居家護理師訪視一位與妻子同住、罹患慢性 COPD 的 60 歲男性病人。訪視期間，護理師觀察到病人上臂和背部有多處新形成、大面積且邊緣不規則的瘀青。病人緊張地表示：「我老是因為失去平衡而撞到門框。」妻子尖銳地打斷他：「他最近就是很粗心。」護理師被法定強制要求的最優先處置為何？
A home health nurse is visiting a 60-year-old male client with chronic COPD who lives with his wife. During the visit, the nurse observes multiple fresh, large, irregular bruises on the client's upper arms and back. The client states nervously, "I keep bumping into doorframes because I lose my balance." The wife sharply interrupts, saying, "He is just very careless lately." What is the nurse's mandated legal priority action?
- AInstall hidden surveillance cameras in the living room to capture evidence of abuse.在客廳安裝隱藏式監視攝影機以捕捉虐待證據
- BArrange to interview the client privately, away from the wife, to explore the inconsistencies.✓ 正解安排與病人私下單獨訪談，遠離妻子，以探討不一致之處
- CConfront the wife about the bruises and demand she explain what happened.當著妻子的面質問瘀青並要求她解釋發生了什麼事
- DAccept the client's explanation and provide him with an assistive walker to prevent further injuries.接受病人的解釋並提供助行器以防止進一步受傷
本題評估老人虐待 (Elder Abuse) 的辨識與通報。當病人身上的傷痕與其陳述的受傷機轉不合（背部、上臂內側等隱蔽部位較難因撞門框造成），且伴隨照顧者的言語貶低或控制談話的舉動，是受虐的紅旗警訊。護理師為法定通報人 (Mandated Reporter)，但首要行動不能是當面質問疑似施虐者，因為這會使施虐者在護理師離開後對病人施以報復。正確且唯一安全的做法是將疑似施虐者支開，在隱私空間中單獨訪談疑似受虐者，以獲取真實的傷害資訊（選項 B）。選項 D 忽略明顯紅旗，屬於失職；選項 C 當面對質會升高病人的危險；選項 A 安裝監視器違反隱私法規，且超出護理師的職責範圍。確認受虐後，護理師應依照各州規定向 Adult Protective Services (APS) 通報。
The presence of unexplained bruises and inconsistent explanations raises suspicion of elder abuse, making private assessment the priority to ensure client safety. Interviewing the client alone allows the nurse to gather accurate information without fear of retaliation from the suspected abuser, whereas confronting the spouse or accepting the explanation could endanger the client further.
家暴/虐老防制原則：台美護理師皆為 Mandated Reporter (責任通報人)。發現疑似家暴，第一步絕對是把施暴家屬請出門，隔離病患單獨問話。