一位患有嚴重強迫症（OCD）的病人入院，每天花 4 小時洗手。在入院的前幾天，護理師應優先採取哪項介入措施？
A client is admitted to the psychiatric unit with severe obsessive-compulsive disorder (OCD). The client spends 4 hours a day washing hands. Which intervention is a priority during the first few days of admission?
- AAllow the client enough time to perform the ritual to prevent overwhelming anxiety.✓ 正解給予病人足夠時間執行儀式，以避免過度焦慮。
- BImmediately start a rigorous behavior modification program with rewards and punishments.立即開始嚴格的行為修正計畫，包含獎勵與懲罰。
- CExplain to the client the physical damage being done to the skin by excessive washing.向病人解釋過度洗手對皮膚造成的物理性損害。
- DRestrict the client from using the bathroom for handwashing to decrease the behavior.限制病人使用廁所洗手，以減少該行為。
對於強迫症病人，強迫行為（洗手）是他們應對強迫思考所產生的極度焦慮的一種方式。在治療初期（入院前幾天），「安全」與「焦慮管理」是首要考量。如果護理師強行限制其行為（如選項 D），會導致病人的焦慮感爆發，甚至引發恐慌或暴力行為。正確的做法是暫時允許其行為，同時與病人建立信任關係，隨後再逐步實施行為治療。治療目標是建立信任並減少環境壓力。雖然長期目標是減少洗手時間，但初期必須尊重其防衛機制以維持心理穩定，這是護理優先原則中的心理安全考量。
Initially, allowing the client time to perform compulsive rituals prevents overwhelming anxiety and facilitates the development of a therapeutic alliance. Abruptly restricting these behaviors can trigger panic-level anxiety, while rational explanations are typically ineffective due to the nature of OCD. Therefore, prioritizing psychological safety and trust-building is essential before implementing behavioral interventions.
美國護理實務強調「循序漸進的行為療法」與病人自主權，重視初期不干預原則；台灣護理師在臨床上可能較快介入生理層面（如給予藥膏、衛教皮膚完整性），對心理層面的「允許期」容忍度有時較低。