護理師照護一位簽有預立指示且註明「不施行復甦術」(DNR) 的高齡病人。病人的女兒要求如果病人停止呼吸，護理師必須進行心肺復甦術 (CPR)。護理師應採取哪項行動？
A nurse is caring for an older adult client who has an advance directive indicating 'Do Not Resuscitate' (DNR). The client's daughter requests that the nurse perform CPR if the client stops breathing. Which action should the nurse take?
- ATell the daughter to discuss this with the physician to change the status.告訴女兒應與醫師討論以變更狀態。
- BComply with the daughter's request to maintain family harmony.配合女兒的要求以維持家庭和諧。
- CContact the facility's legal department immediately.立即聯繫機構的法務部門。
- DExplain to the daughter that the client's advance directive must be honored.✓ 正解向女兒解釋必須遵守個案的預立指示。
預立指示（Advance Directives）是自主原則（Autonomy）的延伸。當病人意識清醒時所做的 DNR 決定具有法律約束力，醫療團隊與家屬都必須尊重。即使家屬（女兒）有不同意見，只要病人先前已表達明確意願且文件有效，護理師的首要職責是擔任「病人擁護者」（Patient Advocate），保護病人的尊嚴與選擇權。選項 B 違反了法律與專業倫理；選項 C 過於激進，應先進行溝通；選項 A 雖然正確，但第一時間應先重申病人的決定與法律效力。這類題目考驗護理師在倫理衝突中保護病人自主權的堅定程度。
Advance directives reflect the client's autonomous right to refuse treatment and must be legally honored. The nurse acts as a patient advocate to ensure the client's previously stated wishes are respected, even if family members disagree. Performing CPR against a valid DNR order violates ethical principles and legal standards.
美國對預立指示（Advance Directives）的法律保障極強，護理師若違反病人意願進行急救會面臨嚴重的法律訴訟。台灣雖然已有《病人自主權利法》，但在文化上家屬意見（家族主義）仍常干擾醫療決策，護理師在執行時常面臨更大的文化壓力。