應用健康信念模式及Becker認知治療照顧一位糖尿病患者之護理過程
1
篇名：應用健康信念模式及Becker認知治療照顧一位糖尿病患者之護理過程
並列篇名：Caring for a Patient with Diabetes Mellitus: The Application of Health Belief Model and Becker's Cognitive Therapy
作者：鍾麗英(Li-Ying Chung)
關鍵字：健康信念模式(Health Belief Model);Becker認知治療(Becker's Cognitive Therapy);糖尿病(Diabetes mellitus);個別衛生教育(Individual Health Education);Health belief model;Becker’s cognitive therapy;Diabetes mellitus;Individual health education
期刊/會議論文集名稱 ：新臺北護理期刊
卷期：2卷1期
出版年：2000
中文摘要：尿病為一終身慢性疾病，而病患對疾病的認知及健康信念深深影響病患血糖控制進而影響病情之發展。本文是筆者運用健康信念模式來探討一位糖尿病患者健康行為表現的影響因素，並利用認知療法及衛生教育來幫助個案獲得有關糖尿病知識，進而改變其行為之個案報告。護理期間以會談法及觀察法收集資料，結果發現個案有疾病自覺威脅低及自覺行動障礙高於利益等問題。針對個案問題，給予之護理措施包括：Becker 認知治療技巧、利用衛教本給予個別衛生教育，使個案能對糖尿病有正確的認識進而採取正向的健康維護行為。
英文摘要：糖尿病為一終身慢性疾病，而病患對疾病的認知及健康信念深深影響病患血糖控制進而影響病情之發展。本文是筆者運用健康信念模式來探討一位糖尿病患者健康行為表現的影響因素，並利用認知療法及衛生教育來幫助個案獲得有關糖尿病知識，進而改變其行為之個案報告。護理期間以會談法及觀察法收集資料，結果發現個案有疾病自覺威脅低及自覺行動障礙高於利益等問題。針對個案問題，給予之護理措施包括：Becker 認知治療技巧、利用衛教本給予個別衛生教育，使個案能對糖尿病有正確的認識進而採取正向的健康維護行為。
起始頁-結束頁：121-129
資料語文：繁體中文
主題分類：醫學與生命科學＞醫護公衛
第五編 醫藥衛生＞綜合性醫藥衛生
出版單位：臺北醫學大學護理學院
2
篇名：糖尿病的大血管病變
並列篇名：Macrovascular Diseases in Diabetes Mellitus
作者：曾慶孝(Chin-Hsiao Tseng)
關鍵字：糖尿病大血管疾病;屍體解剖;流行病學;危險因子;胰島素阻抗性;Diabetic;macrovascular disease;Autopsy;Epidemiology;Risk factor;Insulin resistance
期刊/會議論文集名稱 ：中華民國內分泌暨糖尿病學會會訊
卷期：13卷2期
出版年：2000
中文摘要：糖尿病大血管疾病的成因主要與動脈粥狀硬化有關，因其影響之器官不同而臨床上有腦中風、缺血性心臟病、和下肢壞疽等表現。胰島素在1921年被萃取出來並使用於人體後，糖尿病的死因由先前的急性昏迷轉變為以大血管疾病為主。早在1920年代開始就有研究者從屍體解剖的研究發現糖尿病患者的動脈粥狀硬化病灶較無糖尿病者多而廣泛。一九六0年代以後研究者開始在人口族群中進行大規模的流行學追蹤研究。這些研究結果證實糖尿病為心臟血管疾病的危險因子，且女性糖尿病患者的相對危險性較男性糖尿病患者高。胰島素依賴型糖尿病病人發生大血管疾病的原因與其血糖控制不良引其脂質代謝異常， 或是併發高血壓，或長期胰島素治療引起高胰島素血症有關。非胰島素依賴型糖尿病病人的大血管疾病除了控制不良所產生的代謝異常外，亦可能與胰島素阻抗症候群有關。糖尿病病人發生大血管疾病後，其預後事相當不好的。目前有研究顯示透過控制血壓、治療高膽固醇血症、給於抗血小板擬集藥物、及戒菸等方式可以預防冠狀動脈疾病與腦中風的死亡，亦可預防總死亡。這些作用在糖尿病者比無糖尿病者更能能有效達成，而戒菸對總死亡的成效尤為卓重，因此禁煙運動實在值得吾人倡導。
英文摘要：Macrovascular diseases in diabetes mellitus are related to atherosclerosis. Clinical manifestations of these complications include stroke, coronary artery disease, and gangrene. Before the insulin era, most diabetic patients died of acute coma. Nowaday, the main causes of death in diabetic patients are related to atherosclerosis. Early in 1920s, diabetic patients were found to have more atherosclerotic lesions, and the lesions were more extensive than non-diabetic subjects in various autopsy studies. Since 1960s, several large population-based epidemiologic studies were carried out. Diabetes mellitus has been confirmed to be a major cardiovaslular risk factor, and the relative risk in diabetic women seemed to be higher than the diabetic men. The development of macrovascular disease in insulin-dependent diabetes mellitus is closely related to abnormalities in lipid metabolism secondary to poor glycemic control, hypertension, or hyperinsulinemia associated with insulin therapy. The pathogenesis of macrovascular disease in non-insulin-dependent diabetes mellitus is not only related to lipid abnormalities, but also to insulin resistance. The prognosis of diabetic patients after onset of macro vascular disease is poor. Intervention studies showed that mortality of coronary heart disease and stroke, and total mortality in diabetic patients could be prevented by control of blood pressure, therapy of hypercholesterolemia, taking aspirin, and smoking cessation. Smoking cessation seems to be the most effective method in reducing cardiovascular risk in the diabetic patients, and should be vigorously 4advocated.
