非施暴照顧者面對家內兒童遭受身體虐待之行動抉擇歷程

Facing Children Suffering From Physical Abuse: The Decision-Making Process of Non-Abusing Caregivers

陳嘉容(Chia-Jung CHEN) ； 陳宜彣(Yi-Wen CHEN) ； 張心怡(Hsin-Yi CHANG) ； 馮瑞鶯(Jui-Ying FENG)

《護理雜誌》 66卷4期 (2019/08) Pp. 40-48

https://doi.org/10.6224/JN.201908_66(4).06

摘要

背景：臺灣兒童虐待通報案件中最常見類型為身體虐待。而非施暴照顧者的態度及行動是終止暴力及預防再次受虐之關鍵。目的：了解非施暴照顧者面對家內兒童遭受身體虐待之行動抉擇經驗歷程。方法：採質性描述性研究，以立意與滾雪球選樣，半結構式、深度訪談11位家中有18歲以下兒童遭受身體虐待之非施暴照顧者，依紮根理論持續比較法分析資料。結果：非施暴照顧者之行動抉擇的核心是從被動觀察到主動參與的歷程，包含三個範疇及五個次範疇，分別為（一）不為所動（託付管教、合理化體罰行為）；（二）隱藏行動（以和為貴、策略應用）；（三）採取行動（求救底限）。行動抉擇的歷程會受到個人、家庭、環境及社會等多重因素影響其行動策略。結論／實務應用：非施暴照顧者面對兒童遭受身體虐待的行動不同，依個人求助資源多寡及評估情況危急性而決定是否行動，因而可能造成有些兒童未能及時得到援助，而出現行為問題。專業人員可提供非施暴照顧者面對兒童受虐時因應方式與資源運用，協助非施暴照顧者面對與採取行動。

關鍵字

兒童身體虐待 ； 非施暴照顧者 ； 紮根理論 ； 行動抉擇

並列摘要

Background: Physical abuse is the most common type of child maltreatment reported in Taiwan. The action of non-abusing caregivers is key to ending this maltreatment and to preventing future victimization in the home. Purpose: The purpose of this study was to explore the decision-making process used by non-abusing caregivers to take action after finding that children under their care were being physically abused at home. Methods: A qualitative descriptive approach was adopted and purposive, snowball sampling was used to recruit 11 non-abusing caregivers of children less than 18 years of age who were experiencing physical abuse at home. Data were collected using semi-structured, in-depth interviews. Data analysis was performed using a constant comparison method that was based on grounded theory principles and techniques. Results: The participants adopted a process that shifted over time from passive observation to active participation in dealing with children under their care being physically abused at home. The three main categories and five subcategories in this process are (1) inaction (shirking parental responsibility and rationalizing spouse's use of corporal punishment); (2) obscure action (family harmony first; strategic solutions); and (3) action (bottom line for asking for help). In this study, the decision-making process was influenced by personal, family, and sociocultural factors. Conclusions / Implications for Practice: The decision of the non-abusing caregivers in this study whether or not to take action was influenced by situational factors, which led to various consequences for their children. Non-abusing caregivers should be provided with coping strategies and resources to help them make decisions that protect the best interests of the physically abused child.

並列關鍵字

child physical abuse ； non-abusing caregiver ； grounded theory ； decision making in action

參考文獻

張心怡、馮瑞鶯、曾仁美（2018）．兒童身體虐待倖存者之療癒歷程－破土而生，迂迴成長．護理雜誌，65（3），47–57。[Chang, H. Y., Feng, J. Y., & Tseng, R. M. (2018). The process of healing child physical abuse: Sprouting and twining. The Journal of Nursing, 65(3), 47–57.] https://doi.org/10.6224/JN.201806_65(3).08

陳秀倩、蔡佳玲（2003）．運用「以家庭為中心」理念於一位受虐兒童家庭之照護經驗．護理雜誌，50（6），79–86。[Chen, H. C., & Tsai, J. L. (2003). Nursing experience of applying “family-centered care” to the family of an abused child. The Journal of Nursing, 50(6), 79–86.] https://doi.org/10.6224/JN.50.6.79

Alaggia, R. (2002). Cultural and religious influences in maternal response to intrafamilial child sexual abuse: Charting new territory for research and treatment. Journal of Child Sexual Abuse, 10(2), 41–60. https://doi.org/10.1300/J070v10n02_03

Annerbäck, E. M., Svedin, C. G., & Dahlström, Ö. (2018). Child physical abuse: Factors influencing the associations between self-reported exposure and self-reported health problems: A cross-sectional study. Child and Adolescent Psychiatry and Mental Health, 12, 38. https://doi.org/10.1186/s13034-018-0244-1

Back, C., Gustafsson, P. A., & Berterö, C. (2014). Parental opinions of their child's experience in the legal process: An interpretative analysis. Journal of Child Sexual Abuse, 23(3), 290–303. https://doi.org/10.1080/10538712.2014.888117