— 心理社會完整性 · MEDIUM · MCQ —
護理師照顧一位患有思覺失調症且出現聽幻覺的個案，哪種回應最具治療性？
A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinations. Which response is most therapeutic?
- AWhy do you think these voices are talking to you right now?你認為這些聲音為什麼現在正在跟你說話？
- BI don't hear any voices, so you shouldn't either我沒聽到任何聲音，所以你也應該聽不到
- CTell me more about what the voices are saying to you告訴我更多關於這些聲音對你說了什麼
- DIt sounds like you are hearing something, but I do not hear any voices✓ 正解聽起來你聽到了一些聲音，但我沒有聽到任何聲音
— Explanation · 中文詳解 —
應對幻覺的黃金原則是「肯定個案體驗，但澄清客觀事實」。不否定也不附和。B 選項會導致個案產生防衛心；C 選項易加強幻覺內容；D 的「為什麼」會給個案造成壓力。D 選項明確表達護理師立場，尊重個案感受，有助於建立治療性關係。
The therapeutic gold standard when responding to hallucinations is to validate the client's experience while clarifying objective reality, neither denying nor reinforcing the perception. Option B elicits defensiveness; option C may reinforce hallucinatory content; and option A's "why" places pressure on the client. Option D clearly states the nurse's position while respecting the client's experience, which helps build a therapeutic relationship.
✦ 台美臨床差異
兩地均強調「現實導向療法」，但在台灣臨床，護理師常需更頻繁評估幻覺內容是否有傷害性。