病人堅持自動出院（AMA），護理師首要行動為何？
A nurse is caring for a client who is being discharged against medical advice (AMA). What is the priority nursing action?
- ADocument the client's intent and notify the physician✓ 正解記錄病人之意圖並通知醫師
- BCall the hospital security to prevent the client from leaving呼叫醫院保全以防止病人離開
- CAsk the client to sign a waiver immediately without explanation要求病人立即簽署免責聲明，無需解釋
- DForcibly withhold the client's personal belongings強制扣留病人之個人物品
當病人決定自動出院（AMA, Against Medical Advice）時，護理師的首要任務是維護病人的自主權（Autonomy），同時確保法律與醫療紀錄的完整性。AMA 流程必須包含評估病人的決策能力（Capacity），確認其清楚拒絕治療所帶來的風險。護理師應立即通知醫師，協助醫師進行風險告知，並請病人簽署 AMA 同意書（若拒簽亦需記錄）。護理師不得採取強制手段，因為這會構成非法拘禁（False Imprisonment）與侵權行為。臨床思路應聚焦於溝通、風險告知與詳細的護理記錄。
When a client decides to leave against medical advice (AMA), the nurse's priority is to respect the client's autonomy while ensuring legal and documentation integrity. The AMA process must include assessment of the client's decision-making capacity, confirming that they understand the risks of refusing treatment. The nurse should immediately notify the physician, assist with risk disclosure, and have the client sign the AMA form (if the client refuses to sign, this must also be documented). The nurse must not use coercive measures, as this would constitute false imprisonment and a tort. Clinical reasoning should focus on communication, risk disclosure, and detailed nursing documentation.
在美國，AMA 的法律責任極重，必須詳細紀錄醫師已告知所有風險（Risks of leaving AMA）。台灣臨床較常由護理師進行勸導，而美國法律框架下，護理師的角色更偏向確保醫師已完成告知義務並完成所有法律文件簽署，以規避潛在的訴訟風險。