運用健康控制信念協助慢性阻塞性肺疾病患執行太極拳運動之照護經驗

慢性阻塞性肺疾病患常因各種因素無法持續肺部復健運動，造成健康狀態惡化。如何運用護理獨特性，讓病患願意持續規律的運動以維持身體健康，是臨床護理人員一大考驗。本文探討一位重度慢性阻塞性肺疾病急性發作之住院個案，經歷呼吸困難及活動耐力不足的照護經驗。筆者透過觀察、會談、電話訪談、門診、家訪追蹤方式之參與性護理，發現個案誤解返診時醫護人員的病程解釋，導致對疾病健康資訊認知錯誤，認為自己無法掌控疾病，使得個案面對疾病威脅時，選擇放棄尋求協助，且對治療失去期望，中斷肺部復健運動和常規治療。筆者在互信的護病關係下，運用健康控制信念的概念，先修正疾病認知，再連結個案先前運動經驗和自我期望，提供個別性、適切性的太極拳運動計畫，進而改善個案之呼吸困難感受及運動耐力，強化個案對運動行為的價值，從中獲得成就感，藉此提升個案生活品質及達到持續運動的目標。此結果可供護理人員日後在面對相關個案臨床評估與照護時的參考。

關鍵字

健康控制信念；太極拳運動；慢性阻塞性肺疾病

並列摘要

Owing to numerous factors, patients with chronic obstructive pulmonary disease (COPD) often struggle to sustain regular pulmonary rehabilitative exercise, which worsens their condition. Improving exercise behaviors in these patients poses a major challenge for the application of unique methods in nursing care. This case study describes the nursing experience of a patient with COPD exacerbation who had dyspnea and activity intolerance. Through participatory nursing care, including observation, discussion, phone interviews, outpatient consultations, and home visits, the authors found that the patient discontinued regular use of medication and pulmonary rehabilitation because of the lack of proper communication from healthcare providers. The authors applied the concept of health locus of control to correct the patient's knowledge about his disease and thereby improve his self-management of the disease, and to connect the patient's previous exercise experience with his self-expectation. In addition, the authors provided individualized and appropriate Tai Chi exercise in order to improve dyspnea and activity intolerance. This enhanced the patient's sense of accomplishment, improved his quality of life, and enabled him to achieve the goal of sustained regular exercise. These results may provide clinical nurses a reference for nursing care in the future.

並列關鍵字

health locus of control ； tai chi ； chronic obstructive pulmonary disease

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運用健康控制信念協助慢性阻塞性肺疾病患執行太極拳運動之照護經驗

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