護理師正在照顧一位患有思覺失調症的病人，病人表示：「我看到惡魔站在角落，他在叫我傷害你。」護理師最恰當的回應為何？
A nurse is caring for a client with schizophrenia who states, 'I see the devil standing in the corner, and he is telling me to hurt you.' Which response by the nurse is most appropriate?
- AWhy do you think the devil wants to hurt me? I am here to help you.你認為惡魔為什麼想傷害我？我是來幫助你的。
- BI don't see the devil, but I understand that you are feeling very frightened right now.✓ 正解我沒有看到惡魔，但我理解你現在感到非常害怕。
- CThe devil is not real; it is just a symptom of your illness and will go away with medication.惡魔是不存在的；它只是你疾病的症狀，服藥後就會消失。
- DThere is no one in the corner, and you are safe here in the hospital.角落裡沒有人，你在醫院裡是安全的。
處理幻覺（Hallucination）的核心原則是「承認病人的感受，但不承認幻覺的真實性」。護理師應採用治療性溝通中的「呈現現實」（presenting reality）與「同理心」。選項 B 正確，因為它直接表達了護理師沒有看到幻覺（建立現實邊界），同時又同理了病人因幻覺而產生的恐懼情緒，這有助於建立信任感並降低病人的焦慮。面對具攻擊性威脅的幻覺，護理師必須保持冷靜，確保環境安全。臨床思路應優先考慮病人的情緒安全感，而非爭論幻覺的真假。如果直接否定（如選項 D、C），可能會讓病人覺得不被理解，進而引發防衛或攻擊行為。詢問「為什麼」（選項 A）則是治療性溝通的大忌，因為它會要求病人解釋非理性的幻覺內容，往往導致病人更陷入妄想邏輯中。
The core principle for managing hallucinations is to acknowledge the patient's feelings but not the reality of the hallucination. The nurse should use the therapeutic communication techniques of presenting reality and showing empathy. Option B is correct because it directly states that the nurse does not see the hallucination (establishing a reality boundary) while also empathizing with the fear the patient experiences, which builds trust and reduces anxiety. When the hallucination is aggressively threatening, the nurse must remain calm and ensure environmental safety. The clinical priority is the patient's emotional safety rather than arguing about whether the hallucination is real. Direct denial (as in D and C) can leave the patient feeling misunderstood, triggering defensiveness or aggression. Asking why (option A) is a major pitfall of therapeutic communication, because it asks the patient to explain irrational hallucinatory content and often draws the patient deeper into delusional logic.
在美國，精神科護理高度強調「治療性溝通」的字句選擇，NCLEX 考試中，認同病人情緒（Validation）通常是首選答案。台灣臨床上，護理師有時會更傾向於給予直接的再保證或衛教，但在處理具威脅性的幻覺時，兩地皆一致認同應優先建立安全感並穩定病人情緒。