運用Orem理論照顧一位糖尿病合併腦血管梗塞病人之護理經驗

Nursing Care Experience of using Orem's Theory in a Patient with Diabetes Mellitus and Cerebral Infarction

10.6740/NTUHJN.202401_20(1).0009

陳奕妏(Yi-Wen Chen)；李姿瑩(Tsu-Ying Lee)；劉秀雲(Hsiu-Yun Liu)

治療遵從性 ； Orem理論 ； 糖尿病自我管理 ； 腦血管梗塞 ； Adherence to medical treatment ； cerebral infarction ； diabetes mellitus ； Orem's Theory

臺大護理雜誌

20卷1期（2024 / 01 / 01）

88 - 100

繁體中文;英文

本文描述一位66歲男性，因未遵循胰島素用藥醫囑產生雙腳無力、說話模糊、個性改變等症狀就醫，然個案無法遵從飲食控制導致血糖控制不易，且時常與主要照顧者起爭執、反覆要搭計程車回家造成照護上困難之護理經驗。護理期間為2021/4/30至5/10，經由蒐集理學檢查資料及觀察、會談等方式，運用Orem自我照顧理論評估分析，確立其主要健康問題：一、治療遵從性低；二、自我照顧能力缺失；三、潛在危險性跌倒。護理期間協助個案及照顧者參與糖尿病自我管理及記憶提醒卡使用、學習日常生活技能並教導照顧者照護與溝通技巧、提供預防跌倒措施及護理指導等跨領域團隊的共同照護。期望藉此經驗，提供護理師照護記憶力差且治療遵從性低個案之參考，也建議於個案出院後可主動積極追蹤後續個案糖尿病自我管理及復健訓練之成效，以提供完整的長期照護參考。

A 66-year-old man was admitted with lower limb weakness, slurred speech, and personality changes that may have been caused by non-adherence to insulin. The patient was reluctant to follow the instructions for insulin injection and diet control, which resulted in uncontrolled blood sugar levels. This was a difficult case for nurses because the patient did not cooperate with his caregiver and repeatedly asked to go home. The period of nursing care was from April 30 to May 10, 2021. Based on Orem's Theory, the nurses assessed the health problems by performing physical examinations, observations, and interviews. According to the nursing assessments, patients' health problems included non-adherence to medical treatment, self-care deficits, and risk of falls. The nurse encouraged and assisted the patient and caregiver in participating in diabetes self-management using memory reminder cards and learning living skills. The nurse also taught caregivers how to care for and communicate with patients, how to prevent falls, and ways to collaborate in interprofessional practice. The authors hope that this experience will inform nurses who encounter patients with poor memory and non-adherence to medical treatment. It is recommended that nurses follow patients' diabetes self-management and rehabilitation behaviors after they are discharged from hospital to provide complete long-term care.