一位病人預計進行擇期手術。他告訴護理師:「我不確定醫生說要切除我的一部分大腸是什麼意思。」護理師最合適的處置為何?
A nurse is caring for a client who is scheduled for an elective surgery. The client tells the nurse, 'I am not sure what the doctor meant when he said he would remove part of my colon.' What is the most appropriate action by the nurse?
- ANotify the surgeon that the client needs further explanation of the procedure.✓ 正解通知外科醫師,該客戶需要進一步解釋手術程序
- BDocument that the client has questions but is ready for surgery.記錄客戶有疑問但已準備好接受手術
- CShow the client a diagram of the colon and the planned resection.向客戶展示大腸及計劃切除範圍的圖解
- DExplain the surgical procedure in simple terms to the client.用簡單的詞彙向客戶解釋手術程序
這題考查的是護理師在「知情同意(Informed Consent)」中的法律與專業角色。在知情同意的過程中,醫師的職責是說明手術的風險、益處及替代方案;護理師的職責則是「見證(Witness)」簽名,並確認病患是否具備理解能力。當病患表達對手術「內容」或「目的」的不了解時,這意味著知情同意尚未真正達成。護理師絕對不可代為解釋手術細節(選項 D 和 C),因為這超出了護理職權範圍,且若解釋有誤將承擔法律責任。正確的做法是發揮「病患倡議者(Patient Advocate)」的角色,通知手術醫師(Surgeon)回到病房重新向病患說明,直到病患完全理解為止。在確認病患完全理解前,不應讓病患簽署同意書或將其送往手術室。記錄病患有疑問(選項 B)但未解決即進行手術,是嚴重的護理疏失。
The nurse must notify the surgeon immediately because providing detailed explanations of surgical procedures is the physician's legal responsibility. Informed consent requires the patient to fully understand the procedure, so the nurse acts as an advocate by ensuring the provider clarifies the information before surgery proceeds.
在美國,知情同意的法律責任區分極為嚴格,護理師通常只簽署 Witness 欄位證明簽名真實性;台灣臨床上護理師有時會被要求協助解釋手術,但從法律風險管理角度看,美國的標準做法(要求醫師親自解釋)正逐漸成為全球共識。