運用Swanson關懷照護理論照顧一位遭受性侵害智能障礙個案之急診護理經驗

Emergency Nursing Experience in Caring for a Mild Intellectual Disability Case Experiencing Sexual Assault by Using Swanson’s Caring Theory

本文探討一位輕度智能障礙個案，遭受養父性侵害的急診護理過程，就醫經過為學校老師揭發個案被養父性侵害事件，至急診進行性侵害採證流程。護理期間為2021年05月11日08:30至13:00，筆者藉由直接照護、關懷陪伴、會談及身體評估等方式收集資料，依生理、心理、社會、智能與靈性五大層面加以評估分析，確立個案主要健康問題為急性疼痛、強暴創傷症候群。護理照護過程運用Swanson關懷照護理論提供個別性護理措施，經由「了解」、「在旁陪伴」與個案建立信任治療性關係，鼓勵表達身體不適及內心感受，提供安全心理支持，並運用「為他做某些事」、「使他能夠」的專業知識及熟練護理技巧介入，進行傷口照護以減輕疼痛並進行性侵害採證，最後使個案能「維持信念」尋求專業協助走出身心理傷痛，偕同跨領域團隊合作，幫助個案盡早安置及重返校園日常生活；建議日後可建立性侵害採證標準流程，加強臨床個案相關教育經驗分享，透過實際操作、影片教學等提升實務能力。期望藉由此照護經驗分享，多加運用關懷理論於臨床照護，以同理、陪伴、尊重與信任關係，提供遭受性侵害個案獨立安全環境，提升急診日後對此類個案的照護品質。

This article focused on the nursing experience at emergency department of a case with mild intellectual disability who was encountered sexual assault by the adoptive father. After the case's teacher found out this sexual assault incident, the teacher took the case to the emergency department for the evidence collection of sexual assault. The author collected the case's information through physical assessment, caring, interview, and direct nursing care from 8:30 am to 13:00 pm on May 11 of 2021. Overall physical, psychological, social, mental and spiritual conditions were evaluated and the major health problems were identified: acute pain and rape trauma syndrome. Swanson's Caring Theory was applied to provide individualized care, through the process of ''knowing'' and ''being with'' while establishing the therapeutic relationship and encouraging the expression of physical discomfort and inner feeling, so as to provide psychological support. Through ''doing for'' and ''enabling'', the author use professional knowledge and nursing skill to perform wound caring to reduce pain and go on the evidence collection of sexual assault. Finally, enable the case to keep ''maintaining belief'', cooperating with the inter-professional team to assist the case in achieving recovery from the rape trauma syndrome and return to school daily life as soon as possible. Propose to establish a standard process for sexual assault evidence collection in the future, strengthen the sharing of educational experience related to clinical cases, and improve practical ability through practical operations and video teaching. Looking forward to more application of the Swanson's Caring Theory in clinical nursing through the sharing of this nursing experience. Based on empathy, company, respect and confidence relationship, provide the case of sexual assault with a private and safe environment, also improve the quality of the process of sexual assault evidence collection and physical, mental and spiritual care.