一位患有邊緣性人格障礙（BPD）的病人對護理師 A 說：「妳是唯一理解我的護理師，護理師 B 非常壞，一點都不關心病人。」護理師最恰當的回應為何？
A client with borderline personality disorder (BPD) tells Nurse A, 'You are the only nurse who understands me. Nurse B is so mean and doesn't care about the patients at all.' What is the most appropriate nursing response?
- AI will speak with Nurse B about the way she treats you.我會跟護理師B談論她對待您的方式。
- BWe all work together as a team to provide consistent care for you.✓ 正解我們是一個團隊，共同為您提供一致的照護。
- CNurse B is a very competent professional and you should give her a chance.護理師B是一位非常勝任的專業人員，您應該給她一個機會。
- DIt sounds like you feel misunderstood by others on the team.聽起來您覺得團隊中的其他人不了解您。
本題涉及邊緣性人格障礙中常見的防禦機制：分裂（Splitting）。病人將人區分為「全好」與「全壞」，試圖在工作人員之間製造衝突。正確答案 B 的核心在於維持專業界限並強調團隊的一致性。這能直接切斷病人的分裂操縱，傳達出所有護理人員都會遵循相同的護理計畫。A 掉進了病人的陷阱，會加劇工作人員間的矛盾；D 雖然使用了同理心，但在處理 BPD 的分裂時，過度的同理反而可能被病人利用來強化其對他人的負面看法；C 則是在反駁病人，容易引發病人的防禦與憤怒。護理思路上，處理 BPD 的首要原則是「設定限制（Limit setting）」與「團隊溝通的一致性」，防止病人操縱醫療團隊。
This question addresses a common defense mechanism in borderline personality disorder: splitting. The client divides others into 'all good' and 'all bad,' attempting to create conflict among staff members. The key in option B is to maintain professional boundaries and emphasize team consistency. This directly disrupts the client's splitting maneuver and communicates that all nursing staff will follow the same plan of care. Option A falls into the client's trap and exacerbates conflict between staff members; option D, while empathetic, may, when used to address splitting in BPD, be exploited by the client to reinforce a negative view of others; option C argues with the client and is likely to provoke defensiveness and anger. Clinically, the priority principle in managing BPD is 'limit setting' and consistent team communication to prevent the client from manipulating the health care team.
美國 NCLEX 非常看重「分裂」的識別與對團隊一致性的強調；台灣臨床上則較常稱之為「挑撥離間」，在處理上，台灣護理師可能更傾向於非正式的交班提醒，而美國則會建立嚴格的條文化行為規範與合約。