一位新診斷末期癌症的病人向護理師表示：「我覺得我無法承受，我的生活已經沒有意義了。」哪項護理師的反應最具治療性？
A nurse is caring for a client newly diagnosed with terminal cancer who expresses, 'I don't think I can handle this; my life has no meaning anymore.' Which response by the nurse is the most therapeutic?
- ADon't worry, there are many new treatments that might help you.別擔心，有很多新的治療方法可能對您有幫助。
- BTell me more about what makes you feel that your life has lost its meaning.✓ 正解請告訴我更多關於讓您覺得生活失去意義的事情。
- CMany people feel this way when they first receive a difficult diagnosis.許多人在初次收到困難診斷時都會有這種感覺。
- DYou should focus on the time you have left to spend with your family.您應該專注於剩餘的時間，用來陪伴家人。
此題體現了治療性溝通中的「開放式探索」原則。當病人表達存在性危機（existential crisis）時，護理師的首要任務是展現同理心並鼓勵病人具體化其感受，而非過早提供建議或否定其情緒。選項 B 透過開放式問句，引導病人深入探討其內在需求與痛苦源頭，這是建立治療性信任關係的基石。選項 D 為給予不當建議，忽視了病人的悲傷過程。選項 C 雖意圖安慰，但屬於「常態化（normalizing）」回應，容易讓病人覺得自己的獨特痛苦被敷衍。選項 A 為典型的「虛假安撫（false reassurance）」，末期病人的絕望往往來自對死亡的恐懼或生活價值的瓦解，單純談論治療效果會阻斷雙方的深度對話，導致病人封閉心房。
This item illustrates the principle of 'open exploration' in therapeutic communication. When a client expresses an existential crisis, the nurse's first priority is to convey empathy and encourage the client to elaborate on their feelings, rather than offering premature advice or invalidating their emotions. Option B uses an open-ended invitation to guide the client into a deeper exploration of inner needs and sources of distress; this is the foundation for building a therapeutic, trusting relationship. Option D offers unsolicited advice and ignores the client's grieving process. Option C, although intended to comfort, is a 'normalizing' response that can make the client feel that their unique suffering is being dismissed. Option A is a classic example of false reassurance; the despair of a terminally ill client often stems from fear of death or a collapse of life's meaning, and simply discussing treatment effectiveness blocks meaningful dialogue and causes the client to shut down.
美國護理教育極度重視「治療性溝通」作為核心 Competency，護理師常需記錄溝通過程；台灣臨床現場因病床數多、護理量大，護理師常需採取效率導向的任務式溝通，較少機會深入對談。