醫務社工執行性侵害驗傷採證業務之挑戰與因應

醫務社會工作中，急診社會工作因急診環境、時效性、問題多樣化等，內容繁雜並具挑戰性，其中性侵害案件挑戰醫務社工的專業知能、個人特質、價值觀及文化敏感度。性侵害是受到世界衛生組織關注的議題，發生的因素多重、交織且複雜，造成倖存者生理、心理、社會等層面的創傷。我國透過法律保障倖存者的權益，並明訂各相關專業人員之權責；亦發展性侵害驗傷採證相關服務與方案，以確保驗傷採證品質，避免倖存者受到二次傷害。研究者欲探究醫務社工執行性侵害驗傷採證業務時於個案工作、醫療團隊、跨專業網絡單位、行政的挑戰與因應方式，也了解醫務社工對現今性侵害驗傷採證的流程、政策之改善建議與回饋。本研究採用質性研究方法，透過立意取樣及滾雪球取樣招募研究對象，並使用半結構式問卷，深度訪談16位現職於醫療院所之醫務社工，再以主題分析法為核心概念，進行研究資料之分析。研究發現醫務社工在個案工作中，對於具脆弱性因素的倖存者，能透過專業基礎教育、實務工作中經驗的積累、在職教育訓練，給予性侵害倖存者同理及支持並捍衛倖存者的權益。文化敏感度、驗傷採證程序與認知、工作態度與負荷為影響院內團隊執行性侵害驗傷採證業務之因素，醫務社工透過院內教育訓練、團隊會議，能與團隊成員溝通協調，改善團隊運作情形。在與跨專業網絡單位合作中，醫務社工透過合作經驗的積累，與網絡單位建立關係與合作模式，以利性侵害業務執行順暢。在行政業務層面，院內團隊的人力流失與不足、勞動權益與福利需被重視且改善。醫務社工於性侵害驗傷採證業務中，並非流於執行行政業務角色，實能在驗傷採證業務中發揮其專業，於醫護專業團隊中擔任引導、輔助的角色，發揮社工關懷、人性與柔性的專業角色。本研究對政策業務推動建議有以下：重視醫務社工專業，改善醫務社工勞動條件，給予備勤及出勤津貼，評估並調整人力配置標準；考慮倖存者特性，檢視現今性侵害驗傷採證流程；評估及協助採證責任醫院改善急診空間環境，以建立對倖存者友善之環境；考慮採納國外經驗，評估建立性侵害驗傷採證專責機構之可能性。

In the field of medical social work, social workers in the emergency room (ER) face challenges due to the complex and time-sensitive nature of the ER environment, as well as the diversity of issues that are encountered. Among these challenges, cases involving sexual assault pose a test to the professional competence, personal qualities, values, and cultural sensitivity of medical social workers.Sexual assault is a global concern recognized by the World Health Organization. It involves multiple intersectionality and complex factors contributing to its occurrence, resulting in trauma across physical, psychological, and social dimensions for survivors. In our country, there are legal measures in place to protect the rights of survivors, and the responsibilities of relevant professionals are clearly defined. Services and programs related to sexual assault forensic examinations have also been developed to ensure the quality of forensic evidence, thereby preventing survivors from experiencing secondary harm. This study aims to investigate the challenges and coping strategies of medical social workers in conducting sexual assault forensic examinations in the areas of casework, collaboration with medical teams, interprofessional networking, and administrative aspects. Additionally, it aims to comprehend the recommendations and feedback of medical social workers concerning the current processes and policies related to sexual assault forensic examinations.Using a qualitative research approach, the study recruited participants through purposive and snowball sampling and conducted in-depth interviews with 16 active medical social workers in healthcare institutions. The core concept of thematic analysis was employed to analyze the research data.Findings from the study reveal that in individual casework, medical social workers can provide empathy, support, and advocacy for survivors with vulnerable factors through a combination of professional foundational education, accumulated practical experience, and ongoing in-service education and training. Factors such as cultural sensitivity, the forensic examination process, work attitude, and workload are identified as influencing the execution of sexual assault forensic examinations within the hospital team. Through internal education, training, and team meetings, medical social workers can communicate and coordinate with team members to improve team functioning. In collaboration with interprofessional networking units, accumulated collaborative experiences enable medical social workers to build relationships and cooperation models for the smooth execution of sexual assault-related tasks. On the administrative level, attention and improvements are needed to address staff turnover and shortage within the hospital team, as well as labor rights and welfare considerations.Medical social workers engaged in sexual assault forensic examinations do not merely fulfill administrative roles; instead, they actively contribute their professional expertise within the healthcare professional team, assuming guidance and support roles; and embodying the caring, humanistic, and flexible aspects of social work.The study proposes several policy recommendations: emphasizing the professionalism of medical social workers, improving their working conditions, providing on-call and attendance allowances, and evaluating and adjusting staffing standards. Consideration should be given to the characteristics of survivors in reviewing the current sexual assault forensic examination process. Evaluation and assistance should be provided to hospitals with forensic examination responsibilities to improve the ER space environment, creating a survivor-friendly setting. Drawing from international experiences, the possibility of establishing a specialized agency for sexual assault forensic examinations should be considered and evaluated.