一位 10 歲兒童因全身多處處於不同癒合階段的瘀傷入院。家長全程守在床邊並代替孩子回答所有問題。護理師應優先採取哪項行動？
A 10-year-old child is admitted for multiple bruises in various stages of healing. The child's parent remains at the bedside constantly and answers all questions for the child. Which action should the nurse take first?
- ADocument the bruises in detail with measurements and locations詳細記錄瘀傷，包括測量和位置
- BConfront the parent about the suspicious injuries就可疑傷害與家長對質
- CNotify the authorities of suspected child abuse immediately立即通報主管機關懷疑兒童虐待
- DAsk the parent to leave the room so the nurse can interview the child privately✓ 正解請家長離開房間，以便護理師私下訪談兒童
核心概念是疑似受虐兒童的評估技巧。家長過度保護或代替回答是典型的警訊。為什麼正確答案對？為了獲得真實的病史並保護受害者，護理師必須提供一個安全的環境讓孩子說話，這通常需要將家長帶離房間（例如以填寫表格或辦理手續為藉口）。臨床思路上，先「收集證據與評估」再「通報」。雖然通報是法定義務，但在通報前必須完成關鍵的隱私訪談。安全優先原則要求護理師在不驚動施暴者的情況下，優先確保能與孩子進行無干擾的溝通。選項 C 是後續動作，A 是評估的一部分，但 B 是獲取真相的關鍵步驟。
The core concept is the assessment technique used with a child suspected of being abused. Overprotectiveness or answering on the child's behalf is a classic warning sign. Why is the correct answer right? To obtain an accurate history and protect the victim, the nurse must provide a safe environment in which the child can speak. This typically requires removing the parent from the room (for example, by using an errand such as filling out forms or completing admission paperwork as a pretext). Clinically, the sequence is to 'gather evidence and assess' before 'reporting.' Although reporting is a legal duty, a critical private interview must be completed before that report. The safety-first principle requires the nurse to ensure undisturbed communication with the child without alerting the abuser. Option C is a later action, A is part of the assessment, but D is the key step for uncovering the truth.
在美國，護理師是 Mandatory Reporter（義務通報者），法律保護通報者免受報復。在台灣，雖然也有《兒童及少年福利與權益保障法》規定的通報機制，但臨床實務中，護理師常因擔心醫病關係破裂或家長鬧事而感到壓力，需更依賴社工介入協助。