一位新診斷 HIV 的病人說：「我不希望任何人知道我的病情。」護理師首要行動為何？
A nurse is caring for a client with a new diagnosis of HIV. The client states, 'I don't want anyone to know my status.' What is the nurse's priority action?
- ADocument the client's request in the medical record在病歷中記錄病人的請求
- BAsk the client why they are worried about confidentiality詢問病人擔心隱私的原因
- CNotify the family to ensure they provide proper support通知家屬以確保他們提供適當的支持
- DReassure the client that health information is confidential✓ 正解向病人保證醫療資訊是機密的
核心概念為醫療保密（Confidentiality）與病人的權利保障。HIV 診斷涉及社會汙名，病人對隱私的擔憂是常見的心理反應。護理師的首要行動應是建立治療性關係，透過確認隱私權來緩解病人的焦慮。根據 HIPAA，未經病人同意，不得將病情告知任何第三方，包含家人，除非涉及強制通報疾病（如結核病或性病通報規範，但仍需遵守嚴格隱私限制）。
The nurse's priority is to reassure the client that their health information is confidential, thereby building trust and addressing their anxiety about stigma. Under HIPAA regulations, patient privacy must be maintained, and the nurse cannot disclose the diagnosis to family members without explicit consent. This initial reassurance supports the therapeutic relationship and respects the client's legal rights.
美國 HIPAA 對病患隱私規範極為嚴格，違規罰則高。台灣醫療體系中，醫師有時會優先告知家屬，但在美國這可能導致嚴重的法律糾紛（Lawsuit）。