起始頁-結束頁：8-18
資料語文：繁體中文
主題分類：醫學與生命科學＞醫學
出版單位：中華民國內分泌暨糖尿病學會
3
篇名：某地區教學醫院糖尿病門診病患個案管理照護之成效探討
並列篇名：An Evaluation of Effectiveness of Case Management for Diabetes Mellitus Outpatients in a Regional Teaching Hospital
作者：郝立智(Lyh-Jyh Hao);馬瀰嘉(Mi-Chia Ma);趙海倫(Hailun Chao);簡崇仁(Chung-Ren Jan);楊純宜(Chwen-Yi Yang);林興中(Hing-Chung Lam);李鎮堃(Jenn-Kuen Lee);奚明德(Ming-Der Shi);葛光中(Kuang-Chung Ko);柴國樑(Kuo-Liang Chai);鄭錦翔(Jin-Shiung
關鍵字：糖尿病;糖尿病衛教師;糖尿病醫療給付改善方案;個案管理;diabetes mellitus;diabetes mellitus educator;diabetes mellitus medical benefit improvement project;case management
期刊/會議論文集名稱 ：中華民國內分泌暨糖尿病學會會刊
卷期：20卷4期
出版年：2007
中文摘要：背景：糖尿病是國人最重要的慢性病之一，糖尿病的長期控制需仰賴醫療團隊提供周全的衛教，定期篩檢可能併發症，以達到良好代謝的控制標準，期能減緩各式併發症的發生。中央健保局有鑑於糖尿病衛教的重要，為提升衛教水準，提出糖尿病醫療給付改善方案，以增加衛教給付為誘因，在全台醫療院所進行試辦。
目的：本研究目的在了解『糖尿病醫療給付改善方案』門診個案管理介入措施，對完成年度回診的糖尿病患者，管理前後的血糖控制、糖化血色素及相關代謝指標之影響。
方法：自民國九十三年一月到十二月經由新陳代謝科專科醫師診斷為糖尿病（診斷碼ICD-9為250.0至250.93）確立者，列為收案及管理對象，給予必要之處置及治療。個案轉介給糖尿病衛教師後安排既定之介入措施，包括了解病患之教育水平、服藥習慣、藥物辨識力、生活模式、飲食習性、提供個別的衛教諮詢及引導，並給予適度之心理支持與鼓勵。此外，設計病患就醫提示單，提醒醫師病患此次就診應開立之檢驗及最近一次檢驗數據。同時收集個案基本資料、疾病特性、血液生化檢查，以SPSS10.5中文版統計軟體進行資料分析，以描述性統計方法，描述研究對象的基本資料，如性別、年齡、教育程度、身體質量指數；疾病特性，如糖尿病型態、治療方式、糖尿病史、是否合併其他疾病。以成對樣本t檢定(paired t test)和線性迴歸方法，分析研究對象管理前後各種變項之差異程度。
結果：本研究期間共收集162位個案，平均年齡為67.14歲，男、女性分別佔101位(62.35%)及61位(37.65%)。全部是屬於第二型糖尿病患者，以口服降血糖藥控制血糖者佔153位(95%)。162位之中合併有高血壓者佔67.28%，合併高血脂者佔51.86%。統計結果顯示，經成對樣本t檢定分析發現，舒張壓、體重、空腹血糖、糖化血色素等值，在管理前後，呈現顯著性的改善(P<0.05)。
結論：『糖尿病醫療給付改善方案』門診個案管理介入措施，對於改善血糖、糖化血色素及相關代謝指標，扮演一個正面的角色，特別是那些最初糖化血色素較高的病人(A1C≧9%)。
英文摘要：Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance has proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive.
