一位患有邊緣性人格障礙的病人在住院病房接受照顧。病人對護理師 A 說：「妳是這裡唯一真心關心我的護理師，護理師 B 真的很壞，她根本不應該在這裡工作。」護理師 A 應如何回應？
A client with borderline personality disorder is being cared for on an inpatient unit. The client tells Nurse A, 'You are the only nurse who actually cares about me. Nurse B is so mean and shouldn't be working here.' How should Nurse A respond?
- ANurse B is a very experienced nurse and highly skilled in her work.護理師 B 是一位經驗豐富的護理師，且工作技能高超。
- BI will talk to Nurse B later and see why she was acting that way toward you.我稍後會跟護理師 B 談談，看看她為什麼那樣對待你。
- CIt sounds like you are feeling frustrated. All the staff members here work together as a team to care for you.✓ 正解聽起來你感到很挫折。這裡的所有工作人員都是團隊合作來照顧你的。
- DThank you, I try my best. What specifically did Nurse B do that you found mean?謝謝，我會盡力而為。護理師 B 做了什麼具體的事情讓你覺得她很刻薄？
這題考查的是邊緣性人格障礙（BPD）常見的防衛機制「分裂」（Splitting），即將人理想化或貶低化。處理分裂的核心護理原則是「維持團隊一致性」（Staff Consistency）與「界限設定」（Boundary Setting）。選項 C 是最佳答案，護理師 A 同理了病人的感受（挫折感），但隨即強調「整個團隊是一體的」，這能有效中斷病人企圖分化工作人員的企圖，並將焦點拉回治療性環境。臨床思路上，護理師必須避免掉入病人的讚美陷阱。選項 D 強化了病人的理想化（好的護理師）並參與了貶低（詢問壞護理師的行為），會加劇分裂。選項 A 過於說教且試圖為同事辯護，無助於溝通。選項 B 則直接落入分化陷阱，讓病人成功操控了護理師之間的關係，這對 BPD 病人的治療是極其有害的。
This question addresses the defense mechanism of splitting — idealizing and devaluing people — that is characteristic of borderline personality disorder (BPD). The core nursing principles for managing splitting are maintaining staff consistency and setting limits. Option C is the best answer: Nurse A empathizes with the client's feelings (frustration) while immediately emphasizing that 'the entire team works together as one,' which effectively interrupts the client's attempt to divide the staff and redirects the focus to a therapeutic milieu. Clinically, the nurse must avoid falling into the trap of the client's flattery. Option D reinforces the client's idealization (the 'good' nurse) and participates in the devaluation (asking about the 'bad' nurse's behavior), exacerbating splitting. Option A is overly didactic and attempts to defend the colleague, which is unhelpful for communication. Option B falls directly into the splitting trap, allowing the client to successfully manipulate the relationship among the nurses, which is extremely harmful to BPD treatment.
美國護理教育中，「Splitting」與「Limit Setting」是精神科護理的必考重點，強調護理師不能私下與病人達成「特別協議」。台灣臨床實務中，對於 BPD 病人的處理有時會過於強調和諧，導致護理師可能為了安撫病人而無意中掉入分裂陷阱，因此學習如何堅定地維持團隊立場在跨文化護理中極為重要。