遭受性侵害兒童之急診照護經驗－個案報告

Nursing Experience of a Sexually Abused Child in the Emergency Room: A Case Report

10.6200/TCMJ.202003_17(1).0010

陳燕嬌(Yen-Chiao Chen)；李琇蓉(Hsiu-Jung Li)；林惠美(Hui-Mei Lin)

被性侵害兒童 ； 創傷後壓力症候群 ； 遊戲 ； sexually abused child ； post-traumatic stress syndrome ； game

北市醫學雜誌

17卷1期（2020 / 03 / 30）

131 - 142

繁體中文

本文旨在描述一位四歲女童被性侵出現「創傷後壓力症候群」之急診護理經驗。筆者運用Gordon十一項健康功能性評估及發展評估與家庭評估確立護理問題，包括：恐懼、急性疼痛、主要照顧者角色緊張；護理過程中運用個案發展認知階段的治療性遊戲，藉布偶角色扮演、繪畫等象徵性遊戲溝通技巧，在遊戲中與筆者產生信任關係，讓個案了解醫療過程降低入院恐懼以配合驗傷採證，轉移注意力以減輕傷口疼痛。另筆者主動關懷傾聽案母內心感受，提供後續照護指導，適時給予讚美、鼓勵，讓原本緊張、不知所措的母親，於出院時能強化返家自我照顧的信心。經以上護理措施，讓個案順利完成驗傷採證及有效緩解個案傷口疼痛，同時讓案母獲得信心及減輕擔憂。

The purpose of this report is to describe the experience of emergency care for a four-year-old girl who had been sexually assaulted and showed posttraumatic stress syndrome. The author used the Gordon's eleven health functional assessments and development assessments and family assessments to identify the health issues to be cared including fear, acute pain, and tension of the main caregiver. Therapeutic games matching the case development cognitive stage were applied in the nursing process. Through the role-play of puppets and application of symbolic communication skills in painting, trust was established between the client and the author; the client was made understood of the medical procedures so that her fear was reduced and could comply with the sampling and inspection, and her attention was diverted to reduce wound pain. In addition, the author actively listened to the feelings of the client's mother, provided follow-up care guidance, and gave praise and encouragement timely, so that the nervous and overwhelmed mother could strengthen her self-care confidence after discharge. After these nursing care measures, the client accomplished the inspection and her would pain relieved effectively. Also, the mother had improved confidence and reduced anxiety level.