Purposes: To evaluate the effect of diabetes mellitus medical benefit improvement project case management for those outpatient diabetes who completed the annual education program on glycemic control and associated metabolic index.
Methods: Between January 2004 and December 2004, patients with established diabetes mellitus (ICD-9 number 250.0 to 250.93) were referred to a diabetes mellitus educator and were included in this study. Treatments were given and subsequent patient care and follow up were carried out by the diabetes mellitus educator. The educator inquired into patients' education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The educator then provided necessary healthcare education and instruction as well as offering appropriate psychosocial support. In addition, a table with the latest tests and laboratory data, together with any suggested necessary examinations, was created for the doctor to consult at each OPD consultation. Data including the patients′ baseline characteristics, disease type and biochemical laboratory data were also collected. Differences in the before and after management data were compared by using SPSS 10.5 version statistic software (paired t test and linear regression method).
Results: A total of 162 patients were included. The mean age was 67.14 years old, 101 patients were male (62.35%) and 61 patients were female (37.65%). They are all of type 2 diabetes mellitus. The number of patient taking oral hypoglycemic agents was 153 (95%). Of the 162 patients, 67.28% had hypertension and 51.86% had hyperlipidemia. Analysis with a paired t test of the diastolic blood pressure, body weight, fasting plasma glucose, A1C data showed a significant difference between before and after management (P<0.05).
Conclusion: The intervention results suggested that the diabetes mellitus medical benefit improvement project outpatient case management played a positive role in the improvement of glycemic control and associated metabolic index, especially for those patients who have the higher initial A1C level(≧9%).
起始頁-結束頁：11-33
資料語文：繁體中文
主題分類：醫學與生命科學＞醫學
出版單位：中華民國內分泌暨糖尿病學會
篇名：應用健康信念模式及Becker認知治療照顧一位糖尿病患者之護理過程
並列篇名：Caring for a Patient with Diabetes Mellitus: The Application of Health Belief Model and Becker's Cognitive Therapy
作者：鍾麗英(Li-Ying Chung)
關鍵字：健康信念模式(Health Belief Model);Becker認知治療(Becker's Cognitive Therapy);糖尿病(Diabetes mellitus);個別衛生教育(Individual Health Education);Health belief model;Becker’s cognitive therapy;Diabetes mellitus;Individual health education
期刊/會議論文集名稱 ：新臺北護理期刊
卷期：2卷1期
出版年：2000
中文摘要：尿病為一終身慢性疾病，而病患對疾病的認知及健康信念深深影響病患血糖控制進而影響病情之發展。本文是筆者運用健康信念模式來探討一位糖尿病患者健康行為表現的影響因素，並利用認知療法及衛生教育來幫助個案獲得有關糖尿病知識，進而改變其行為之個案報告。護理期間以會談法及觀察法收集資料，結果發現個案有疾病自覺威脅低及自覺行動障礙高於利益等問題。針對個案問題，給予之護理措施包括：Becker 認知治療技巧、利用衛教本給予個別衛生教育，使個案能對糖尿病有正確的認識進而採取正向的健康維護行為。
