— 心理社會完整性 · HARD · MCQ —
一位精神分裂症個案表示：「那些聲音告訴我，你是來毒害我的。」護理師最適切的回應為何？
A client with schizophrenia states, 'The voices are telling me that you are here to poison me.' What is the most appropriate response by the nurse?
- AWhy do you think the voices are saying that about me?你為什麼認為那些聲音對我這麼說？
- BI understand that you are scared, but I am not going to hurt you.✓ 正解我理解你很害怕，但我修不會傷害你。
- CLet's talk about something else to take your mind off the voices.我們談點別的吧，轉移一下對那些聲音的注意力。
- DThat is not true, I am here to help you get better.那不是真的，我是來幫助你康復的。
— Explanation · 中文詳解 —
針對幻聽與妄想的個案，護理師不應挑戰其虛假認知（D），也不應要求追究原因（A），而是應直接切入個案的情緒層面（恐懼）。B 選項承認了個案的感受（恐懼）並表達立場（安全），能有效建立治療性信任關係，同時避開與妄想內容爭辯。
The nurse should acknowledge the client's feelings of fear without validating the delusion or arguing against it. By expressing empathy and reassuring the client of their safety, the nurse builds trust and reduces anxiety while avoiding confrontation that could increase defensiveness.
✦ 台美臨床差異
在美國精神科護理中，「不挑戰妄想（Don't argue with delusions）」是核心原則；台灣臨床有時會因忙碌而直接給予藥物處理，忽略溝通技巧。