一位獨居老年糖尿病病患藥物遵從之照護經驗～King目標達成理論之運用

A Nursing Experience of Medication Adherence by an Independently Living Elderly Diabetes Patient-Application of the King's Goal Attainment Theory

10.6692/KJN-2011-28-1-6

黃秋玲(Chiu-Ling Huang)；戴研光(Yen-Kuang Tai)；呂麗戎(Li-Jung Leu)

King目標達成理論 ； 藥物遵從 ； 糖尿病 ； King's Goal Attainment Theory ； drug compliance ； diabetes

高雄護理雜誌

28卷1期（2011 / 04 / 01）

59 - 69

繁體中文

本文主要描述一位獨居老年糖尿病病患因不遵從藥物而導致血糖控制不良之臨床護理經驗。護理期間為98年3月16日至5月15日止。運用King目標達成理論之架構進行護理評估，發現個案主要問題為：不遵從藥物。相關導因包括(1)對藥物認知不足；(2)生理功能老化導致遺忘用藥；(3)對自我存在的價值產生負面的觀感；(4)病人角色概念不足，難以遵從規律服藥；(5)因複雜的治療而產生壓力；(6)缺乏社會、家庭支持系統。於護理過程中，依據藥物不遵從的護理問題，筆者運用會談、溝通與個案達成藥物認知上的共識，一同設定目標，並提供適合個案之護理計畫，包括每日督促、電話提醒、利用輔助器材等策略，協助個案克服用藥障礙；適度賦予個案主權與決策力，強化自我效能，透過彼此互動及交流的過程，一同達成藥物遵從之目標。期待藉由此次護理經驗，做為其他同仁臨床照護上之參考。

This article describes clinical nursing experience in the case of an independently living elderly diabetes patient with poorly controlled blood sugar levels due to noncompliance (a failure to comply with the drug treatment). Nursing took place from March 16th to May 15th 2009. The King's Goal Attainment Theory framework was applied to obtain a nursing evaluation, and we found that the patient had one main problem, namely noncompliance; that is, a failure to comply with his drug treatment. The relevant causes included (1) insufficient knowledge of drugs; (2) degraded physiological functioning, specifically forgetting to take the drugs; (3) a negative perception of self-being; (4) insufficient patient role recognition and difficulty in taking medicine regularly; (5) patient pressure from the complicated therapy; and (6) lack of support from social and family systems. With regard to noncompliance, during the nursing process, the researcher used communication to come to a consensus with the patient on understanding the drugs, and then together, a goal was set. A suitable nursing program was provided, including daily encouragement, reminder phone calls, auxiliary devices, etc., in order to help the patient overcome the obstacles associated with taking the drugs. In addition, the patient was given a certain amount of autonomy and decision-making power in order to enhance his self-efficacy. Through interaction with the patient, the goal of drug compliance was attained. We hope that this nursing experience will act as a reference for colleague nurses in clinical care.