英文摘要：糖尿病為一終身慢性疾病，而病患對疾病的認知及健康信念深深影響病患血糖控制進而影響病情之發展。本文是筆者運用健康信念模式來探討一位糖尿病患者健康行為表現的影響因素，並利用認知療法及衛生教育來幫助個案獲得有關糖尿病知識，進而改變其行為之個案報告。護理期間以會談法及觀察法收集資料，結果發現個案有疾病自覺威脅低及自覺行動障礙高於利益等問題。針對個案問題，給予之護理措施包括：Becker 認知治療技巧、利用衛教本給予個別衛生教育，使個案能對糖尿病有正確的認識進而採取正向的健康維護行為。
起始頁-結束頁：121-129
資料語文：繁體中文
主題分類：醫學與生命科學＞醫護公衛
第五編 醫藥衛生＞綜合性醫藥衛生
出版單位：臺北醫學大學護理學院
2
篇名：糖尿病的大血管病變
並列篇名：Macrovascular Diseases in Diabetes Mellitus
作者：曾慶孝(Chin-Hsiao Tseng)
關鍵字：糖尿病大血管疾病;屍體解剖;流行病學;危險因子;胰島素阻抗性;Diabetic;macrovascular disease;Autopsy;Epidemiology;Risk factor;Insulin resistance
期刊/會議論文集名稱 ：中華民國內分泌暨糖尿病學會會訊
卷期：13卷2期
出版年：2000
中文摘要：糖尿病大血管疾病的成因主要與動脈粥狀硬化有關，因其影響之器官不同而臨床上有腦中風、缺血性心臟病、和下肢壞疽等表現。胰島素在1921年被萃取出來並使用於人體後，糖尿病的死因由先前的急性昏迷轉變為以大血管疾病為主。早在1920年代開始就有研究者從屍體解剖的研究發現糖尿病患者的動脈粥狀硬化病灶較無糖尿病者多而廣泛。一九六0年代以後研究者開始在人口族群中進行大規模的流行學追蹤研究。這些研究結果證實糖尿病為心臟血管疾病的危險因子，且女性糖尿病患者的相對危險性較男性糖尿病患者高。胰島素依賴型糖尿病病人發生大血管疾病的原因與其血糖控制不良引其脂質代謝異常， 或是併發高血壓，或長期胰島素治療引起高胰島素血症有關。非胰島素依賴型糖尿病病人的大血管疾病除了控制不良所產生的代謝異常外，亦可能與胰島素阻抗症候群有關。糖尿病病人發生大血管疾病後，其預後事相當不好的。目前有研究顯示透過控制血壓、治療高膽固醇血症、給於抗血小板擬集藥物、及戒菸等方式可以預防冠狀動脈疾病與腦中風的死亡，亦可預防總死亡。這些作用在糖尿病者比無糖尿病者更能能有效達成，而戒菸對總死亡的成效尤為卓重，因此禁煙運動實在值得吾人倡導。
英文摘要：Macrovascular diseases in diabetes mellitus are related to atherosclerosis. Clinical manifestations of these complications include stroke, coronary artery disease, and gangrene. Before the insulin era, most diabetic patients died of acute coma. Nowaday, the main causes of death in diabetic patients are related to atherosclerosis. Early in 1920s, diabetic patients were found to have more atherosclerotic lesions, and the lesions were more extensive than non-diabetic subjects in various autopsy studies. Since 1960s, several large population-based epidemiologic studies were carried out. Diabetes mellitus has been confirmed to be a major cardiovaslular risk factor, and the relative risk in diabetic women seemed to be higher than the diabetic men. The development of macrovascular disease in insulin-dependent diabetes mellitus is closely related to abnormalities in lipid metabolism secondary to poor glycemic control, hypertension, or hyperinsulinemia associated with insulin therapy. The pathogenesis of macrovascular disease in non-insulin-dependent diabetes mellitus is not only related to lipid abnormalities, but also to insulin resistance. The prognosis of diabetic patients after onset of macro vascular disease is poor. Intervention studies showed that mortality of coronary heart disease and stroke, and total mortality in diabetic patients could be prevented by control of blood pressure, therapy of hypercholesterolemia, taking aspirin, and smoking cessation. Smoking cessation seems to be the most effective method in reducing cardiovascular risk in the diabetic patients, and should be vigorously 4advocated.
