavior Modification in a Type 2 Diabetes Patient Using the Transtheoretical Model ABSTRACT Shw-Ling ChenChiou-Ling Huang* In this case report we share our experience of diet and behavior modification in a type 2 diabetes patient using the transtheoretical model. This case had been followed up from May through September 2006, during which time data were obtained by regular observation, interviews, telephone interviews, and . The results showed that the study subjects were initially in the preparation stage of behavior change. With help from nurses, the subject was able to move into the action stage using intervention including arranging client s own diet plan, recording diet diary, revising diet behavior, with joint collaboration from family members to achieve at healthy diet behavior. The author hopes to provide a reference for health professionals with the transtheoretical model of health behavior change in the care of this type of patient. (Tzu Chi Nursing Journal, 2009; 8:1, ) Key words: type 2 diabetes, behavioral modification, transtheoretical model. RN, Kaohsiung Municipal United HospitalDiabetes Nurse Educator, Yuan s General Hospital* Received: December 10, 2007Revised: January 9, 2007Accepted: April 21, 2008 Address correspondence to: Chiou-Ling Huang, F4, 88, Ding-Chon Street, San-Ming District, Kaohsiung, Taiwan 807, Taiwan (R.O.C.) Tel: 886(7) ext metaedu_lab@yahoo.com.tw 112

This case had been followed up from May through September 2006, during which time data were obtained by regular observation, interviews, telephone interviews, and e-mail.

88 Nursing Experience With Diabetes Control Diet 2005 1.2. 3. 4. 5.6. 7.8.9. 2006 1. 2. 3. 4.5.6. 3/1813.6% 4/13 9.3% 2007 1. 2.3. 4.5.6. 60 90 5 2006

88 Nursing Experience With Diabetes Control Diet 2005 1.2. 3. 4. 5.6. 7.8.9. 2006 1. 2. 3. 4.5.6. 3/1813.6% 4/13 9.3% 2007 1. 2.3. 4.5.6. 60 90 5 2006 87 應用跨理論模式照護一位糖尿病患飲食之護理經驗張迪真詹惠雅 * 姜遠萍 ** 摘要 : 糖尿病是一典型需要終身自我管理的慢性病, 對於一位缺乏糖尿病認知的個案, 以跨理論模式來促進個案維護健康的行為, 將有助於提昇個案自我