一位初次診斷為重度憂鬱症的病人表示：「我真的覺得凡事都沒有意義了，我的家人沒有我會過得更好。」護理師最具治療性的回應為何？
A client newly diagnosed with major depressive disorder states, 'I just don't see the point in anything anymore. My family would be better off without me.' Which response by the nurse is the most therapeutic?
- AIt sounds like you are feeling very hopeless right now. Are you thinking of ending your life?✓ 正解你現在感覺非常絕望。你有結束生命的念頭嗎？
- BMost people with depression feel this way at first, but it will get better with medication.大多數憂鬱症患者一開始都有這種感覺，但服藥後情況會好轉。
- CWhy do you feel that your family would be better off without you?為什麼你覺得你的家人沒有你會過得更好？
- DYou have so much to live for; your family loves you very much.你有許多活下去的理由；你的家人非常愛你。
面對表達無望感（hopelessness）且暗示有自殺念頭的病人，護理師的首要任務是直接評估自殺風險。核心概念在於「安全優先」與「直接溝通」。選項 A 透過反映病人的感受（無望感）來建立共感，並直接詢問自殺意圖，這是預防自殺的關鍵步驟。相比之下，選項 C 使用「為什麼」開頭，容易讓病人感到被指責並產生防衛心；選項 D 屬於給予虛假的保證和否認病人的感受，會阻斷溝通；選項 B 則過於簡化問題並給予不切實際的期待。臨床思路上，精神科護理首重識別風險，直接詢問自殺計畫不會增加病人自殺的風險，反而能提供安全的宣洩窗口。
The most therapeutic response is to acknowledge the client's feelings of hopelessness and directly assess for suicidal ideation to ensure safety. Directly asking about suicide does not increase risk but is essential for identifying the need for intervention. Other options minimize the client's experience, offer false reassurance, or use non-therapeutic questioning techniques.
在美國護理實務中，護理師被訓練要極其直接地詢問自殺意圖（Direct Inquiry）；台灣護理教育雖也強調此點，但在文化背景下，護理人員有時會較委婉，但 NCLEX 考試必須遵循「直接、明確、安全」的美國標準。