臺灣博碩士論文加值系統

背景：性侵害是一種犯罪行為，且對受害者帶來負面的身心理影響。目前台灣性侵害案件逐年增加，健康照護者在性侵害採證照護上的知識與技術多來自經驗的傳承，因此衛生福利部發展的「性侵害案件採證及驗傷流程」之光碟與手冊，協助健康照護者在照護受害者過程有所依據。但光碟與手冊缺乏以實證照護為基礎的發展過程。若有一份性侵害採證照護指引可以具體提供專業照護者照護標準與依據，可提供更好及有能力的照護，協助受害者身心之恢復。
研究目的：針對16歲以上的女性性侵受害者為對象，發展以實證為基礎的採證臨床指引及成效評值
研究方法：根據Bowker等人（2008/2009）之步驟發展指引分主要分為指引發展期與成效評值期兩階段，指引發展期有七大步驟，包含（1）成立指引發展小組；（2）依指引主題回顧國外臨床指引內容；（3）建構臨床相關問題；（4）依臨床問題進行系統性文獻回顧、使用Critical Appraisal Skill Program (CASP)評讀文獻；（5）撰寫臨床指引建議草案；（6）有32位的醫政、社政、警政領域專家，進行三回合德爾菲法共識決策過程(Delphi consensus process)；（7）邀請3位方法學專家，使用Appraisal of Guideline for Research and Evaluation II (AGREE II) 評值指引發展過程。成效評值期為邀請10位急診臨床護理人員，評值指引的執行可行性及執行困難度、邀請12位性侵害受害者，評值對採證照護過程之滿意度。
研究結果：在指引發展期，經32位跨領域的專家，進行三回合的德爾菲共識，最後指引內容以 1.性侵害受害者為中心的照護、 2.知情同意、 3.通報/報案、 4.身體評估/治療、 5.證據收集、 6.預防懷孕/性傳染病、 7.安排門診追蹤及轉介、 8.記錄等八大面向，包含72項臨床指引建議項目。每項臨床指引建議項目達87.5%以上的專家同意度，其中，記錄面向達最高的專家同意程度（99.4%），身體評估/治療面向為最低的同意程度（96.1%）。再經3位方法學專家以六大面向評值本指引發展過程的品質與嚴謹度，有2位專家建議採用本指引，但有1位專家雖建議採用本指引，但內容需修改。指引整體的品質平均分數為5分 (SD = .94, range =4-6, potential range =1-7 )，各面向的標準化分數為58~83%，範圍及目的面向達最高，應用性面向為最低。在指引評值期，有10位的臨床護理人員實際應用於性侵採證照護，評值此指引的整體執行可行性之平均分數為4.4（SD = .51, potential range: 1-5），執行困難度之平均分數為1.7 (SD = .26, potential range: 1-5），意指此指引實際應用於臨床，大部分可行且容易做到。有12位女性性侵害受害者評值採證照護過程滿意度，整體照護平均滿意度為9.5 (SD = .77, potential range = 0-10)，而在以個案為中心的照護、臨床護理人員的專業性之分量表中，每題項的滿意程度皆達4.5分以上 (potential range = 1-5)，他們也提供了正向的經驗（如護理人員能以同理心對待我）。
結論：本研究為台灣第一份16歲以上的女性性侵害採證照護指引，能提供健康照護者最新及以實證為基礎的知識，且在照護性害受害者有一致性的臨床做法，以提供最佳、敏感及有能力的照護過程。另也可作為未來他人參考此指引發展過程的例子。

SUMMARY
This study aimed to develop and evaluate a clinical guideline on sexual assault evidence collection for female victims aged 16 and above guided by Bowker et al. (2008/2009) including development and evaluation phases. The guideline development phase consists of 7 steps: (1) building a guideline development team; (2) reviewing international sexual assault forensic exam guidelines; (3) forming major PICO questions; (4) conducting systemic reviews and critically appraising studies; (5) drafting a guideline; (6) conducting a 3-round Delphi study with 32 multidisciplinary experts; and (7) evaluating the newly developed guideline by 3 methodologists. In the implementation and evaluation phase, 10 emergency department (ED) nurses evaluated the clinical feasibility and difficulty of using the guidance, and 12 sexual assault victims rated their satisfaction during the process. The final version of guideline yielded 72 items in 8 domains: victim-centered care, informed consent, reporting, physical assessment/treatment, evidence collection, pregnancy/STD prevention, follow-up care, and medical forensic record. All items achieved an 87.5% or above consensus. Three methodological experts evaluated the guideline as good quality (M ̅ = 5, SD = .94). Ten ED nurses felt the guideline was feasible (M ̅ = 4.4, SD = .51) and not difficult (M ̅ = 1.7, SD = .26) to use. Twelve victims were highly satisfied with the care they received (M ̅ = 9.5, SD = .77). This guideline can provide forensic examiners with up-to-date, evidence-based and standardized care strategies and protocols to provide sensitive and competent care for female victims of sexual assault.

中文摘要 i
英文延伸摘要 iii
誌謝 vi
表目錄 x
圖目錄 x
第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 5
第三節 研究問題 5
第四節 名詞解釋 6
第二章 文獻查證 7
第一節 女性性侵害受害者的身心健康影響 7
第二節 性侵害證據 10
第三節 以性侵害受害者為中心的照護 12
第四節 實證臨床照護指引的發展 14
第三章 研究方法 19
第一節 研究設計 19
第二節 研究工具 37
第三節 資料收集過程 40
第四節 倫理考量 41
第五節 資料分析 43
第四章 研究結果 45
第一節 德爾菲專家共識結果 45
第二節 方法學專家評值指引品質及嚴謹度之結果 79
第三節 臨床護理人員評值指引臨床適用性 82
第四節 性侵害受害者評值採證照護過程的滿意度 92
第五章 討論 94
第一節 發展指引內容的共識過程 94
第二節 指引的品質與嚴謹度 101
第三節 指引的適用性 102
第四節 性侵害受害者對採證照護過程滿意度 104
第五節 研究限制 105
第六節 未來研究方向 106
第六章 結論 107
第七章 參考資料 108
附件一 臨床試驗委員會同意臨床試驗證明書 120
附件二 系統性文獻回顧搜尋歷程 122
附件三 第一回合德爾菲法共識決策問卷 135
附件四 第二回合德爾菲法共識決策問卷 153
附件五 第三回合德爾菲法共識決策問卷 171
附件六 16歲以上女性性侵害採證臨床指引 191
附件七 指引臨床適用性問卷 199
附件八 採證照護過程之滿意度問卷 219

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