背景：創傷是全球重要的公共健康問題，其影響個體的健康與行為，增加使用醫療與健康照護的機會。醫療環境、治療處置或與健康照護人員的互動皆可能觸發創傷記憶，尤其是充滿壓力的急診環境。創傷知情照護可幫助急診健康照護人員暸解創傷的影響，預防替代性創傷及病人與家屬再度受創。建構急診健康照護人員創傷知情照護的能力是提升健康照護品質的基礎。然而，台灣健康照護領域缺乏創傷知情照護的實務與研究，且現有應用於急診的創傷知情照護教育訓練相關研究中，將創傷知情照護視為一種普遍預防措施者亦有限。了解台灣健康照護人員與有創傷史的人對急診創傷知情照護的需求與阻礙，是建構能符合照顧者與使用者需求與期待之教育訓練課程的基礎。
目的：本研究的目的旨在發展一適用於急診健康照護人員創傷知情照護的教育訓練計畫並驗證其可行性。
方法：本研究採三階段進行。第一階段為需求評估，以質性描述性研究與主題分析法探討創傷知情照護的需求與阻礙。5位急診護理師（平均年齡 = 34.4 ± 4.2 歲）及5位有創傷史的病人或家屬（平均年齡 = 33 ± 11.3 歲）接受訪談。第二階段為措施發展與驗證，採用O'Cathain等人（2019）提出的健康照護介入措施發展架構五步驟以發展創傷知情照護教育訓練措施。邀請5位專家評值訓練課程的內容效度，並以內容效度指標來驗證。第三階段則以前、後測與一個月的追蹤後測評值訓練計畫的可行性。以方便選樣分別納入5位（平均年齡 = 38.8 ± 5.4 歲）及16位（平均年齡 = 37.0 ± 12.1 歲）急診護理師於前驅和主要的可行性研究，探討創傷知情照護教育訓練計畫的可行性、運用創傷知情照護的信心、對創傷知情照護的態度，以及一個月後使用創傷知情照護的行為。描述性統計用來分析參與者的人口學資料及主要變項結果，Friedman's test則用來評估急診健康照護人員信心和態度的變化。
結果：第一階段訪談5位急診護理師與5位有創傷史的病人或家屬，急診健康照護人員的經驗涵蓋3個核心主題和12個次主題，有創傷史的人則涵蓋3個核心主題和9個次主題。提供和接受急診照護的經驗以及對創傷知情照護相關課程的建議皆納為課程發展的參考。第二階段發展之Triple TICs訓練計畫由3大主題和9個元素所組成。五位專家審查之內容效度結果，訓練計畫中各主題之I-CVI及S-CVI/Ave均為1分，顯示具良好的內容效度。Triple TICs訓練計畫最終以混合線上影片與實體工作坊的方式教學。第三階段可行性研究顯示，Triple TICs訓練計畫具高度的可行性、實用性、滿意度，平均分數分別為4.56（SD = .51）、4.49（SD = .56）和4.83（SD = .38）。參與者接受訓練計畫後其對創傷知情照護顯著持有好感及信心，且於一個月追蹤後測持續維持（態度：X2Fr = 8.53, p < .05；信心：X2Fr = 19.34, p < .01）。
結論：Triple TICs為台灣第一個設計給急診健康照護人員的創傷知情照護訓練計畫。本訓練計畫已完善地建構和驗證，並驗證是可行和實用的。未來需要進一步研究檢驗訓練計畫對健康照護人員和病人健康結果的有效性。將創傷知情照護付諸實踐需要機構領導者和所有工作人員之間的合作。Triple TICs 訓練計畫可作為基本的在職教育，以為所有員工和醫療資源使用者創造一個具支持性、創傷知情的環境，從而提高健康照護品質。

Background: Trauma is a significant global public health issue that impacts individuals' overall health and behavior, often leading to increased use of healthcare services. In high-pressure environments like the emergency department (ED), the healthcare setting, treatments, and interactions with providers can sometimes trigger traumatic memories. Trauma-informed care (TIC) helps ED healthcare providers understand the effects of trauma, preventing vicarious trauma and re-traumatization of patients and families. Enhancing ED healthcare providers' competence in TIC is crucial for delivering high-quality care. However, the practice and research of TIC are limited in Taiwan, with a scarcity of TIC educational training programs designed as universal precautions in emergency care. Understanding the needs and barriers related to TIC for ED healthcare providers, as well as the experiences of individuals with trauma histories, is essential for developing an effective educational program.
Purpose: This study aimed to develop and validate a TIC training program for ED healthcare providers and evaluate its feasibility.
Methods: The study was conducted in three phases. Phase I involved a needs assessment using a qualitative descriptive design and thematic analysis to explore the needs and barriers related to TIC at ED in Taiwan. Five ED nurses (mean age = 34.4 ± 4.2 years) and five individuals with trauma histories (mean age = 33 ± 11.3 years) were recruited for qualitative interviews. Phase II focused on developing and validating a TIC training program. O'Cathain et al. (2019)’s 5-step framework for developing healthcare interventions guided the construction of the TIC training program. Five experts were invited to evaluate the program's content validity. Phase III employed a pre-post and one-month follow-up design, including a pilot testing with 5 nurses (mean age = 38.8 ± 5.4 years) and a main feasibility study with 16 nurses (mean age = 37.0 ± 12.1 years) to test the program’s feasibility. Measures included feasibility, confidence in TIC, attitudes toward TIC, and self-reported TIC behaviors. Descriptive statistics described demographics and outcomes, while Friedman's test assessed changes in confidence and attitudes.
Results: In Phase I, qualitative interviews with five female nurses and five individuals with trauma histories identified three core themes and twelve sub-themes for nurses and three core themes and nine sub-themes for individuals with trauma histories. These insights informed the program’s development. Phase II resulted in the creation of the Triple TICs training program. The Triple TICs training program consists of 3 main topics and 9 components, was delivered using a blended learning approach, including pre-recorded online videos and an in-person one-day workshop. Five experts evaluated the program's content validity, with content validity indexes (I-CVI and S-CVI/Ave) all scoring 1, indicating strong validity. Phase III demonstrated high feasibility, practicality, and participant satisfaction with mean scores of 4.56 (SD = .51), 4.49 (SD = .56), and 4.83 (SD = .38), respectively. Participants showed significantly improved and sustained positive attitudes and confidence in TIC from post-test to one-month follow-up (X2Fr = 8.53, p < .05 for attitudes; X2Fr = 19.34, p < .01 for confidence).
Conclusions: The Triple TICs training program is the first TIC training program designed for ED healthcare providers in Taiwan. It was well-established, validated, and demonstrated high feasibility and practicality. Future research should examine the program’s impact on both providers' and patients' health outcomes. Implementing TIC requires a cultural shift and collaboration among institutional leaders and staff. The Triple TICs training program can serve as a foundational tool to enhance leadership and staff awareness of TIC, fostering a supportive environment for all staff and users that improves healthcare quality.

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