一位患有重度憂鬱症的病人告訴護理師：「我真的覺得任何事情都沒有意義了。沒有我，大家都會過得更好。」護理師最恰當的回應為何？
A client with major depressive disorder tells the nurse, 'I really don't see the point in anything anymore. Everyone would be better off without me.' Which response by the nurse is most appropriate?
- AWhy do you feel that way? You have a loving family.你為什麼會有這種感覺？你有一個愛你的家庭。
- BYou shouldn't say things like that. It's not true.你不應該那樣說。那不是真的。
- CI've felt like that before too; things will get better soon.我以前也有過那種感覺；事情很快就會好轉。
- DIt sounds like you are feeling very hopeless right now. Are you thinking of hurting yourself?✓ 正解聽起來你現在感到非常絕望。你有考慮傷害自己嗎？
面對表達無望感（hopelessness）且語帶輕生念頭的病人，護理師的首要任務是直接評估自殺風險。核心概念在於『治療性溝通』與『病人安全』。選項 D 使用了反映性技巧（Reflecting）來認同病人的感受，並直接、具體地詢問是否有自殺意圖，這是自殺介入的第一步。這不僅提供了支持，也獲取了關鍵的安全評估數據。選項 A 的「為什麼」會讓病人產生防衛心，且給予虛假的保證；選項 C 轉移了焦點到護理師身上，且淡化了病人的痛苦；選項 B 則是帶有評判性的否定，會阻斷溝通並讓病人感到被羞辱或不被理解。
When a patient expresses hopelessness and hints at suicidal ideation, the nurse's first priority is to directly assess suicide risk. The core concepts are 'therapeutic communication' and 'patient safety.' Option D uses a reflective technique to acknowledge the patient's feelings and then directly and specifically inquires about suicidal intent, which is the first step in suicide intervention. This not only provides support but also obtains critical safety assessment data. Option A's 'Why' question makes the patient defensive and offers false reassurance; option C shifts the focus to the nurse and minimizes the patient's suffering; option B is a judgmental denial that blocks communication and makes the patient feel shamed or misunderstood.
在美國護理實務中，對於自殺念頭的詢問必須非常直接（Direct Inquiry），這被視為專業且負責的表現。台灣文化中，雖然近年來已進步許多，但部分護理人員在面對「死」字時仍可能較為委婉，或傾向先聯絡家屬，但在 NCLEX 考試中，直接詢問與反映感受是唯一的標準答案。