護理師正在照顧一位最近失去相處 40 年配偶的病人。病人表示：「我簡直不敢相信他走了，我一直覺得他會像平常一樣走進家門。」根據庫伯勒-羅斯（Kübler-Ross）的理論，此病人最可能處於悲傷的哪個階段？
A nurse is caring for a client who recently lost their spouse of 40 years. The client states, 'I just can't believe they are gone. I keep expecting them to walk through the door.' Which stage of grief is the client most likely experiencing according to Kübler-Ross?
- AAnger憤怒
- BDepression憂鬱
- CDenial否認正確答案
- DBargaining討價還價
- C否認
本題的核心概念是庫伯勒-羅斯的悲傷五階段模型（DABDA）。病人描述「不敢相信」以及「期待對方出現」，是典型的否認階段（Denial）特徵。這是一種心理防禦機制，用來緩衝突如其來的巨大衝擊。在護理臨床推理中，首要任務是評估病人的應對能力與支持系統。正確答案 C 是因為病人表現出對現實的拒絕與不信。憤怒（A）通常表現為對醫護、命運或家屬的責備；討價還價（D）則常見於病人試圖與神明或命運達成協議以延緩結局；憂鬱（B）則涉及深刻的哀傷與撤退。護理師應提供支持性的傾聽，而非強迫病人立即接受現實，安全優先原則在於監測病人是否有自我傷害的風險，但在否認初期通常以情感支持為主。
- A憤怒
憤怒階段通常會將痛苦轉化為對外界的敵意，例如責怪醫護人員或抱怨社會不公。本題中病人的言語中並未出現攻擊性或憤怒情緒，僅表達了對配偶離開的震驚。
- B憂鬱
憂鬱階段發生在病人開始認清現實，並感受到深刻的孤獨與失落感時。本題病人尚處於「期待對方進門」的幻想與震驚中，還未進入到那種深刻體認到現實後的沉重憂鬱感。
- C · 正確答案否認
否認是悲傷的第一階段，這是一種心理緩衝機制，幫助個體應對難以承受的現實。病人表示「不敢相信」是典型的心理防禦，護理師應給予空間，容許病人逐步處理情緒。
- D討價還價
討價還價階段通常涉及「如果當初...就好了」或「如果我多做什麼，神能讓他回來嗎」等想法。這是一種試圖挽回失控局面的心理妥協，與本題描述的震驚與不信不符。
在美國，悲傷輔導常由護理師與專業諮商師、社工共同組成團隊；台灣臨床上則較多由家屬主導照顧，護理師需特別注意家族動力，且台灣文化中較常出現壓抑悲傷的情形，護理師需主動引導表達。
English explanation
The core concept of this question is the Kübler-Ross five-stage model of grief (DABDA). The patient's description of "not being able to believe it" and "expecting the deceased to return" is characteristic of the denial stage. Denial is a psychological defense mechanism used to buffer the patient from a sudden, overwhelming impact. In nursing clinical reasoning, the first task is to assess the patient's coping ability and support system. Option C is correct because the patient is demonstrating rejection of and disbelief in reality. Anger (A) is typically expressed as blame toward the medical staff, fate, or family; bargaining (D) is commonly seen when the patient tries to make a deal with God or fate to delay the outcome; depression (B) involves deep sorrow and withdrawal. The nurse should provide supportive listening rather than forcing the patient to immediately accept reality. The safety principle requires monitoring the patient for risk of self-harm, but during the early denial phase, emotional support is generally the primary focus.
最近修訂：2026-10-05