一位診斷為末期腎病的老年病患拒絕了必要的常規透析治療，表示：『我已經厭倦了這些機器，我想停止。』病患意識清楚且具備行為能力。首要的護理行動為何？
An older adult client diagnosed with end-stage renal disease refuses an essential scheduled dialysis treatment, stating, 'I am tired of all these machines and want to stop.' The client is oriented and competent. What is the priority nursing action?
- AContact the client's family members to come convince the client to change their mind.聯繫個案的家屬前來說服個案改變心意。
- BExplain the deadly consequences and insist the client proceed with the dialysis session.說明致命的後果並堅持個案進行透析。
- CRespect the client's decision, document the refusal, and notify the attending physician.✓ 正解尊重個案的決定，記錄其拒絕行為，並通知主治醫師。
- DSchedule a detailed psychiatric consultation to evaluate the client for severe depression.安排詳細的精神科諮詢，以評估個案是否有嚴重憂鬱症。
本題測驗病患自主權與知情拒絕 (Informed Refusal/Autonomy)。所有具有心智能力 (competent) 的成人都擁有絕對的權利拒絕任何醫療介入，甚至這個決定會導致他們的死亡。護理師的核心倫理原則是『尊重自主權 (Autonomy)』。當病患拒絕透析，護理師必須確保他們了解後果，然後尊病患的意願，記錄這個拒絕，並立刻通知醫師。選項 C 正確。選項 B 強迫病患或過度說教都是不當的強迫行為。選項 A 找家屬來施壓也違反了保護病患意願的原則。選項 D 拒絕延命治療並不等於患有憂鬱症。
This item tests client autonomy and informed refusal. All competent adults have the absolute right to refuse any medical intervention, even when the decision will lead to their death. The nurse's core ethical principle is respect for autonomy. When the client refuses dialysis, the nurse must ensure they understand the consequences, then honor the client's wishes, document the refusal, and immediately notify the physician. Option C is correct. Option B, forcing or lecturing the client, is improper coercion. Option A, enlisting family members to apply pressure, also violates the principle of protecting the client's wishes. Option D, refusing life-sustaining treatment, is not equivalent to suffering from depression.
台美皆強調病人的知情拒絕權 (Right to refuse)。