照護一位遭網友性侵害青少女之急診護理經驗

本文描述一位因網路交友遭受性侵害的青少女，急診就醫期間發現個案除了身體因反抗導致創傷傷口疼痛外，更出現情緒激動、保持警覺、作惡夢之症狀，案母未能適時給予情緒支持，引發筆者探討之動機。護理期間2020/08/15 14:00至08/16 09:00，共19小時，依生理、心理、社會發展、靈性層面評估，藉由直接照顧、觀察、病歷查閱、會談等方法收集資料，確立個案有急性疼痛、強暴創傷症候群、家庭因應失能等健康問題。針對上述問題，除了止痛藥物治療外，教導冷熱敷、放鬆技巧等轉移注意力緩解疼痛；提供獨立空間採證，避免重複陳述受害經過，連結校園以後續心理諮詢；另透過治療性護病關係，了解個案需求及確認問題，幫助建立親子溝通管道，改善家庭因應之能力。許多青少年除了課程需要使用網路，在查詢資料的同時，透過交友軟體及遊戲交友，這也讓網路犯罪性侵害的犯罪率逐年遽增。筆者提供受害者一站式服務，提高性侵害案件處理效率。再者，建議設立「個案管理社工師」進行個案管理，利用多媒體、親子教育學堂及設立校園心理輔導機制，強化親子溝通技巧與與青少年性健康促進網路教育資源服務。另外，急診護理人員在職教育訓練中，應強化心理創傷之危機處置及溝通技巧，提供受害者一個安全、可信任的醫療環境。

關鍵字

性侵害；急性疼痛；強暴創傷症候群；家庭因應失能

並列摘要

This article describes a young girl who was sexually assaulted due to online dating. During the emergency medical visit, it was discovered that in addition to physical resistance that caused traumatic wound pain, she also experienced symptoms of emotional agitation, vigilance, and nightmares. The mother of the case failed to give timely emotional support, and hence motivates the author to explore. Nursing period took place in October 2020, from 14:00 of 15th to 09:00 of 16th, a total of 19 hours, according to physical, psychological, social development, and spiritual level of assessment; data are collected through direct care, observation, medical record review, interviews to established that the case experiences health problems such as acute pain, rape trauma syndrome, and family response disabilities. In response to the above problems, in addition to analgesic medications, teach cold and hot compresses, relaxation techniques, and so on to divert attention for pain relieve; provide independent space for evidence collection, avoid repeating the victimization process, and connect with the campus for follow-up psychological consultation. In addition, through the therapeutic relationship between nurses and patients, understand the needs of individual cases and identify problems, help establish parent-child communication channels, and improve the family's ability to respond. Many young people make friends through dating software and games apart from using the internet as search engine for information during their curriculum. This also led to the rapid increase in the rate of cybercrime sexual assaults as years goes by. The author provides a one-stop service for victims to improve the efficiency of handling sexual assault cases. Furthermore, it is recommended to set up a "case management social worker" for case management, use multimedia, parent-child education school, and establish a campus psychological counseling mechanism to strengthen parent-child communication skills and promote online service resource for youth sexual health education. In addition, in the on-the-job education and training of emergency nurses, the crisis management and communication skills of psychological trauma should be strengthened to provide victims with a safe and trustworthy medical environment.

並列關鍵字

sexual assault ； acute pain ； rape trauma syndrome ； family coping disability

參考文獻

張羽鳳、陳國彥（2017）．兒少時期女性受性侵者性態度重建歷程之研究．性學研究， 7(2) ， 91-120 。 https://doi.org/10.6206/SIS.2017.0702.04

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Palmieri, J., & Valentine, J. L. (2021). Using trauma-informed care to address sexual assault and intimate partner violence in primary care. The Journal for Nurse Practitioners, 17(1), 44-48. https://doi.org/10.1016/j.nurpra.2020.08.028

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