運用多元化策略提昇筆型胰島素患者注射技巧之正確率

Applying Diversified Strategies to Improve the Injection Accuracy of Pen-type Insulin

林靖芸(Jing-Yun Lin) ； 陳佳蓉(Chia-Jung Chen) ； 蔣昀孜(Yun-Tzy Jiang) ； 孫美華(Mei-Hua Sun) ； 陳麗珍(Lee-Chen Chen)

《醫務管理期刊》 13卷4期 (2012/12) Pp. 281-294

摘要

目的：血糖控制應由飲食、運動及藥物三部分進行監測，臨床上，住院患者聽到需要胰島素注射時，即會用各種理由來推託、婉拒，加速產生合併症；也發現，沒有好好學會胰島素注射技巧時，常會影響藥物效能；而有鑑於此，引發專案成立動機。經專案組員查檢得知：筆型胰島素患者注射技巧之正確率僅為：55%。方法：經專案組員討論後，運用多元化的策略、跨領域團隊（醫生、護理師、藥師、營養師）的加入，且拍攝『筆型胰島素注射技巧』VCD，提供個別性護理衛教，增加自我健康信念，也製作糖尿病使用手冊，供其隨身翻閱，更設計創新輔具：哎哎便利包，讓衛教指導流程更加完善，符合患者需求，以增強其配合意願。結果：經措施介入後，筆型胰島素患者注射技巧之正確率提升至98%。結論：護理衛教時數也由32.7分鐘／人，降低僅需4.8分鐘／人，顯示本專題之措施成效顯著，確實有助於血糖控制及提升照護品質的目的，達成返家正確注射施打筆型胰島素之用意。

關鍵字

筆型胰島素 ； 糖尿病 ； 多元化策略

並列摘要

Objective: Glycemic control should be monitored through diet, exercise, and medication. In clinical practice, however, hospitalized patients, upon hearing the need for insulin injection, often make various excuses to decline and avoid that responsibility. They are frequently unaware, however, that such behavior will only exacerbate their complications. Researchers have also found that the lack of a well learned insulin injection technique often affects drug efficacy, a finding which, on its own, is sufficient enough to motivate the establishment of the current project. Specifically, studies conducted by experts have determined that the accuracy rate of insulin injection technique for patients using insulin pens is only 55%.Method: After consultations with experts, a diversified strategy was created that involved the participation of interdisciplinary groups of medical practitioners (doctors, nurses, pharmacists, and dieticians) and the creation of a VCD entitled ”Insulin Injection Technique Using Insulin Pens” that was designed to provide individualized nursing care education in order to increase patient belief in the necessity of protecting one's own health. A portable diabetic user manual for convenient patient reference at any time was also created. In addition, the project also included the creation of Ai Ai convenience packages that were given to patients to help meet their needs while making the health education guidance process even more effective and increasing the patients' willingness to follow instructions.Result: After the intervention, the accuracy rate of the insulin injection technique of patients using insulin pens was raised to 98%.Conclusion: The drop in the amount of time spent on nursing care education went from 32.7 min per person to only 4.8 min per person, indicating the effectiveness of the measures proposed in this project in realizing glycemic control and quality-of-care objectives through the achievement of more accurate home-based insulin injection using insulin pens.

並列關鍵字

insulin pen ； diabetes ； diversified strategy

參考文獻

張秋純、陳鈺如(2009)。以專案提昇門診糖尿病病患胰島素注射治療之接受度。中山醫學雜誌。20(2)，233-245。

高肇隆、林玉雯、張道明(2009)。胰島素治療對第2型糖尿病病人生活品質之影響及相關因素探討。中華民國內分泌暨糖尿病學會會刊。22(2)，1-8。

陳曉悌、李怡娟、李汝禮(2003)。健康模式之信念理論源起與應用。護理廣場。7(4)，632-639。

鍾麗英(2000)。應用健康信念模式及Becker認知治療照顧一位糖尿病患者之護理過程。新臺北護理期刊。2(1)，121-129。

Sharifirad, G.,Entezari, M.,Kamran, A.,Azadbakht, L.(2009).The effectiveness of nutritional education on the knowledge of diabetic patients using the health belief model.Journal of Research in Medical Sciences.14(1),1-6.