一位病人預定進行非緊急手術。在術前評估時，病人對護理師說：「我不確定我是否還想做這個手術。」護理師應首先採取哪項行動？
A client is scheduled for an elective surgery. During the pre-operative assessment, the client tells the nurse, "I'm not sure if I want to have this surgery anymore." Which action should the nurse take first?
- ADocument that the client is non-compliant with the treatment plan.記錄該客戶未配合治療計畫。
- BInform the surgeon that the client is refusing the procedure.告知外科醫師該客戶拒絕該手術程序。
- CReinforce the benefits of the surgery discussed previously.強化先前討論過的手術益處。
- DAsk the client to clarify their concerns about the surgery.✓ 正解請該客戶釐清他們對手術的擔憂。
本題涉及「告知後同意」（Informed Consent）與病人自主權（Autonomy）。當病人表達猶豫或不確定時，護理師的第一步應是「溝通與澄清」（Communication and Clarification）。這符合評估（Assessment）優先於介入（Intervention）的原則。透過開放式提問，護理師可以了解病人的擔憂是來自對過程的恐懼、對併發症的誤解，還是單純需要更多資訊。若只是誤解，護理師可提供澄清；若是對風險有疑慮，則需通知醫師重新解釋。直接通知醫師拒絕（B）太過草率；記錄不配合（A）是錯誤的標籤化；強化優點（C）則可能演變成說服，忽略了病人的感受。護理師應扮演病人擁護者（Patient Advocate）的角色。
This question involves informed consent and patient autonomy. When the patient expresses hesitation or uncertainty, the nurse's first step should be communication and clarification. This is consistent with the principle of assessment before intervention. Through open-ended questioning, the nurse can determine whether the patient's concerns stem from fear of the procedure, misunderstanding of complications, or simply a need for more information. If it is merely a misunderstanding, the nurse can provide clarification; if there are concerns about risks, the physician must be notified to provide further explanation. Notifying the physician of refusal outright (B) is too hasty; documenting noncompliance (A) is incorrect labeling; and reinforcing the benefits (C) may slide into persuasion and ignore the patient's feelings. The nurse should act as a patient advocate.
在美國，病人自主權受法律嚴格保障，護理師在 Informed Consent 過程中主要擔任「見證人」與「擁護者」。在台灣，由於醫病關係較為家長式（Paternalism），護理師有時會被家長或醫師要求協助「勸說」病人，但 NCLEX 標準下，理解並尊重病人意願才是首要任務。