研究背景：健康照護人員對兒童虐待性頭部創傷的知識及敏感度為處理兒童虐待性頭部創傷事件時的醫療決策之關鍵，然而，健康照護人員對兒童虐待性頭部創傷知識卻是不足的，透過兒童虐待性頭部創傷相關教育訓練計畫為增加健康照護人員對兒童虐待性頭部創傷之知識、處理信心及減低嬰幼兒因兒童虐待性頭部創傷所致導的失能或死亡。目前針對兒童虐待性頭部創傷之教育訓練計畫內容不足且不一致，無法因應第一線醫護人員照護之需求，也無法滿足兒童虐待性頭部創傷之健康照護需求。因此，發展兒童虐待性頭部創傷教育訓練計畫為刻不容緩之事宜，藉此增加健康照護人員對此議題的臨床知能及信心，亦可增進兒童虐待性頭部創傷之嬰幼兒及其家庭的照護品質。
研究目的：本研究目的為發展兒童虐待性頭部創傷教育訓練計畫並驗證其可行性。
研究方法：本研究採兩階段進行，第一階段係以德爾菲研究法發展兒童虐待性頭部創傷教育訓練計畫之核心要素及驗證此教育訓練計畫之內容效度。以立意取樣邀請15位專家作為德爾菲專家群，另邀請5位專家驗證此教育訓練計畫的內容效度。第二階段則為可行性研究，以驗證兒童虐待性頭部創傷教育訓練計畫之可行性。以方便取樣招募31位護理師作為可行性研究之研究對象，其工作領域涵蓋急診、新生兒科、兒科及產科等單位。以研究者自擬式的可行性問卷評估兒童虐待性頭部創傷教育訓練計畫的可行性、實用性及滿意度。以描述性統計分析研究資料。
研究結果：Triple-CARES 為本研究所發展之教育訓練計畫。15位德爾菲專家完成三回合的德爾菲問卷，涵蓋4位醫師、4位護理專家、3為社會福利領域專家、2位檢察官及2位復健領域專家。經過三回合的德爾菲問卷後，專家對於Triple-CARES之核心要素達到一致性，大多數的Triple-CARES之要素達到4分以上，以育兒態度、依附關係及賦能等相關題項在適合度及重要性的分數最低。Triple-CARES之內容效度均為1分。依照專家建議，修正Triple-CARES內容後，共包含預防、辨識及照護等三層面的核心要素，且以1.5天的工作坊進行教授，以課室教學、課堂練習及討論作為教授Triple-CARES之策略。共29位護理師完成可行性研究及可行性問卷，有26位（89.7%）護理師表示Triple-CARES為可行、實用且滿意的，最令護理師感到可行、實用及滿意的課程為「兒童虐待性頭部創傷之危險因子」、「照顧者自我情緒調節」及「安撫哭泣中嬰兒之技巧」。28位（96.6%）護理師表示接受Triple-CARES後，其在預防、辨識及照護兒童虐待性頭部創傷嬰幼兒及其家庭的信心及自我效能是有增加的，特別是在教導父母親安撫哭泣中嬰兒的技巧，然而，在提供父母親自我情緒調節及早期復健相關資訊的信心及自我效能最低。
研究結論：Triple-CARES 為台灣第一個發展的兒童虐待性頭部創傷之教育訓練計畫，其內容涵蓋預防、辨識及照護兒童虐待性頭部創傷個案及家庭之完整要素。訓練種子師資及將Triple-CARES之內容表準化為未來推廣之重要環節，此外，Triple-CARES之內容亦可作為未來專業人員發展兒童虐待性頭部創傷個案及家庭之衛教媒材的參考。未來可再進一步驗證Triple-CARES 之成效及對其他專業人員之可行性。

Background: Healthcare professionals’ knowledge of and sensitivity to AHT is the key to medical decision-making when they encounter an AHT event. However, insufficient knowledge of AHT among healthcare providers has been noted. AHT education programs for healthcare professionals are an essential step to increase the knowledge of AHT warning signs and to increase confidence, while also to decrease children’s diabilities or mortality resulting from AHT. Current AHT education programs in Taiwan are insufficient and inconsistent with content of education programs, and cannot meet the needs of first-line healthcare professionals or the needs of AHT infants/children. It is imperative to develop AHT education programs for healthcare professionals because such programs can improve healthcare professionals’ clinical knowledge, help them gain confidence, and improve quality of care for AHT infants/children and their families.
Purposes: The purposes of this study were to develop and to validate an AHT education program and evaluate its feasibility.
Methods: A two-stage study was conducted for the purposes of developing an AHT education program and validating its feasibility. The first stage of this study used a Delphi study to develop the core elements of the AHT education program and to validate the content validity of the program. Purposive sampling was used to recruit 15 experts as the panel of experts in the Delphi study. Five experts who were professionals in the medical and social welfare fields were invited to determine the content validity of the initial AHT education program. The second stage of this study was a feasibility study to assess the feasibility of the implementation of the AHT education program. Convenience sampling was used to recruit 31 nurses who worked in emergency departments, neonatal units, pediatric units, and obstetrics units. An investigator-developed instrument was used to evaluate the feasibility, practicality, and degree of satisfaction of the AHT educational program. Descriptive statistics was used to analyze the data of this study.
Results: Triple-CARES was developed as the intervention in this study. Fifteen experts participated in the three rounds of the Delphi study, including 4 physicians, 4 nursing professionals, 3 professionals in social welfare, 2 prosecutors, and 2 professionals in rehabilitation. After 3 rounds of question survey, a consensus of the elements of Triple-CARES was reached by expert panel. Most elements of Triple-CARES were higher or equal to 4 points. Items related to attitude towards childrearing, attachment, and empowerment had the lowest scores on appropriateness and importance. All the I-CVI and S-CVI/Ave of each domain in Triple-CARES were 1. Triple-CARES was comprised of core elements of prevention, identification, and care domains related to AHT, and was conducted as a one-and-a-half day workshop with different teaching strategies of didactic lecture, practice, and discussion. Data of 29 completed questionnaires for the feasibility study were analyzed. Twenty-six (89.7%) nurses indicated that the Triple-CARES was feasible, practical, and satisfied. Sections of “risk factors for AHT”, “emotional self-regulation of caregiver”, and “soothing crying infants” were most feasible, practical, and satisfied section. Twenty-eight (96.6%) thought that their confidence and self-efficacy in preventing, identifying, and caring for children with AHT and their family members have increased after attending the Triple–CARES education program, especially issues related to “educating parents the skills of soothing crying infants”, but had lowest confidence in providing parents with the strategies of emotional self-regulation and information of rehabilitation.
Conclusions: Triple-CARES is the first AHT education program developed in Taiwan. Triple-CARES is comprised of comprehensive elements of prevention, identification, and care for AHT cases and their families. Training seeded trainers and standardizing the content of the course are essential for popularizing Triple-CARES in the future. The content of Triple-CARES can also be used as the base for development of material for professionals to educate parents about prevention of AHT and care for infants with AHT. The effectiveness of Triple-CARES on the knowledge and skills and applicability to other professionals needs to be further examined.

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