護理師照護一位末期病人。家屬要求護理師不要將末期診斷告知病人。護理師應採取哪項行動？
A nurse is caring for a client who is terminally ill. The client's family requests that the nurse not tell the client about the terminal diagnosis. Which action should the nurse take?
- ARefer the family's request to the hospital's ethics committee for a decision.將家屬的要求轉介至醫院倫理委員會以做出決定。
- BInform the client of the diagnosis immediately, as the client has a right to know.立即告知病人診斷結果，因為病人有知情的權利。
- CComply with the family's request to protect the client's emotional well-being.順從家屬的要求以保護病人的情緒福祉。
- DEncourage the family to discuss their concerns with the healthcare provider.✓ 正解鼓勵家屬與醫療提供者討論他們的擔憂。
這是一個典型的倫理與法律衝突考題，涉及病人自主權（Autonomy）與家屬意願的拉鋸。在美國法律與倫理準則下，病人有權知道自己的診斷（Right to Know）。然而，護理師在處理此類敏感問題時，首要行動應是促進溝通。選項 D 是最合適的初步行動：護理師應了解家屬擔憂的原因，並引導家屬與醫療團隊（醫師）進行正式討論。護理師不應直接答應隱瞞（選項 C，違反誠實原則），也不應在未評估情況下衝動告知（選項 B，可能造成心理衝擊）。透過跨領域的對話，可以找出最符合病人利益且尊重文化背景的告知方式。這是護理管理中「溝通協調」與「權利保護」的實踐。
While clients have a right to know their diagnosis, the nurse's initial role is to facilitate communication between the family and the healthcare provider to address underlying concerns. Encouraging this discussion allows for a coordinated approach that respects both the client's autonomy and the family's cultural or emotional needs without prematurely disclosing information or ignoring ethical principles.
美國文化極度尊重個人自主權，醫療團隊通常會傾向直接告知病人。在台灣（及許多亞洲文化中），「保護性隱瞞」較為常見，家屬常主導醫療決策。但 NCLEX 是美國考試，答案必須以「病人自主權」為核心，同時兼顧專業溝通程序。