起始頁-結束頁：8-18
資料語文：繁體中文
主題分類：醫學與生命科學＞醫學
出版單位：中華民國內分泌暨糖尿病學會
3
篇名：某地區教學醫院糖尿病門診病患個案管理照護之成效探討
並列篇名：An Evaluation of Effectiveness of Case Management for Diabetes Mellitus Outpatients in a Regional Teaching Hospital
作者：郝立智(Lyh-Jyh Hao);馬瀰嘉(Mi-Chia Ma);趙海倫(Hailun Chao);簡崇仁(Chung-Ren Jan);楊純宜(Chwen-Yi Yang);林興中(Hing-Chung Lam);李鎮堃(Jenn-Kuen Lee);奚明德(Ming-Der Shi);葛光中(Kuang-Chung Ko);柴國樑(Kuo-Liang Chai);鄭錦翔(Jin-Shiung
關鍵字：糖尿病;糖尿病衛教師;糖尿病醫療給付改善方案;個案管理;diabetes mellitus;diabetes mellitus educator;diabetes mellitus medical benefit improvement project;case management
期刊/會議論文集名稱 ：中華民國內分泌暨糖尿病學會會刊
卷期：20卷4期
出版年：2007
中文摘要：背景：糖尿病是國人最重要的慢性病之一，糖尿病的長期控制需仰賴醫療團隊提供周全的衛教，定期篩檢可能併發症，以達到良好代謝的控制標準，期能減緩各式併發症的發生。中央健保局有鑑於糖尿病衛教的重要，為提升衛教水準，提出糖尿病醫療給付改善方案，以增加衛教給付為誘因，在全台醫療院所進行試辦。
目的：本研究目的在了解『糖尿病醫療給付改善方案』門診個案管理介入措施，對完成年度回診的糖尿病患者，管理前後的血糖控制、糖化血色素及相關代謝指標之影響。
方法：自民國九十三年一月到十二月經由新陳代謝科專科醫師診斷為糖尿病（診斷碼ICD-9為250.0至250.93）確立者，列為收案及管理對象，給予必要之處置及治療。個案轉介給糖尿病衛教師後安排既定之介入措施，包括了解病患之教育水平、服藥習慣、藥物辨識力、生活模式、飲食習性、提供個別的衛教諮詢及引導，並給予適度之心理支持與鼓勵。此外，設計病患就醫提示單，提醒醫師病患此次就診應開立之檢驗及最近一次檢驗數據。同時收集個案基本資料、疾病特性、血液生化檢查，以SPSS10.5中文版統計軟體進行資料分析，以描述性統計方法，描述研究對象的基本資料，如性別、年齡、教育程度、身體質量指數；疾病特性，如糖尿病型態、治療方式、糖尿病史、是否合併其他疾病。以成對樣本t檢定(paired t test)和線性迴歸方法，分析研究對象管理前後各種變項之差異程度。
結果：本研究期間共收集162位個案，平均年齡為67.14歲，男、女性分別佔101位(62.35%)及61位(37.65%)。全部是屬於第二型糖尿病患者，以口服降血糖藥控制血糖者佔153位(95%)。162位之中合併有高血壓者佔67.28%，合併高血脂者佔51.86%。統計結果顯示，經成對樣本t檢定分析發現，舒張壓、體重、空腹血糖、糖化血色素等值，在管理前後，呈現顯著性的改善(P<0.05)。
結論：『糖尿病醫療給付改善方案』門診個案管理介入措施，對於改善血糖、糖化血色素及相關代謝指標，扮演一個正面的角色，特別是那些最初糖化血色素較高的病人(A1C≧9%)。
英文摘要：Background: Diabetes mellitus has become one of the major chronic diseases in Taiwan. Long-term control of diabetes mellitus largely depends on comprehensive education program and regular screening of diabetes related complications in order to achieve optimal control goals. To enhance delivery of education program to diabetic subjects in various medical settings, Bureau of National Health Insurance has proposed a Diabetes Education Improvement Program by providing additional reimbursement as an incentive.
Purposes: To evaluate the effect of diabetes mellitus medical benefit improvement project case management for those outpatient diabetes who completed the annual education program on glycemic control and associated metabolic index.
Methods: Between January 2004 and December 2004, patients with established diabetes mellitus (ICD-9 number 250.0 to 250.93) were referred to a diabetes mellitus educator and were included in this study. Treatments were given and subsequent patient care and follow up were carried out by the diabetes mellitus educator. The educator inquired into patients' education level, medication use ideas, medication discrimination ability, lifestyle, and diet behavior. The educator then provided necessary healthcare education and instruction as well as offering appropriate psychosocial support. In addition, a table with the latest tests and laboratory data, together with any suggested necessary examinations, was created for the doctor to consult at each OPD consultation. Data including the patients′ baseline characteristics, disease type and biochemical laboratory data were also collected. Differences in the before and after management data were compared by using SPSS 10.5 version statistic software (paired t test and linear regression method).
Results: A total of 162 patients were included. The mean age was 67.14 years old, 101 patients were male (62.35%) and 61 patients were female (37.65%). They are all of type 2 diabetes mellitus. The number of patient taking oral hypoglycemic agents was 153 (95%). Of the 162 patients, 67.28% had hypertension and 51.86% had hyperlipidemia. Analysis with a paired t test of the diastolic blood pressure, body weight, fasting plasma glucose, A1C data showed a significant difference between before and after management (P<0.05).
Conclusion: The intervention results suggested that the diabetes mellitus medical benefit improvement project outpatient case management played a positive role in the improvement of glycemic control and associated metabolic index, especially for those patients who have the higher initial A1C level(≧9%).
起始頁-結束頁：11-33
資料語文：繁體中文
主題分類：醫學與生命科學＞醫學
出版單位：中華民國內分泌暨糖尿病學會
回應(0)