充能介入方案對糖尿病早期腎病變病患之自我效能、自我管理及生理指標之成效

背景：世界各國末期腎臟疾病(End-Stage Renal Diseases, ESRD)發生率與盛行率逐年增加，尤其糖尿病是其主因。若能在糖尿病早期慢性腎臟病(Diabetic Early Chronic Kidney Disease)階段及早介入，使其增進自我管理能力，將可延緩腎病變進展。然而，CKD 有2/3是同時罹患2種以上疾病的慢性病共病者，照護相對複雜，病人需有足夠的自信及能力才得以延緩腎疾病進展及與疾病和平共存，因此，該如何協助患者將疾病照護行為與生活整合達成平衡，實為現今CKD照護一大挑戰。目的：測試充能介入方案對糖尿病早期腎病變病患之自我效能、自我管理及生理指標之效應。方法：本研究採前後測雙組類實驗設計，收集自南部某醫學中心之診斷為糖尿病合併早期慢性腎臟病患者，共實驗組21位，控制組22位。介入前兩組同時接受自我效能、自我管理及生理指標之前測(T0)。實驗組參加為期四週之充能介入方案；控制組則採現行個案管理模式。介入後滿第三個月(T1)及第六個月(T2)，兩組再進行自我效能、自我管理及生理指標後測。資料經統計軟體SPSS 19分析。結果：研究結果顯示，經糖尿病早期腎病變充能方案介入後，實驗組個案在自我效能、自我管理、BMI、WL、HbA1c之前後測平均值的組內比較皆達顯著差異(p <.05)，對照組則無顯著差異；實驗組個案在自我效能、自我管理、BMI、WL、HbA1c之組間比較顯著優於對照組(p< .05)。結論：充能自我管理方案可顯著改善二型早期糖尿病腎病變病患之自我效能、自我管理及生理指標，經此實證結果，吾人建議未來可將充能介入方案，推廣於糖尿病早期腎臟病病人之慢性病照護活動之一。

關鍵字

糖尿病早期腎病變；充能；自我效能；自我管理

並列摘要

Background：The occurrence and prevalence of end-stage renal diseases (ESRD) in the world has been on the rise each year. Diabetes is one of the reasons leading to ESRD. Intervening at the early stage of diabetes, i.e. during the diabetic early chronic kidney disease, to improve the self-management skills of a patient may delay the progress of the kidney disease. However, two third of the CKD patients have two or more chronic diseases concurrently and this complicates patient care. The patient needs to have sufficient confidence and ability in order to delay the progress of his/her kidney disease and co-exists with the disease. Finding the means to help patients integrate disease care behaviors into daily routine has therefore become one of the greatest challenges in today’s CKD care. Objective：The objective of this study is to investigate the effects of empowerment intervention on the self-efficacy, self-management, and physiological indicators such as body mass index (BMI), waistline (WL), HbA1C, and low density lipoprotein (LDL) of a diabetic early chronic kidney disease patient. Methods：This study used a quasi-experimental, two-group repeated measurement design. Diabetic patients diagnosed with early chronic kidney disease are recruited from a medical center located south of Taiwan. A total of 21 subjects are recruited for the experimental group while 22 for the control group. Prior to intervention, members in both groups are given pretests (T0) relating to self-efficacy, self-management, and physiological indicators. The experimental group members are then required to participate in a 4-week empowerment intervention program while the control group members remained in the current case management regime. On the third month (T1) and sixth month (T2) after the intervention, members in the two groups are given posttests relating to self-efficacy, self-management, and physiological indicators at the same time. The data is analyzed with SPSS 19 statistical software. Results：Results show that after the empowerment intervention course for diabetic early chronic kidney disease patients, the experimental group members showed a higher mean in the self-efficacy, self-management, BMI, WL, and HbA1c posttest results as compared with their pretest results. The results are significant (p <.05). The control group, however, does not show any significant results in the posttests. The experimental group also shows significantly better results in self-efficacy, self-management, BMI, AG, and HbA1c (p <.05) as compared with the control group. Conclusion：Results of this study has proven that empowerment and self-management program can significantly improve the self-efficacy, self-management, and physiological indicators of a diabetic early kidney disease patient. With this empirical result, it is recommended that empowerment intervention programs may be adopted as one of the chronic disease care activities for diabetic early kidney disease patients in the future.