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 照 顧 能 力 個 案 住 院 期 間, 筆 者 藉 觀 察 及 會 談 法 來 評 估 個 案 於 執 行 糖 尿 病 飲 食 行 為 改 變 過 程 所 遭 遇 的 困 難, 經 由 行 為 改 變 策 略 對 其 飲 食 控 制 做 個 別 性 的 衛 教, 指 導 個 案 依 自 己 每 日 的 12 份 主 食 執 行 飲 食 代 換, 再 教 導 自 行 操 作 血 糖 機 來 監 測 自 己 飲 食 控 制 的 成 效, 培 養 個 案 在 行 動 期 對 自 我 照 護 具 有 決 定 的 能 力, 期 盼 進 入 維 持 期 後 能 因 自 我 效 能 提 昇 而 有 信 心, 相 信 自 己 是 有 能 力 達 成 自 我 照 顧 行 為 的 信 念 ; 從 個 案 出 院 後 電 話 訪 問 得 知, 個 案 能 遵 守 每 日 的 主 食 維 持 在 12 份, 執 行 血 糖 監 測, 測 飯 前 血 糖 值 70-105mg/dl, 飯 後 血 糖 值 110-160mg/dl, 飲 食 控 制 持 續 處 於 行 動 期, 個 案 也 能 從 血 糖 值 中 有 效 評 估 自 我 照 顧 的 缺 失, 持 續 執 行 維 護 健 康 的 行 為 關 鍵 詞 : 跨 理 論 模 式 自 我 效 能 生 活 型 態 2010 330 2010 2005 Dunbar-Jacob, 2007 2006 2006 Transtheoretical Model Prochaska DiClement 1983 10 Marcus, Rossi, Selby, Niaura, & Abrams, 1992; Richards & Digger, 2008 13D*** 98 8 17 99 2 4 10002 7 02 23123456 63179
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 1.2. 3. 4.5. Lewis, 2007 Seley, Weinger, & Mason 2007 ( 2006) Peeples & Seley, 2007 51 2007 2007/10/04 2007/10/15 380mg/dl 12.6% 2007/10/15 2007/10/29 155 65 BMI27 kg/m 2 12.6%380mg/dl 263mg/dl249mg/dl 5 350c.c.
89 2005 10/16 10/18 1. 2. 10/18 10/19 10/21
90 Nursing Experience With Diabetes Control Diet ㈠1. 2. ㈡ 1. 2. 10/19 10/21 1/4 10/22 11/28 ㈠ 1. 2. ㈡ ㈢ 1. 1650/Kcal12 2 2. ㈣ 10/22 10/28 ㈤ 5gm 10/2210/23 10/24 12 10/26 16 244mg/dl 10/27
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92 Nursing Experience With Diabetes Control Diet Applying the Transtheoretical Model to a Patient on a Diabetes Control Diet: A Nursing Experience Ti-Chen Chang Hui-Ya Chan * Yuan-Ping Chiang ** Abstract: Diabetes mellitus is a chronic disease that requires lifelong self-management. The author used a transtheoretical model to help improve the self-care abilities of one diabetes mellitus patient who lacked initial appreciation / understanding of self-care needs. During hospitalization, the author employed observation and communication to evaluate subject needs with regard to transforming her dietary behavior in order to better stabilize her medical condition. The author educated the subject on a one-toone basis in dietary control using change tactics, and recommended that she adjust her 12 portions and food exchange. The patient was instructed to operate the blood sugar machine to monitor the effects of diet control. This method was designed to help the patient build self-care decision-making abilities during the action phase and bolster confidence during the maintenance phase through self-efficacy promotion, and to increase confidence in her self-care abilities. Telephone interview follow-ups demonstrated that the patient was able to self-comply with 12 portion rules and monitor her blood sugar on a daily basis. With blood sugar measurements at 70 105mg/dl and 110 160mg/dl, respectively, before and after meals, her diet control remained in the action phase. The patient was able to selfmonitor her personal health status via blood sugar level and conduct personal healthcare maintenance work. Results support the effectiveness of applying the transtheoretical model to self-care strategies for diabetic patients. Key Words: Transtheoretical Model, self-efficacy, life-style. RN, BSN, Ward 13D, National Taiwan University Hospital; *RN, MS, Discharge Plan Team of Nursing Department, National Taiwan University Hospital & Doctoral Student, Department of Nursing, College of Medicine, National Taiwan University; **RN, MS, Supervisor, Department of Nursing, National Taiwan University Hospital. Received: August 17, 2009 Revised: December 18, 2009 Accepted: February 4, 2010 Address correspondence to: Hui-Ya Chan, No.7, Chung-Shan S. Rd., Taipei 10002, Taiwan, ROC. Tel: +886 (2) 2312-3456 ext. 63179; E-mail: freya@ntuh.gov.tw