一位邊緣性人格障礙（BPD）的病人對護理師說：「大夜班的護理師比妳好多了，她才是真正關心我的人。」護理師哪項回應最合適？
A client with borderline personality disorder (BPD) tells a nurse, 'The nurse on the night shift is so much better than you. She actually cares about me.' Which response by the nurse is most appropriate?
- AYou shouldn't say that; it's hurtful to the staff working hard for you.你不應該那樣說；這對努力照顧你的員工來說很傷人。
- BIt sounds like you are trying to divide the staff. We all follow the same plan.你似乎試圖分化員工。我們都遵循相同的計畫。
- CLet's talk about your schedule and the activities you have planned for today.✓ 正解讓我們談談你的行程以及你今天計劃的活動。
- DI'm glad you feel comfortable with her, but we all care about you.很高興你覺得跟她相處自在，但我們都關心你。
邊緣性人格障礙病人常展現「分裂」（Splitting）的防衛機制，將人看作「全好」或「全壞」，意圖分化醫療團隊（Staff Splitting）。護理核心在於不陷入病人的情緒操縱，維持專業中立，並將焦點轉回到當下的治療性活動或常規上。選項 C 成功地轉移了話題，並將重點放在病人的治療計畫，避免了與病人的爭論。過度的情緒回應或解釋（如 D、B、A）反而可能強化病人的分裂行為，破壞團隊一致性。護理師應確保團隊成員間密切溝通，維持統一的照護標準，這才是處理 BPD 病人的關鍵臨床思路。
Patients with borderline personality disorder often exhibit the defense mechanism of splitting, viewing others as "all good" or "all bad" and attempting to divide the healthcare team (staff splitting). The core of nursing is to avoid being caught up in the patient's emotional manipulation, to maintain professional neutrality, and to redirect the focus back to the present therapeutic activities or routines. Option C successfully changes the topic and refocuses on the patient's treatment plan while avoiding an argument with the patient. Excessive emotional responses or explanations (such as D, B, and A) may actually reinforce the patient's splitting and undermine team consistency. The nurse should ensure close communication among team members and maintain unified care standards; this is the key clinical reasoning when working with patients with BPD.
美國 NCLEX 非常強調「Splitting」與「Staff Splitting」的辨識，要求護理師絕對的一致性；台灣臨床上對於人格障礙的處理有時較依賴資深護理師或心理師介入，基層護理師在應對此類操縱行為時的系統性訓練較少。