護理師正在評估一位病人戒菸的準備程度。病人的哪項陳述顯示其處於跨理論模型 (TTM) 中的「沉思期」(Contemplation)？
A nurse is assessing a client's readiness for smoking cessation. Which statement by the client indicates they are in the 'Contemplation' stage of the Transtheoretical Model?
- AI haven't had a cigarette for three months, but it's still hard sometimes我已經三個月沒抽菸了，但有時還是覺得很難熬
- BI have bought nicotine patches and plan to stop smoking next Monday我買了尼古丁貼片，計畫下週一開始戒菸
- CI know smoking is bad for my health, and I'm thinking about quitting in the next few months✓ 正解我知道抽菸對健康有害，我正在考慮在接下來幾個月內戒菸
- DI have no interest in quitting smoking; it's my only way to relax我對戒菸毫無興趣；放鬆是我唯一的管道
行為改變模型（TTM）是健康促進的核心理論，護理師需根據病人所處階段提供對應的介入。1.「無意圖期」(Precontemplation)：病人否認問題，不想改變（選項 D）。2.「沉思期」(Contemplation)：病人意識到行為的問題，開始權衡利弊，考慮在未來（通常指 6 個月內）改變，但尚未採取行動（選項 C）。3.「準備期」(Preparation)：病人有明確計畫，並在近期（1 個月內）打算行動，甚至已開始小規模改變（選項 B）。4.「行動期」(Action)：已改變行為但不滿 6 個月。5.「維持期」(Maintenance)：行為改變已持續超過 6 個月（選項 A）。臨床思路上，辨識「沉思期」的關鍵是「知曉危害但猶豫不決」，此時護理師的職責是幫助病人增加「改變的動機」而非直接給予戒菸方法。
The Transtheoretical Model guides stage-matched interventions. 1) Precontemplation: denies problem (D). 2) Contemplation: aware of problem, weighing pros/cons, considering change within ~6 months but not acting (C). 3) Preparation: concrete plan within 1 month, may have started small changes (B). 4) Action: change sustained < 6 months. 5) Maintenance: change sustained > 6 months (A). The key to identifying Contemplation is 'aware of harm but ambivalent.' The nurse's role here is to build motivation, not give cessation techniques.
在美國護理實務中，TTM 理論被廣泛應用於保險支付的健康管理計畫與動機式訪談（Motivational Interviewing）。台灣臨床護理師亦會使用此模型，但較常簡化為「是否有意願戒菸」，對於階段性的精確介入（如針對沉思期做利弊分析）落實程度不一。