註冊護理師正在照護一位最近因急性嚴重重度憂鬱症入院的 50 歲男性，他出現主動的幻聽並要求他暴力地傷害自己。他目前是自願入院狀態 (voluntary status)。在大夜班期間，該病患突然把行李收拾好，極具侵略性地衝出房間，並要求立即離開機構，他宣稱：『我是自願入院的，你們在法律上不能違背我的意願扣留我！』護理師最恰當的行動為何？
The RN is caring for a 50-year-old male recently admitted for acute severe major depressive disorder with active auditory hallucinations telling him to violently hurt himself. He is currently voluntary. During the night shift, the client suddenly packs his bags, aggressively bursts out of his room, and demands to leave the facility immediately, stating, 'I am voluntary, you cannot hold me legally against my will!' What is the most appropriate action by the nurse?
- AAllow the client to leave immediately after securely obtaining his signature entirely on an Against Medical Advice (AMA) form.在安全取得其完全簽署的自動出院（AMA）表單後，允許病人立即離開
- BState calmly that voluntary clients explicitly possess absolute constitutional freedom to depart instantly without signing forms.冷靜地表示自願入院客戶明確擁有絕對的憲法自由，可以立即離開而無需簽署表單
- CForcefully physically restrain the active client directly against the wall while simultaneously calling hospital security for an emergency takedown.在將活躍的病人直接強行按壓在牆上的同時，呼叫醫院保全進行緊急制服
- DDetain the client firmly on the unit and instantly notify the primary healthcare provider to initiate an involuntary psychiatric hold protocol.✓ 正解堅定地將病人扣留於病區內，並立即通知主要醫療保健提供者以啟動非自願精神科留置程序
本題測驗精神科病患權益與強制約束法規 (Client Rights / Mental Health Holds)。在美國與台灣的護理法規中，即使是『自願入院 (Voluntary admission)』的精神科病患，他也不一定享有「隨時可以拔腿就走」的絕對自由。法律的絕對界線是：『他是否對自己或他人造成立即的生命威脅 (Danger to self or others)』。這個病患不僅罹患嚴重憂鬱，還有「命令式幻聽 (Command hallucinations)」叫他去死，他具備了極度高危險的自殺急迫性。如果護理師此時放他走（即使簽了 AMA），將構成嚴重的醫療過失致死。合法的緊急處置是：護理師必須將他留在封閉式病房內，並立刻聯絡醫師，啟動『非自願強制留院 (Involuntary psychiatric hold / 72-hour hold)』程序（選 D 正確）。選項 A 與 B 錯誤，高自殺風險病患在法律上不具備簽署 AMA 並離開的能力。選項 C 錯誤，第一時間立刻使用物理肢體重度壓制 (Takedown) 而不先試圖口頭降溫或啟動法規，違反了約束的最後手段原則 (Least restrictive environment)。
A voluntary client exhibiting command hallucinations to harm themselves poses an imminent danger to self, thereby losing the right to leave against medical advice. The nurse must detain the client safely and immediately notify the provider to initiate an involuntary psychiatric hold to prevent suicide.
精神科的最高留置權力。病患只要滿足三條件其一：「自殺傾向 (Danger to self)」、「殺他傾向 (Danger to others)」、「嚴重無法自理 (Gravely disabled)」，醫師就可以無條件報警啟動強制治療 (美國通常為 5150 hold / 台灣為強制住院)。連自願病人也跑不掉。