一位思覺失調症病人出現「語詞沙拉」(word salad) 現象。護理師應採取何種溝通介入最為適當？

核心概念：與思覺失調症（Schizophrenia）病人進行有效溝通的技巧。 為什麼正確答案 C 對：思覺失調症病人常出現思考障礙，如「語詞沙拉」（word salad），即說出一連串無關聯的詞彙。此時，護理師最合適的回應是直接、誠實地告知病人自己無法理解其內容。這樣做能維持溝通的真實性（reality），避免病人誤以為自己表達清晰，同時也設定了清晰的溝通界線，讓病人知道其表達方式需要調整。避免讓病人覺得是自己出了問題。 為什麼其他選項錯： A. 要求病人解釋每個詞彙的意義，對處於語詞沙拉狀態的病人來說可能非常困難，甚至會加劇其焦慮和挫敗感。病人可能無法提供有意義的解釋。 C. 要求病人「說慢一點」或「專注於現實」可能過於直接或帶有評判意味，尤其是在病人已出現嚴重思考障礙時，效果不佳，且可能引起病人抗拒。 D. 忽視病人的言語內容而僅關注情緒，雖然在某些情況下適用，但在病人出現明顯的思考障礙（如語詞沙拉）時，忽視其表達會錯失評估病人認知狀態的機會，也未能提供有效的溝通支持。 臨床思路：此題考量的是「溝通技巧」與「同理心」。面對思覺失調症病人的溝通障礙，護理師的目標是建立信任、提供清晰的回饋，並盡可能維持有效的互動。直接告知「我聽不懂」是一種誠實且有助於釐清溝通障礙的策略。

Core concept: Techniques for effective communication with a client with schizophrenia. Why correct answer C is right: Clients with schizophrenia often exhibit thought disorders, such as "word salad," producing a string of unrelated words. In this situation, the most appropriate response is for the nurse to honestly and directly inform the client that they cannot understand the content. This maintains the reality of the communication, avoids letting the client believe their expression is clear, and sets a clear communication boundary so that the client knows their way of expressing needs to be adjusted. It avoids making the client feel that there is something wrong with them. Why the other options are wrong: A. Asking the client to clarify the meaning of each word can be extremely difficult for a client in a word salad state and may further intensify their anxiety and frustration. The client may be unable to provide a meaningful explanation. C. Asking the client to "speak more slowly" or "focus on reality" may seem too direct or judgmental, especially when the client already exhibits severe thought disorder. The effectiveness is limited and may provoke resistance. D. Ignoring the client's verbal content and focusing only on emotions, although applicable in some situations, misses the opportunity to assess the client's cognitive state when an obvious thought disorder (such as word salad) is present, and fails to provide effective communication support. Clinical reasoning: This question addresses communication skills and empathy. When facing communication barriers in a client with schizophrenia, the nurse's goals are to establish trust, provide clear feedback, and maintain effective interaction as much as possible. Honestly stating "I cannot understand" is an honest strategy that helps clarify communication barriers.