性侵受害成年男性於急診採證之照護經驗

Care Experience of Forensic Evidence Collection and Initial Care of a Sexually-Assaulted Male in the Emergency Department

10.6540/NTJN.202309_25(2).0011

戴光輝(Kuang-Hui Tai)；吳柏勲(Bo-Hsun Wu)

性侵害 ； 急診 ； 性侵害採檢 ； 性侵害照護 ； 成年男性 ； sexual assault ； emergency department ； forensic examination ； sexual assault care ； adult male

新臺北護理期刊

25卷2期（2023 / 09 / 01）

120 - 129

繁體中文;英文

本文闡述一位成年男性遭受性侵害後，因擔心同性戀傾向曝光而延遲就醫的急診採證及照護經驗。照護期間為2019年10月22日20：26至23：33，以會談、觀察與直接照護，運用生理、心理、社會及靈性評估架構進行資料收集後，確立個案有「急性疼痛」、「急性壓力症候群」等健康問題。在急診忙碌的環境，筆者透過不批判的態度，接納個案的性別傾向，建立護病信任基礎，讓個案願意闡述自己的被害經驗及可能現身（coming out）的擔憂是分享此個案的重要理由。性侵害對個案生理及心理有極大傷害，而急診是性侵採檢與照護的主要窗口，忙碌而開放的環境可能使個案更加緊張與不安，因此確保個案隱私，以專業及尊重的態度協助個案採檢，盡早評估因性侵引發的急性壓力症候群之照護是個案能否成功度過性侵危機關鍵。因為個案停留在急診的時間較短，對於個案後續變化的追蹤有其限制，因此後續社工的轉介與社會資源的連結更是延續性侵照護的重要策略。希望藉由此照護經驗提供第一線急診護理人員日後照護類似個案之參考。

This is an emergency nursing care experience with forensic evidence collection in the emergency department (ED) that described a gay-male who delayed seeking for medical intervention after being sexually assaulted due to the concern of disclosing his gay sexual orientation. The direct care, nurse-to-patient conversation, and observation skills were provided to this case from 20:26 to 23:33, October 22nd, 2019. Data was collected through an integrated physiological, psychological, societal, and spiritual needs assessment framework. Afterward, two health issues of "acute pain" and "acute stress disorder" were confirmed. This experience demonstrated the importance of the non-judgmental and supportive attitude in caring for patients with different sexual orientation in a busy emergency environment. Furthermore, a trustful nurse-to-patient relationship facilitated patient describing his victimization experience and concerns about coming out. Sexual assault often led to significant physiological and psychological harm to the patient and the ED is the main avenue for forensic medical examination of sexual assault in Taiwan. However, the hectic and open ED environment may increase patient's discomfort and worsen anxiety. Therefore, protecting the patient's privacy and assisting in the patient's examination with a professional and friendly attitude, and investigating the symptoms of his acute stress as soon as possible were keys that allowed our patient to manage this crisis. Due to the short stay in ED, we were not able to provide follow-up care for the patient. Thus, further referral of social workers and connection to social care resources are vital to continuous care. We share this ED care experiences with other ED nursing staff who can benefit from this knowledge when taking care of similar patients in the future.

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