性侵兒童之急診治療性遊戲歷程

A Nursing Experience of the Application of Play Therapy to a Preschool Child with Sexual Assaults

陳瑞怡(Rui-Yi Chen) ； 李香君(Hsiang-Chun Lee)

《領導護理》 10卷3期 (2009/12) Pp. 54-64

https://doi.org/10.29494/LN.200912.0006

摘要

本文是描述運用馬斯洛理論之護理評估，照顧一位4歲遭到性侵案童的護理經驗。護理期間爲2007年2月25日上午八點十分至下午五點，地點位於急診觀察室，採用開放性問診方式向祖母詢問案童情況及到院就診目的：得知案童遭受性侵，故先將案童先帶至隱蔽、安全的空間保護案童，再進行進一步的問診、婦產科會診及採證；筆者經由間診及觀察發現案童主要的護理問題有；創傷後反應與親職功能障礙問題。護理措施因考量案章爲學齡前期孩童，故運用遊戲治療，轉換見童可以理解方式向其解說，以引導案童說明發生經過。護理過程中除協助驗傷、診療外，也提供安全隱密環境並運用關懷、傾聽技巧，讓案童及家屬能卸下心防，傾訴家庭結構及事件來龍去脈，教導個案家屬避免可能使個案再次受到傷害及如何利用社會資源，讓個案及家屬能在就醫時得到完整且適切性的護理照護。期望藉此護理經驗能提供護理人員適當、且具個別保護性護理措施，作爲日後照顧類似病人之參考。

關鍵字

馬斯洛理論 ； 性侵害 ； 學齡前兒童 ； 遊獻治療

並列摘要

This article described a nursing experience of a 4-year-old preschooler with sexual assaults in the emergency department. The nursing period was from 08:10 to 17:00 on February 25, 2007. With Maslow's theory, the case was assessed via an open interview with the child and the child's grandmother. Based on the child's status, the purpose of the emergency visit, and for the sake of safety and protection, the patient was brought to a private room. Evidences were collected and obtained via further interview and gynecological and obstetrical consultations. Identified major nursing problems were post-traumatic sydrome and parenting dysfunction. Through play therapy, the child was led to tell the happening of sexual assaults. The nursing interventions included not only the examination and treatment of physical injury, but also the provision of a safe and private environment for the child and family to tell the event without psychological concern. The child's family was taught how to protect the child against sexual assaults and utilize social resources to obtain integral and appropriate nursing care. This article shared a personal nursing experience with nurses who will care for similar cases in the future, with the expectation of offering nursing interventions with individual privacy and protection.

並列關鍵字

Maslow theory ； sexual assault ； pre-school child ； play therapy