護理師協助一位年長病人進行個人衛生清潔，哪項行動最能促進病人的自主性？

核心概念：護理倫理中的「自主性」（autonomy）原則，以及如何在照護中體現尊重。 為何正確答案對： B. 詢問病人想先清潔身體哪個部位：尊重病人的自主性意味著賦予他們在照護過程中的選擇權和控制感。讓病人決定清潔的順序，是讓他們參與決策、表達偏好的一種方式。這不僅能增強病人的尊嚴感，也能讓他們感覺被尊重，並在照護中扮演更積極的角色，而不是被動地接受。 為何其他選項錯： A. 快速完成沐浴：雖然效率很重要，但以「快速」為優先，可能忽略了病人的感受和需求，甚至可能讓病人覺得被倉促對待，這與尊重自主性的原則相悖。 C. 告知病人該清潔了：這是一種告知（informing）而非協商（negotiating）或賦予選擇（offering choices）的方式。雖然病人需要被告知，但直接告知「現在該清潔了」缺乏彈性，沒有給予病人參與決策的機會。 D. 事先準備好所有用品：這是良好的護理準備工作，能提高效率，但這項行為本身與病人的自主性無直接關聯。它是一個護理師的準備動作，而非與病人互動以促進其自主性的行為。 臨床思路：此題考量的是「基本照護與舒適」（Basic Care & Comfort）領域，特別是護理倫理中的「自主性」原則。在執行任何侵入性或個人化的照護措施（如清潔）時，護理師應盡可能給予病人選擇的機會。這不僅是禮貌，更是對病人個人權利的尊重，有助於建立信任的治療性關係。

Core concept: the ethical principle of autonomy in nursing and how to demonstrate respect for the client during care. Why the correct answer is correct: B. Asking the client which part of the body they would like to wash first: respecting autonomy means giving the client choice and a sense of control during care. Letting the client decide the order of bathing involves them in decision making and lets them express preferences. This enhances dignity, conveys respect, and allows the client to play an active rather than passive role. Why other options are incorrect: A. Performing the bath quickly: although efficiency matters, prioritizing speed may ignore the client's feelings and needs and can make them feel rushed, conflicting with respect for autonomy. C. Telling the client it is time to get cleaned up: this informs rather than negotiates or offers choices. While clients need to be informed, a directive statement leaves no room for participation in decision making. D. Gathering supplies beforehand: this is good nursing preparation that increases efficiency, but it is a nurse-focused task and does not directly support the client's autonomy. Clinical reasoning: this item falls under the basic care and comfort area, particularly the principle of autonomy. When performing personal or invasive care such as bathing, the nurse should provide choices whenever possible. Doing so is not only courteous but also a recognition of the client's individual rights and supports a trusting therapeutic relationship.