一位未成年少女遭網友性侵害導致出血性休克之急診護理經驗

本文描述一位17歲少女與男網友約會遭性侵害導致陰道撕裂傷、大量出血且具休克徵象之急診護理經驗，照護期間為2020年7月18日08點00分至15點30分，入院時血壓83/52 mmHg，因血壓低且需提供隱密環境，故入急救室並給予圍簾使用，經醫師內診後發現陰道撕裂傷三公分且出血不止，需入開刀房縫合；筆者有感近年來性侵害年齡層降低且個案受害後大量出血、生命徵象不穩定，故引發筆者選案之動機，透過直接護理、觀察及會談等方式，運用Gordon十一項健康功能評估，確立有一、潛在危險性休克；二、急性疼痛；三、強暴創傷症候群等三項健康問題。筆者全程陪同並引導個案表達其內心感受及擔憂，後續轉介社會資源及支持團體，除給予疾病照護與鼓勵配合治療外，應深入心理層面了解需求，協助家屬共同陪伴給予情緒支持與抒發，因性侵害個案於急診停留時間短暫，個案遭受嚴重身心創傷，建議除會診社工外，應與精神科整合共同會診，一同引導個案度過心理創傷，建議院方提供相關教育訓練或派員參加院外所舉辦之性侵害防治研習等相關課程及講座，使急診同仁深刻體會個案的處境及加強實務訓練，期望藉此個案報告之經驗，提供急診護理同仁之照護參考。

關鍵字

未成年；性侵害；急診室

並列摘要

This article describes a 17-year-old girl who was sexually assaulted whilst on a date with a male netizen, resulting in vaginal laceration, massive bleeding, and signs of shock. During the nursing period, from 08:00~15:30 on July 18, 2020, blood pressure on admission was 83/52 mmHg. Due to the low blood pressure and the need for privacy, we provided her an emergency room with curtain. A vaginal examination conducted by a doctor found that the vagina was lacerated to three centimeters and the bleeding continued, so it was necessary to go to the operating room for suturing. Through direct nursing, observation, and interviews, the author feels that the age group of sexual assault has decreased in recent years. The victim suffered a lot of bleeding and unstable vital signs which triggered the motivation of the author to research this case. Using Gordon 11 Function Health Patterns Assessment, identified three issues include Risk for Shock, Acute Pain, and Rape Trauma Syndrome. The author accompanies and guides the victim to express her feelings and concerns, hence refers her to social resources and support groups. In addition to provide disease care and encourage cooperative treatment, nurses should also understand their own psychological requirements; assist to arrange family members to be presented for support. For sexual assault cases in the emergency department was merely a short stay, if the case suffers from severe physical and mental trauma, it is recommended that in addition to consult social worker, also integrated consultations with the psychiatry to guide the case through the psychological trauma. It is also recommended that the hospital provide relevant education and training for all emergency nurses or dispatch personnel to participate in relevant courses and lectures such as sexual assault prevention seminars held outside the hospital, so that emergency colleagues can fully understand the situation of the case and strengthen practical training. Hopefully this case report can serve as a reference for emergency care colleagues.

並列關鍵字

underage ； sexual assault ； emergency room

參考文獻

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