照顧一位初次診斷第一型糖尿病青少女的護理經驗

The Nursing Experience in Caring for an Adolescent Girl with Newly Diagnosed Type 1 Diabetes Mellitus

王品淳(Pin -Chun Wang) ； 呂明蕙(Ming-Huei Lu) ； 黃凰媖(Huang-Ying Huang)

《馬偕護理雜誌》 15卷1期 (2021/01) Pp. 79-90

https://doi.org/10.29415/JMKN.202101_15(1).0008

摘要

本篇個案報告描述協助一位初次診斷第一型糖尿病青少女心理、社會調適之護理經驗。護理期間為2017年11月6日至2017年11月19日，以Gorden十一項功能性健康型態評估為護理評估工具。運用觀察、開放式會談、身體評估及病歷查閱等獲得資料加以分析。確立個案有：一、焦慮／與疾病對身體健康造成之威脅有關，二、知識缺失／與個案及主要照顧者缺乏正確的第一型糖尿病知識、第一型糖尿病自我照顧知識技能不了解有關，三、照顧者角色緊張／主要照顧者無照護知識、技巧與經驗有關。筆者運用同理心、鼓勵、主動傾聽與個案及家屬建立信任關係，針對其個別性需求提供第一型糖尿病的衛教指導，以提升照護知識，引導個案說出感受，個別化認識疾病與自我照護，促進個案提升自信心，促使個案以正向觀點來看待疾病治療的過程，以提升自信心，最後達到最佳的適應狀態。期盼藉此護理經驗能提供臨床護理同仁與照顧此類個案之參考。

關鍵字

第一型糖尿病 ； 青少女 ； 照顧者焦慮

並列摘要

The case report described a nursing experience in helping a young girl who was diagnosed with type 1 diabetes for the first time and assist her to cope with it mentally and socially. The nursing care started from November 6 to 19, 2017 based on Gorden's 11 functional health patterns as the evaluation tool. The data were collected from methods of observation, interviews, physical assessment and medical progress notes, which have resulted in at least three nursing diagnoses. The diagnoses included (1) Anxiety related to a concern of her health status threaten by the disease; (2) a lack of knowledge related to an insufficient level of correct knowledge and skills regarding care of Type 1 DM in both the patient herself and her main caregiver; (3) Anxiety in caregiver related to a lack of experience in caring for Type 1 DM. The author attempted firstly to build a trust relationship with the adolescent patient and her family members by empathizing, encouraging and listening actively. Secondly, patient education offered focused on personal skills in improving illness knowledge and self-care skills, guiding the patient to reveal her feelings and master with how to care by herself, for the goal of enhancing the confidence and resulted in a positive attitude toward the treatment process. Finally, the outcome was aimed for the patient to achieve the best condition to adapt to the disease. It is hoped that this nursing experience can provide as a reference for clinical nursing colleagues when providing care in similar cases.

並列關鍵字

Type1 Diabetes Mellitus (T1DM) ； adolescent girl ； anxiety in caregivers

參考文獻

宋瑞蘭、武佳縈（2011）‧照顧一位罹患第一型糖尿病之青少年接受透析之經驗‧長庚護理，22（1），105-113。[Sung, J. L., & Wu, C. Y. (2011). Nursing experience of caring a patient of type 1 diabetes mellitus receiving hemodialysis. Chang Gung Nursing, 22(1), 105-113.] doi:10.6386/CGN.201103_22(1).0011

陳巧芳（2010）‧協助一位主要照顧者降低壓力源 之護理經驗‧護理雜誌，57 （2），81-86。[Chen, C. F. (2010). Experience helping a caregiver reduce stressors. The Journal of Nursing, 57(2), 81- 86.] doi:10.6224/JN.57.2S.81

黃彩雲、林宥葶（2019）‧一位初診斷為第一型糖尿病學前兒之護理經驗‧領導護理，20（2），55-71。[Huang, C.Y. & Lin, Y. T. (2019). A nursing experience for an elementary preschool child with type I diabetes mellitus. Leadership Nursing, 20(2), 55-71.] doi:10.29494/LN.201906_20(2).0005

楊培筠、高碧霞（2017）‧第一型糖尿病青少年同 儕支持之性別差異‧台灣醫學，21（4），343- 350。[Yang, P. Y. & Gau, B. S. (2017). Gender differences in peer supports among adolescents with type 1 diabetes. Formosan Journal of Medicine, 21 (4), 343-350.] doi:10.6320/FJM.2017.21(4).2

楊苤葶、柯雅齡、曾紀瑩（2018）‧應用Orem的自 我照顧理論於一位多次酮酸中毒青春期少女之 照護‧台大護理雜誌，14（2），21-32。[Yang, P. T., Kao, Y. L. & Tseng, C. Y. (2018). The appli- cation of Orem’s self-care theory on a teenage female patient with multiple ketoacidosis. National Taiwan University Hospital Journal of Nursing, 14 (2), 21-32.] doi:10.6740/NTUHJN.201807_14(2).0004