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[ADA2012]以授权为基础的糖尿病自我管理与教育
——本届ADA年会杰出糖尿病教育者、密歇根大学医学院Robin Nwankwo教授
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作者:R.Nwankwo 2012/6/18 15:59:00    加入收藏
内容概要:Nwonkwo教授:授权即尊重患者为他们自己的专家。也就是我作为医疗服务提供者时更多地是担任辅助和支持的角色,而不是教导和指引的角色。告诉患者应该锻炼和该怎么吃是没用的。别以为告诉患者每天早上8点吃药,之后吃早饭,然后再锻炼30分钟,就万事大吉了。跟患者讲无论喜欢与否,他得一直这样吃药。

  <International Diabetes>: You do empowerment in diabetes care and diabetes education. What is empowerment?
  Dr Nwankwo:Empowerment is respecting the patient as their own expert. That then takes my position or role as a healthcare provider and puts it more in the context of assisting and supporting rather than dictating and directing. It is useless for me to tell a patient to exercise, eat, take their medicine at 8am every single morning and eat breakfast right after that and exercise for thirty minutes right after that and then everything will be OK. You are going to have to keep taking your medicine for ever and ever whether you like it or not. It is not very helpful. The patient does not get engaged. I am in effect asking that patient to adopt a lifestyle that isolates them from their own culture, their own routines, their own preferences, their own way of looking at breakfast and the placement of things and priorities. I can’t take that position. If I do take that position I am shooting myself in the foot and burning myself out because the patient won’t do it. And I will say it is their fault; they didn’t do what I told them to do. Non-compliance. It’s a bad word.

  《国际循环》:您从事的是糖尿病管理和教育的授权工作。什么是授权(empowerment)?
  Nwonkwo教授:授权即尊重患者为他们自己的专家。也就是我作为医疗服务提供者时更多地是担任辅助和支持的角色,而不是教导和指引的角色。告诉患者应该锻炼和该怎么吃是没用的。别以为告诉患者每天早上8点吃药,之后吃早饭,然后再锻炼30分钟,就万事大吉了。跟患者讲无论喜欢与否,他得一直这样吃药。这样做并没有多大帮助。患者并没有参与进来。实际上,我是在让患者采取一种新的生活方式,这使得患者与自己的文化、日常做法、偏好、对早餐的看法和事情的优先顺序隔离开来。我不能这样做。如果我这样做的话,就等于搬起石头砸自己的脚,让自己筋疲力尽,因为患者不会照做。我会说这是患者的错,他们没有按我说的去做。“不依从”不是一个好词儿。

  <International Diabetes>:  So what do you do? Our readers who are clinicians may have heard before that they shouldn’t just talk down to their patients but they may not know any other way of talking. How do you start the process of changing your approach?
  Dr Nwankwo:Primarily what clinicians offer is expertise on medical management. Therefore they have an array of choices and options that they can present to the patient. They have the ability to screen all of those choices as to which ones will be medically safe for their patient to do. They provide those as references or resources for the patient so that then the patient can choose. It is the clinician’s job to educate that person on every single option. That means taking a step back from saying I really think you should take this or I don’t feel like taking that much time to educate you on five options. It should be, I have five options which we should consider. Which ones would you be most interested in? What are you ready to do at this time? What is the biggest struggle for you and how can we merge or make a difference on at least one of those struggles and then we can work on the remainder of them throughout the rest of our time together? That then tells the patient that the clinician is willing to team with them and carry them step by step to every other part of their medical management that they will need to do.

  《国际循环》:那如何授权?我们的读者是临床医生,他们可能之前听说过不应当只是尝试说服患者,但是他们可能不知道其他说服患者的方法。你是如何开始改变方法的?
  Nwonkwo教授:临床医生主要是提供药物治疗的专业知识。因此,他们给患者提供一系列选择。医生能够衡量所有选择,以确定哪些在医疗上对患者是安全的。他们把这些选择作为标准或资源提供给患者,这样患者就能够选择。对患者就每一个选择进行健康教育是医生的工作。这意味着我们要退后一步,不是像以前那样对患者说,“我确实认为你应当选择这个,或者我不想花那么多时间就这五个选择给患者做健康教育”。应当对患者说,我这里有五个选择可供你考虑。你最感兴趣的是哪一个?这次你想怎么办?你觉得最大的挑战是什么?我们如何能够携手克服至少其中一个挑战,在未来的时间里我们将针对其余挑战。这就是在告诉患者,临床医生愿意跟患者组成团队,与患者一同走过他们需要接受治疗的各个阶段。
 



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 延伸阅读
网站用户: 吴天凤 时间:2012/9/5 21:05:19
很好,很有启发。

网站用户: 靳素梅 时间:2012/6/18 23:21:05
非常好,深得启示,将 在给患者做教育中知道该如何来让患者接受正确的治疗,如何能和患者站在一起,并让他们充满信心。

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