一位患有思覺失調症的病人出現幻聽，告訴護理師：「那些聲音一直說我是個壞人。」哪種護理回應具治療性？
A client with schizophrenia is experiencing auditory hallucinations and tells the nurse, 'The voices are telling me I am a bad person.' Which response by the nurse is therapeutic?
- AI understand the voices are real to you, but I do not hear them.✓ 正解我明白這些聲音對你來說很真實，但我聽不到。
- BWhat exactly are the voices saying to you right now?現在那些聲音到底在跟你說什麼？
- CDon't listen to them; they aren't real and can't hurt you.不要聽它們；它們不是真的，也傷害不了你。
- DI don't hear any voices; you are just imagining things.我聽不到任何聲音；你只是想像出來的。
對於幻覺（Hallucinations）的護理原則是「呈現現實」（Presenting Reality）與「同理感受」。護理師必須明確表示自己沒有相同的感知，但要尊重病人的主觀體驗（這對他來說是真的）。選項 A 完美平衡了這兩點：既不強化幻覺（不說我也聽到了），也不直接否定病人（不說你在亂想）。選項 D 帶有否定與指責；選項 B 雖然在評估內容，但若重複詢問細節有時會強化病人的幻覺固定感；選項 C 則過於簡化問題。護理師應在承認病人感受的同時，溫柔地將病人導向現實環境，這有助於建立信任並降低其恐慌感。
The nursing principles for managing hallucinations are 'Presenting Reality' and 'Empathizing with the Client's Feelings.' The nurse must clearly state that they do not share the same perception, while still respecting the client's subjective experience (which is real to the client). Option A perfectly balances these two principles: it neither reinforces the hallucination (by claiming to hear them) nor directly negates the client (by saying they are imagining things). Option D is dismissive and accusatory; Option B, although it assesses content, can sometimes reinforce the client's fixation on the hallucinations if details are repeatedly probed; Option C oversimplifies the problem. The nurse should validate the client's feelings while gently redirecting the client to objective reality, which helps build trust and reduce panic.
美國 NCLEX 強調「Presenting Reality」的溝通字眼需精準（I do not hear...）；台灣臨床照護中，護理師有時會過快轉向藥物衛教（如「那是因為你沒吃藥」），較少使用結構化的治療性溝通術語來處理當下的幻覺。