一位重度憂鬱症病人即將出院。病人表示：「我覺得好一點了，但我不確定能不能獨自待在家裡。」護理師的哪項回應最具治療性？
A client with Major Depressive Disorder is being discharged. The client states, 'I feel a bit better, but I'm not sure if I can handle being alone at home.' Which response by the nurse is most therapeutic?
- AWhy do you feel like you cannot handle being alone?你為什麼覺得自己無法獨自一人？
- BMost people feel a little nervous when they first go home.大多數人在剛回家時都會感到有點緊張。
- CIt sounds like you are feeling anxious about managing your recovery at home.✓ 正解聽起來你對於在家中復原感到焦慮。
- DYou have made so much progress; I'm sure you will do fine.你已經取得了很大的進步；我相信你會沒事的。
這題的核心概念在於「反映情感（Reflection）」與「治療性溝通」。病人表達了對出院後孤獨狀態的不確定感，這暗示了焦慮與缺乏安全感。選項 C 使用了反映性技巧，精確捕捉到病人的情感層面（焦慮）並回饋給病人，能引導病人進一步探索這種情緒。臨床思路上，護理師應先同理病人的感受，而非急著解決問題或給予空洞的保證。選項 A 以「為什麼」開頭，容易讓病人產生防衛心；選項 D 屬於虛假保證，忽視了病人的真實擔憂；選項 B 則是將病人的感受「普遍化（Generalizing）」，這會讓病人覺得自己的特殊感受被輕視，不利於建立深層的信任關係。安全優先原則要求我們確保護理師能識別病人的潛在不安，以防出院後發生意外。
The core concept of this item is 'reflection of feelings' and therapeutic communication. The client expressed uncertainty about loneliness after discharge, hinting at anxiety and lack of security. Option C uses a reflection technique that precisely captures and feeds back the client's emotional dimension (anxiety), guiding the client to further explore this emotion. Clinically, the nurse should first empathize with the client's feelings rather than rushing to solve the problem or providing hollow reassurance. Option A begins with 'why,' which easily places the client on the defensive; option D is false reassurance that ignores the client's true concerns; option B generalizes the client's feelings, making the client feel that their unique feelings are dismissed, which is unhelpful for building deep trust. The safety-first principle requires us to ensure that the nurse can recognize the client's underlying unease to prevent accidents after discharge.
在美國 NCLEX 考試中，極度強調「反映情感」和避免「為什麼」問句；台灣臨床實務中，護理師有時會傾向於快速給予鼓勵或建議，但在心理衛生照護上，兩地標準一致強調同理心，只是美國考題對溝通技巧的「純度」要求更高。