一位童年遭受性侵倖存者創傷後反應之護理經驗

The Care Experience of an Adult Survivor of Post-Traumatic Reactions to Childhood Sexua1 Abuse

本文皆在描述協助一位童年時曾遭受熟識者性侵的27歲未婚女性，由於連續腹瀉而住院，住院時因陌生人無意的搬床動作，使個案創傷再現，內心出現恐懼、害怕、焦慮、等。行為出現哭泣、憤怒甚至有自殺意念，經筆者護理輔導後逐漸走出陰霾之照護經驗。護理期間為2011 年3 月16 日至2011 年4 月18 日。個案因長期不易信賴他人、人際互動不良，對於親密肢體接觸更是戒慎恐懼。筆者運用會談、傾聽、身體評估、電話訪談收集資料，以五大層面進行整體性護理評估，發現其健康問題有「潛在危險性自我殘害」、「睡眠型態紊亂」、「強暴創傷症候群」。利用Watson十項關懷照護因素指引提供個案溫暖、安全、支持性環境建立信任感。運用關懷陪伴與傾聽，鼓勵個案表達及說出心中成受，教導她如何宣洩情緒，並給予支持和鼓勵。提供疾病相關照護資訊，引導自我察覺、增進人際互動，並以創傷後心理問題為重心，協助個案接受心理諮商，找回屬於自己的生命意義與存在價值，開創新的自我以面對未來的生活。This paper reported the nursing experience with a 27-year-old unmarried woman who suffered from sexual assault by a known man when she was in childhood. The woman was hospitalized due to continuous diarrhea. The trauma event of the woman reappeared due to the accidental action of the stranger next to her bed. The patient had feeling of fear and anxiety. She cried, angered and even tried to commit suicide. After nurse-provided counseling by the author, the patient gradually came out of the shadow. The nursing care period was between March 16 and April 18, 2011. The patient had a deep distrust of other people for a long period and had bad interpersonal relationships. She was very cautious about close physical contact. During the nursing care period, the author used personal talks, careful listen, physical assessment, and telephone interview together with five levels of integrity nursing assessment and found that the patient had three unhealthy issues, namely, potential risk of self-mutilation. sleep disturbance, and the rape-traumatic syndrome, By using ten carative factors of Watson's human caring theory to provide warm, safe and supportive environment, the nurse built a trusty relationship with the patient. Using thoughtfulness to accompany and listen, the nurse encouraged the patient to speak out about her feelings as well as taught her how to vent her depression. We also supported and encouraged the patient to study information about her disease, to guide her self-awareness, and eventually to increase her social interaction with others. Based upon her problems, we assisted the patient to accept psychological counseling with an emphasis on Post-Traumatic psychological issues. Then she could find her own meaning of life and existence value to start a new life.