— 心理社會完整性 · MEDIUM · MCQ —
一位思覺失調症病人出現聽幻覺，告訴護理師：「聲音在叫我跳窗。」護理師最恰當的回應為何？
A client with schizophrenia is experiencing auditory hallucinations and tells the nurse, 'The voices are telling me to jump out the window.' What is the nurse's most appropriate response?
- AWhy would you want to hurt yourself?你為什麼想傷害自己？
- BYou are safe here, but I am concerned about what you are saying. Tell me more about the voices.✓ 正解這裡很安全，但我對你所說的話感到擔憂。請告訴我更多關於那些聲音的事。
- CI don't hear any voices in the room right now.我現在在房間裡聽不到任何聲音。
- DThe voices you are hearing are not real.你聽到的聲音並不是真實的。
— Explanation · 中文詳解 —
面對命令式幻聽，重點在於維護安全、同理病人感受，但不認同幻聽的真實性。B 選項平衡了安全保障與臨床治療性溝通。C 與 D 直接否定病人經驗會破壞護病關係；B 用「為什麼」會讓病人感到防衛，無助於治療。
When facing command auditory hallucinations, the focus is to ensure safety and empathize with the client without validating the reality of the hallucination. Option B balances safety with therapeutic communication. C and D directly negate the client's experience and damage the relationship; B's 'why' makes the client defensive and is not therapeutic.
✦ 台美臨床差異
台美護理教育均強調不與幻覺爭辯，但在台灣醫療環境中，評估幻聽內容後需立即通報並採取保護約束措施。