病人表達想要出院但不遵醫囑（AMA）。護理師優先採取的行動為何？
A client expresses the desire to leave the hospital against medical advice (AMA). What is the nurse's priority action?
- APhysically restrain the client until the doctor arrives在醫師到達之前對病人進行身體約束
- BImmediately discharge the client without documentation在未記錄的情況下立即讓病人出院
- CLock the exit doors鎖住出口大門
- DIdentify the reasons for the client's desire to leave✓ 正解釐清病人想要離院的原因
核心概念在於尊重病人的自決權（Autonomy）。當病人提出不遵醫囑（Against Medical Advice, AMA）出院時，護理師的首要任務是進行評估與溝通，而非立即採取強硬手段。了解病人想離開的原因，有助於釐清是否因溝通不良、疼痛未緩解或對病情誤解所致，並提供衛教或協助解決其擔憂。若護理師在未經法律程序下限制病人行動，將觸犯非法拘禁（False Imprisonment）。
The core concept is respect for the patient's right to self-determination (autonomy). When a patient expresses the desire to leave against medical advice (AMA), the nurse's primary task is assessment and communication rather than coercion. Identifying the reasons for the patient's wish to leave helps clarify whether the situation results from poor communication, unrelieved pain, or a misunderstanding of the condition, and provides an opportunity for teaching and addressing the patient's concerns. If the nurse restricts the patient's movement without proper legal process, this constitutes false imprisonment.
在美國，AMA 的法律責任極重。護理師必須確保醫生已向病人說明潛在風險，且病人具備決策能力，並完成 AMA form 的簽署。若病人拒絕簽署，護理師需在護理紀錄中詳實記載已告知風險及其拒簽事實，並由兩名證人簽名見證。