護理師為高跌倒風險病人規劃照護，應包含哪些措施？（選所有適合的）
A nurse is planning care for a client who is at high risk for falls. Which interventions should the nurse include? (Select all that apply.)
- AKeep the bed in the lowest position✓ 正解將床降至最低位置
- BPlace the call light within reach✓ 正解將呼叫鈴放置在伸手可及之處
- CApply physical restraints to keep the client in bed使用身體約束具將客戶固定在床上
- DClear the room of clutter✓ 正解清除房間內的雜物
- EEncourage the client to wear non-skid footwear✓ 正解鼓勵客戶穿著防滑鞋
預防跌倒是住院照護的核心安全目標（Safety Goal）。高跌倒風險的病人應採取多面向的預防措施：降低環境危險（保持床位最低、清除走道障礙物）、強化溝通（呼叫鈴在手邊）、提供個人防護（防滑鞋襪）。物理約束（Physical Restraints）則屬於「最後手段」，必須有醫囑且需持續評估，絕不能作為預防跌倒的常規照護手段，以免造成病人心理創傷與身體損傷。
Fall prevention is a core safety goal of inpatient care. For high-fall-risk patients, multifaceted preventive measures should be employed: reducing environmental hazards (keeping the bed in the lowest position, clearing obstacles from walkways), strengthening communication (keeping the call light within reach), and providing personal protection (non-slip footwear). Physical restraints are a last resort, requiring a physician's order and ongoing assessment, and must never be used as a routine measure to prevent falls, since doing so can cause psychological trauma and physical injury to the patient.