運用行為改變跨理論模式協助一位血液透析患者控制飲食以降低血磷之護理過程

The Nursing Process of Using the Transtheoretical Model to Help a Hemodialysis Patient Control Hyperphosphorus Through Dietary Control

江永貞(Yung-Chen Chiang) ； 徐碧秀(Pi-Hsiu Hsu)

《臺灣腎臟護理學會雜誌》 13卷3期 (2014/09) Pp. 69-81

https://doi.org/10.3966/172674042014091303006

摘要

傳統的護理指導多以口頭和紙本的方式來表現，患者很難將其運用於生活中，非但成效不彰，更因無所依從的挫折感想要放棄，本文筆者運用行為改變跨理論模式，評估個案所處階段，運用策略提供不同的資訊及協助；照護期間為2012年5月18日至2012年9月30日，藉由觀察、會談、電訪等方式收集資料，確立其護理診斷為健康尋求行為／與自覺高磷酸的飲食型態將危害健康有關；收案時，個案正處於準備期階段，血磷平均值為5.7 mg/dl，過去雖已採取飲食控制的行動，但血磷值仍常高於6.0 mg/dl，筆者運用模式中的各個策略，釐清錯誤觀念、強化降磷動機進入行動期，接著協助其運用工具為三餐進行替代選擇和調配，使整個護理過程充滿探索和成就感，更建立了個案自主控制血磷的行為模式；因而筆者期望藉此次護理經驗的分享提供醫護人員以行為改變跨理論模式照護此類個案之參考。

關鍵字

高血磷 ； 飲食控制 ； 血液透析 ； 跨理論模式

並列摘要

Nursing instructions are traditionally expressed verbally or in writing making them harder for patients to practice in everyday life. These nursing instructions are therefore not only ineffective but also frustrating so patients tend to give up. By using the transtheoretical model process to assess different stages, the author offered different information and advice on possible solutions. The care period ran from May to September, 2012. Information was carefully collected through observation, personal interviews and telephone calls. At the time of writing, the case was in the preparation stage with the average level of phosphorus at 5.7 mg/dl. Although the patient had already gone through dietary control, phosphorous was still frequently higher than 6.0 mg/dl. By using various strategies from the transtheoretical model, the author assisted patient with entering a period of action. During this period, the author succeeded in teaching the patient to use the correct tools during meal selection and preparation, creating an atmosphere of discovery and self-accomplishment throughout the process. By sharing this experience, the author hopes to provide other medical personnel with an example of how the transtheoretical model of behavioral change can be used to care for this type of patients.

並列關鍵字

hyperphosphorus ； diet control ； hemodialysis ； transtheoretical model