— 心理社會完整性 · HARD · SATA —
對於有自傷行為史的病人，下列哪些介入是適當的？（選所有適合的）
Which of the following interventions are appropriate for a client with a history of self-mutilating behavior? (Select all that apply.)
- AContracting for safety with the client✓ 正解與病人簽訂安全契約
- BObserving the client at frequent, unscheduled intervals✓ 正解以頻繁且不預期的間隔觀察病人
- CEncouraging the client to express emotions through verbalization✓ 正解鼓勵病人透過言語表達情緒
- DRemoving all items that could be used for self-injury✓ 正解移除所有可用於自傷的物品
- EIgnoring the client to avoid reinforcing the behavior忽略病人以避免強化該行為
— Explanation · 中文詳解 —
處理自傷行為重點在於環境安全（D）、契約承諾（A）、密切監控（B）與情緒替代（C）。契約承諾讓病人學習與醫護人員約定安全邊界；不定期觀察可預防其預判監控空檔。忽視（E）是絕對錯誤的，會讓病人感到被遺棄，反而更可能自傷以尋求注意。
Appropriate interventions include establishing a safety contract to set boundaries, performing frequent unscheduled observations to prevent prediction of monitoring gaps, encouraging verbal expression of emotions as a healthy alternative to self-harm, and removing potential weapons from the environment. Ignoring the client is contraindicated as it may increase feelings of abandonment and risk of self-injury.
✦ 台美臨床差異
台美皆強烈反對對自傷者採取忽視政策；美國護理界對於安全契約（No-suicide contract）的有效性有更多臨床討論。