運用「以家庭為中心」理念於一位受虐兒童家庭之照護經驗

Nursing Experience of Applying 'Family-Centered Care' to the Family of an Abused Child

本個案報告主要運用「以家庭為中心」理念呈現一位受虐兒童家庭之照護經驗。父母雙方感情不睦，案母平時習慣體罰病童且情緒難以控制，過去病童曾發右髖關節骨折及雙腿踝燙傷等記錄，身體佈滿嚴重受虐的新舊瘀傷痕跡，診斷為兒痛虐待、腸道破裂及急性胰臟炎，筆者將與個案及家庭互動過程寫成九篇行為過程實錄，以內容分析法歸納出分離焦慮、退化性行為及親職功能障礙等護理問題，運用「以家庭為中心」的護理理念、內在心理互動模式及結合醫療團隊來協助個案家庭渡過危機，並採取留在原生家庭的「家庭維繫方案」，以維持家庭功能的正常運作。經過此次受虐事件後，案父已向法院訴請離婚並取得監護權，並暫時辭職以便專心照顧個案，出院後則轉由案祖母及三姑媽養育，案父再找工作，案母則會診精神科服藥治療。本個案報造將有助於提高兒科護理人員對兒童虐待的警覺度及洞察力，並提供臨床照護的重要參考。

This case report describes the application of “ family-centered care” to the care of the family of an abused child. Owing to parental disharmony, the mother had difficulty in controlling her emotions and used physical punishment on her child. The history of the abused child included right hip fracture, burning of both ankles, severe old and new abuse bruise scars on the body, gastrointestinal rupture and acute pancreatitis. Nine process recordings participant observation and medical chart review were used for data collection. Content analysis revealed separation anxiety, regressive behavior and impaired parenting. Family-centered care, inner psychological interaction model and medical teamwork were used to assist the family in getting through the crisis. We selected a family maintenance program to promote family function. After the child abuse event, the father sought divorce and wardship, and quit his job to care for the child. The child's grandmother and aunt reared her after discharge. Then, her father could look for a job again. Her mother received psychiatric therapy. This case study may increase pediatric nurses' alertness and insight toward abused children, and provide guidance for clinical nursing care.