一位第四期癌症病人表達想要停止所有延長生命的治療。護理師最優先採取的行動為何？
A client with stage IV cancer expresses a desire to stop all life-prolonging treatments. What is the most important initial nursing action?
- ANotify the attending physician to sign a DNR order通知主治醫師簽署 DNR 醫囑
- BDiscuss the client's decision with the family members first首先與家屬討論患者的決定
- CValidate the client's feelings and explore the reasons behind the request✓ 正解驗證患者的感受並探討請求背後的原因
- DImmediately contact the palliative care team立即聯繫姑息治療團隊
當病人表達放棄生命延續治療的意願時，護理師的首要任務是進行「治療性溝通（Therapeutic Communication）」。這不僅是為了評估病人的心理狀態，更是為了確保病人對其決定的決策能力（Decision-making capacity）有充分的理解。在臨床上，護理師必須先釐清病人是否因為短期的憂鬱、疼痛控制不佳或誤解病情而做出此決定。直接跳過溝通進入行政程序（如DNR）或將其意願告知家屬，皆忽略了病人的自主權（Autonomy）與護理評估的必要性。
When a client expresses the wish to stop life-prolonging treatment, the nurse's first task is to engage in therapeutic communication. This is not only to assess the client's psychological state but also to ensure that the client has adequate understanding (decision-making capacity) for the decision. Clinically, the nurse must first determine whether the decision is being made due to short-term depression, poor pain control, or misunderstanding of the illness. Bypassing communication for administrative procedures (such as DNR) or relaying the client's wishes to family overlooks the client's autonomy and the necessity of nursing assessment.
在美國，病人若有決策能力，其自主權（Autonomy）極高。護理師需確認病人已進行「預立醫療指示（Advance Directives）」的討論。台美皆重視病人自主，但美國臨床更強調跨團隊（如社工、法律倫理顧問）對病人決策能力的嚴謹評估。