護理師照護一位邊緣性人格障礙（BPD）病人。病人說：「妳是唯一真正關心我的護理師，其他護理師都很壞且不專業。」哪項回應最合適？
A nurse is caring for a client with Borderline Personality Disorder (BPD). The client tells the nurse, 'You are the only nurse who actually cares about me. All the other nurses are mean and incompetent.' Which response is most appropriate?
- AIt sounds like you are feeling frustrated with the care you've received from others.聽起來你對從他人那裡獲得的照護感到挫折。
- BAll of our nurses are competent professionals; you shouldn't say that.我們所有的護理師都是專業且勝任的；你不應該那樣說。
- CWe all work as a team to provide your care, and I will be sharing our conversation with the staff.✓ 正解我們是一個團隊，共同提供你的照護，我會將我們的對話分享給其他工作人員。
- DI'm glad you feel that way, but I'm sure the other nurses are doing their best.很高興你有這樣的感覺，但我相信其他護理師已經盡力了。
邊緣性人格障礙病人的典型防禦機制是「分裂（Splitting）」，即將人簡單歸類為「全好」或「全壞」。這種行為常導致護理團隊內部的矛盾與不一致。選項 C 的回應最為精準：它強調了團隊合作（Teamwork），打破了病人的分裂嘗試，並明確告知會進行團隊溝通（Transparency），這有助於維持護理界限（Boundaries）。選項 D 掉入了病人的陷阱，接受了「全好」的角色；選項 A 雖然有同理心，但在處理 Splitting 時，過度強調個人感受可能會強化病人的分裂行為；選項 B 則帶有指責性，容易引發衝突。臨床思路上，處理 BPD 病人的核心在於「一致性」與「設定界限」，防止病人透過操弄來分化工作人員。
A classic defense mechanism in clients with borderline personality disorder is 'splitting,' in which people are categorized simply as 'all good' or 'all bad.' This behavior often produces conflict and inconsistency within the nursing team. Option C is the most accurate response: it emphasizes teamwork, breaks down the client's attempt at splitting, and clearly states that the conversation will be shared with the team (transparency), which helps maintain nursing boundaries. Option D falls into the client's trap by accepting the 'all good' role; option A, while empathetic, may reinforce the client's split view by overemphasizing personal feelings when managing splitting; option B is judgmental and likely to provoke conflict. Clinically, the core of caring for a client with BPD is 'consistency' and 'setting boundaries' to prevent the client from manipulating and dividing the staff.
美國 NCLEX 考題非常強調「Splitting」的識別與「Setting Boundaries」；台灣臨床上在處理此類病人時，有時會過於強調個別護理師的同理心，而忽略了團隊溝通的一致性，這在 NCLEX 邏輯中是被視為高風險的護理方式。