護理師照護一位有跌倒史的病人。下列哪些是有效的跌倒預防措施？（選所有適合的）
A nurse is caring for a client with a history of falls. What are effective fall prevention measures? (Select all that apply.)
- AKeep the bed in the lowest position✓ 正解將病床維持在最低位置
- BEnsure the call light is within reach✓ 正解確保呼叫鈴在可及範圍內
- CEncourage the client to get up independently鼓勵病患獨立下床
- DKeep the environment well-lit✓ 正解保持環境照明充足
- EApply soft physical restraints使用軟性身體約束
針對有跌倒史的病人，護理計畫需採取多重介入措施。將病床調至最低以減少跌倒高度、確保呼叫鈴在手邊以利病人隨時求助、維持環境明亮以利視力辨識，這些皆屬於「減少風險潛力（Reduction of Risk Potential）」的基本護理標準。約束裝置則需嚴格遵守醫囑，僅在病人有立即自傷或傷人風險且其他替代方案失效時才考慮使用。
For clients with a history of falls, the nursing plan must include multiple interventions. Lowering the bed to its lowest position to reduce the fall height, ensuring the call light is within reach so the client can request help at any time, and maintaining adequate lighting to assist visual recognition are all basic nursing standards of "Reduction of Risk Potential." Restraints require strict adherence to the physician's orders and should only be considered when the client poses an immediate risk of self-harm or harm to others and alternative measures have failed.