背景：母乳喂养的益处是其他喂养方式无可比拟的。世界卫生组织（WHO）呼吁各国政府重视母乳喂养，提高母乳喂养率，培训助产士和护士等卫生保健工作者，向母亲和家庭提供熟练的母乳喂养指导。但目前国内医护人员的母乳喂养知识以及对母乳喂养咨询专业人员的培养尚存在不足，并缺乏相应的胜任力指标体系构建研究。

目的：基于洋葱模型构建我国母乳喂养咨询护士核心胜任力指标体系。

方法：本研究采用文献分析、半结构化访谈和德尔菲法，检索万方、知网、PubMed等六个中英文数据库，从建库至2022年9月国内外开展母乳喂养咨询或指导相关的护士胜任力指标体系构建的文献；结合半结构访谈，从母乳喂养咨询护士（n=18）以及进行母乳喂养的哺乳期女性（n=11）的双视角探索胜任力特征，建立我国母乳喂养咨询护士核心胜任力框架。最后经过两轮专家函询，邀请15名相关领域的专家，结合层次分析法，确定了母乳喂养咨询护士核心胜任力指标体系内容及Ⅰ、Ⅱ级指标权重。

结果：

1. 本研究通过文献分析，从IBCLC临床能力及纳入的14篇文献中提取了15个类别，以及78条具体胜任力指标；通过半结构访谈增加了1个类别，以及22条胜任力指标。基于洋葱模型进行整合分析，初步构建我国母乳喂养咨询护士核心胜任力框架，包含4个Ⅰ级指标，16个Ⅱ级指标，100个Ⅲ级指标。

2. 本研究进行了两轮专家函询，两轮专家积极系数均为100%；专家权威程度较高（Cr=0.92）；两轮专家的Kendall’s W协调系数在0.206（χ²=293.69）~0.296（χ²=62.07）之间，经χ²检验差异有统计学意义（P<0.01），说明专家意见的协同性较好，CV在0.00~0.23；第一轮函询各条目重要性平均得分为4.63（3.93~5.00）±0.305分，满分比为0.667~1；第二轮函询各条目重要性平均得分为4.54（4.20~5.00）±0.297分，满分比为0.80~1。最终形成我国母乳喂养咨询护士核心胜任力指标体系，包括Ⅰ级指标4个（核心知识与技能、专业能力、维持专业标准、职业与个人特质），Ⅱ级指标15个，Ⅲ级指标95个。各Ⅰ级指标的权重排名依次为：核心知识与技能（0.3498），然后依次是专业能力（0.2858）、维持专业标准（0.1915）、职业和个人特质（0.1728），均通过一致性检验CR<0.10。

结论：本研究构建的我国母乳喂养咨询护士核心胜任力指标体系内容较为全面，具有一定的科学性、可靠性和全面性，能为我国母乳喂养咨询护士的培训或认证提供参考，提高其母乳喂养咨询能力，促进母乳喂养率的提高。

Background: The benefits of breastfeeding are unmatched by any other form of feeding. The World Health Organization (WHO) is calling on worldwide governments to focus on breastfeeding, increase breastfeeding rates, train health care workers such as midwives and nurses, and provide skilled breastfeeding guidance to mothers and families. However, at present, there are still deficiencies in breastfeeding knowledge of medical staff and the training of breast-feeding consulting professionals in China, and the corresponding competency index system construction research is lacking.

Objectives: We aims to construct the index system of core competencies of breastfeeding consulting nurses in China based on onion model.

Methods: In our study, we used literature analysis, semi-structured interview, Delphi method. Clinical Competencies for the Practice of International Board Certified Lactation Consultants and literatures on the construction of competency index system related to breastfeeding consulting and guidance nurses at home and abroad were retrieved to extract competency entries in domestic and abroad database such as Wan Fang, PubMed etc. from the establish of database to September 2022. Combined with semi-structured interviews, competency characteristics were explored from the dual perspectives of breastfeeding counseling nurses (n=18) and lactating women (n=11), the core competency framework of Chinese breastfeeding counseling nurses was established. Finally, through two rounds of Delphi, in which 15 experts in related fields were invited, the core competency index system contents and index weight were determined with analytic hierarchy process.

Results:

1. Through literature analysis, 15 categories and 78 specific competency indicators were extracted from IBCLC clinical competence and 14 included literatures. One category and 22 competency indicators were added through semi-structured interview. After integration analysis based on the onion model, the core competency framework of Chinese breastfeeding consulting nurses was preliminarily constructed, including 4 first-level indexes, 16 second-level indexes and 100 third-level indexes.

2. Through two rounds of Delphi, the positive coefficients of the two rounds of expert consultation were both 100%; the degree of expert authority was high (Cr=0.92); the Kendall's W of two rounds of experts was between 0.206(χ2=293.69) and 0.296(χ2=62.07), and the difference was statistically significant by χ2 test (P<0.01), indicating that the coordination of expert opinions was good, with CV ranging from 0.00 to 0.23. In the first round of consultation, the average importance score of each item was 4.63(3.93-5.00) ±0.305, and the full score ratio was 0.667-1. The average importance score of each item in the second round of consultation was 4.54(4.20-5.00) ±0.297, and the full score ratio was 0.80-1. Finally, the index system of core competence of breastfeeding consulting nurses in China was finally formed, including 4 first-level indicators (core knowledge and skills, professional competence, maintaining professional standards, professional and personal traits), 15 second-level indicators and 95 third-level indicators. The weight ranking of each level I index is as follows: core knowledge and skills (0.3498), professional ability (0.2858), maintenance of professional standards (0.1915), and professional and personal traits (0.1728), all of which pass the consistency test CR<0.10.

Conclusions: The core competency index system for Chinese breastfeeding counseling nurses constructed in this study is comprehensive, scientific, systematic and authoritative. The index system can provide a reference for the training or certification of breastfeeding counseling professionals in China, improve their breastfeeding counseling ability and promote the improvement of breastfeeding rate.