— 基本照護與舒適 · MEDIUM · MCQ —
病人術後感到劇烈疼痛，護理師哪項評估方式最為有效？
A client is experiencing severe pain post-surgery. Which nursing action demonstrates effective assessment?
- AAsking family members about the client's pain詢問家屬關於病人的疼痛狀況
- BTrusting the client's self-report of pain✓ 正解信任病人對疼痛的自我報告
- CObserving the client's facial expression觀察病人的面部表情
- DMonitoring vital signs for signs of distress監測生命徵象以察覺痛苦跡象
— Explanation · 中文詳解 —
疼痛是主觀感受，病人的自我報告（Self-report）被視為疼痛評估的黃金標準（Gold Standard）。即便生命徵象正常，病人仍可能處於劇烈疼痛中。護理師不應依賴客觀徵象或他人敘述來否定病人的主觀痛苦體驗。
The client's self-report is the gold standard for pain assessment because pain is a subjective experience that may not correlate with objective signs like vital signs or facial expressions. Relying on the client's own description ensures accurate evaluation and appropriate management of their discomfort.
✦ 台美臨床差異
台灣臨床護理師常受限於工作量，對疼痛評估的落實度有時不及美國精細的護理評估系統。