運用疾病詮釋模式於一位末期腎病變患者之照護經驗

Using the Illness Representation Model to Care for a Patient with End-Stage Renal Disease

10.3966/172674042015061402004

黃惠玲(Hui-Ling Huang)；林秋菊(Chiu-Chu Lin)

疾病詮釋 ； 末期腎病變 ； illness representation model ； end-stage renal disease

臺灣腎臟護理學會雜誌

14卷2期（2015 / 06 / 01）

38 - 46

繁體中文

當個人面臨疾病衝擊時，知識與經驗會影響其對疾病的詮釋，疾病詮釋的結果引導其就醫與接受治療的態度與行為。臨床醫護人員，應能以病患為中心，深入了解病患對疾病衝擊之認知與因應，才能準確找出病患的問題，提供個別化照護，協助採取正向的健康行為，增進慢性病患之自我照顧能力，以達到有效控制疾病之效果。本文描述一位腎衰竭患者，對「糖尿病」認知的偏頗，認為糖尿病是「可以自癒」的，加上初期沒有症狀，而未控制血糖，導致「疾病惡化進入末期腎病階段」，27歲就必須依賴血液透析治療來維持生命。筆者於2014年3月17日至4月16日護理照護期間，透過身體評估、會談、病歷查閱等方式收集資料，確立有體液容積過多、透析病患角色適應不良、疾病控制知識缺失健康問題，運用「Leventhal自我調節模式」之「疾病詮釋」模式，了解個案對末期腎病及血液透析治療的認知感受及其如何因應疾病與治療的衝擊，讓其知道身體症狀與末期腎臟病之關聯，澄清不符合現實的看法和觀念，強化末期腎病是無法痊癒的；引導個案藉由自我觀察及評價，了解透析治療可緩解身體不適並維持生命，使其能接受疾病及透析病患角色並持續透析治療；學習使用適宜的健康行為，達到有效控制疾病，早日重回工作崗位並維持生活品質。

Faced with the treat of illness, how a patient interprets that illness is affected by his or her experience and knowledge. The result of that interpretation in turn influences the patient's attitude towards seeking treatment and healthy behavior. Nurses who understand the patient's interpretation of the illness may be better able to provide appropriate intervention treatments for enhancing the patient's self-care skills and achieving disease self-management. This article present the case of a 27-year-old diabetic patient whose poor control of blood sugar and cognitive bias leading resulted in the condition rapidly deteriorating to end stage renal disease and having to rely on dialysis. The author applied the ＂illness representation model＂ to understand the patient's perception of his illness, help the patient correct his misconceptions about hemodialysis treatment, changed his illness representation then guided him in accepting his new role and improving his quality of life.

1. Cameron, L. D.(Ed.),Leventhal, H.(Ed.)(2003).The self-regulation of health and illness behavior.New York, ROC:Routledge.
2. Fowler, C.,Baas, L. S.(2006).Illness representation in patients with chronic kidney disease on maintenance hemodialysis.Nephrology Nursing Journal,33(2),173-187.
3. Groaje, A.,Curtis, R.,Coughlan, R.,Gsel, A.(2005).The impact of illness representation and disease activity on adjustment in women with rheumatoid arthritis: A longitudinal study.Psychology and Health,20(5),597-613.
4. Hale, E. D.,Treharne, G. J.,Kitas, G. D.(2007).The Common-Sense Model of Self-regulation of health and illness: How can we use it to understand and respond to our patients’ needs.Rheumatology,46(6),904-906.
5. Molaison, E. F.,Yadrick, M. K.(2003).Stages of changes and fluids intake indialysis patients.Patient Education and Counseling,49(3),5-12.
6. United States Renal Data System (2010). Incidence of reported ESRD. Retrieved from http://www.usrds.org/adr.htm
7. Welch, J. L.,Perkins, S., M,Johnson, C. S.,Kraus, M. A.(2006).Patterns of interdialytic weight gain during thefirst year of hemodialysis.Nephrology Nursing Journal,33(5),493-499.
8. Yui, C.,Tsai, Y. F.(2012).From silence to storm- patient illness trajectory from diabetes diagnosis to hemodialysis in Taiwan: A qualitative study of patients’ perceptions.Journal of Advanced Nursing,69(9),1943-1952.
9. 王智賢,徐邦治,方德昭(2006)。糖尿病腎臟病變。慈濟醫學，18(11)，25-28。
10. 台灣腎臟醫學會（2011）．台灣腎臟醫學會 2009 統計資訊．2013 年 10 月12 日取自 http://www.tsn.org.tw
11. 林秋菊,張淑真,吳佳珍(2009)。Leventhal 疾病詮釋概念於臨床之應用。護理雜誌，56(5)，87-92。
12. 孫嘉慧,林秋菊(2006)。應用自我調節理論發展血液透析病患水份控制方案。護理雜誌，53(2)，80-83。
13. 楊舒涵(2011)。中國醫藥大學醫務管理學系碩士班。