一位反社會人格障礙病人試圖說服護理師讓他在禁菸區抽菸。最佳的護理回應為何？
A client with an antisocial personality disorder is trying to convince a nurse to let them smoke in a non-smoking area. What is the best nursing response?
- AIf you don't stop asking, I will have to report you to the doctor.如果你繼續要求，我必須向醫師報告。
- BI'll let you do it just this once, but don't tell anyone.這次我就讓你破例，但不要告訴別人。
- CThe rules apply to everyone. Smoking is only permitted in the designated area.✓ 正解規定適用於所有人。吸菸僅限在指定區域。
- DSmoking is not allowed here. Let's talk about why you feel you need to break the rules.這裡不准吸菸。我們來談談你為什麼覺得需要違反規定。
反社會人格障礙（Antisocial Personality Disorder, ASPD）病人常表現出操控性強、漠視規則、缺乏同理心和衝動的行為特徵。在臨床照護中，建立清晰、一致的界限（setting limits）和嚴格執行規定對這類病人至關重要。護理師必須避免被病人說服或操控，因為這會強化其不良行為模式，並破壞治療環境的秩序。堅定而客觀地陳述規定，能傳達明確的訊息，即規則適用於所有人，且沒有例外。
Clients with antisocial personality disorder often test boundaries and manipulate others; therefore, the nurse must establish firm, consistent limits without becoming emotional or engaging in power struggles. The correct response directly restates the policy that rules apply to everyone, which prevents reinforcement of manipulative behavior and maintains a therapeutic environment.
對於人格障礙病人的照護原則，特別是界限設定和一致性，在美國和台灣的臨床實踐中是普遍認同的。然而，在台灣的某些臨床情境中，醫護人員可能更傾向於避免直接衝突，或在規則執行上保有較高的彈性，這與美國強調明確界限的文化可能略有不同。NCLEX 強調一致性與治療性界限的建立。