背景：母乳是婴儿最理想的食物，但我国目前纯母乳喂养率低于世界平均水平且以其目前增长速度难以实现2025年我国纯母乳喂养率目标以及2030年全球纯母乳喂养率目标。医疗卫生人员提供的母乳喂养支持可有效促进母乳喂养率，我国孕产妇对医护人员专业性母乳喂养指导和延续性母乳喂养护理服务的需求较高，但我国母乳喂养咨询人员总体咨询能力不足，对母乳喂养咨询专业人员的培养欠缺统一、科学的培养方案。

目的：构建我国母乳喂养咨询护士培养方案。

方法：本研究首先采用文献分析，检索PubMed、Web of Science、CNKI等八个中英文数据库建库至2023年9月国内外母乳喂养指导或咨询从业人员培养方案的文献，提取培养方案条目；其次通过对从事母乳喂养咨询工作的护士（n=9）以及母婴护理管理者（n=11）进行半结构化访谈，补充培养方案条目，形成我国母乳喂养咨询护士培养方案初稿。最后遴选16名母乳喂养领域专家，通过两轮专家函询，最终确定母乳喂养咨询护士培养方案终稿。

结果：

1. 本研究文献研究部分纳入17篇文献、1个网站、3本书籍，结合母乳喂养咨询护士核心胜任力，最终形成条目池包含4个一级条目，31个二级条目，106个三级条目；通过半结构化访谈增加了10个三级条目，并对已有的9个条目内容进行符合我国国情的修改和补充；整理归纳后形成我国母乳喂养咨询护士培养方案初稿，包括4个一级条目，31个二级条目，116个三级条目。

2. 本研究进行了两轮专家函询，两轮专家积极系数均为100%；专家权威系数0.89；两轮函询后二级条目的Kendall’s W协调系数由0.214(χ²=83.280)增加为0.495(χ²=115.196)，三级条目的Kendall’s W协调系数由0.200(χ²=322.173)增加为0.509(χ²=435.421)，χ²检验P<0.01，均有统计学意义，在95%置信度下专家意见协调性较好且趋于一致；第一轮专家函询各条目重要性得分为4.66(4.06~5.00)±0.233分，满分比为0.375~1；第二轮专家函询各条目重要性得分为4.77(4.25~5.00)±0.175分，满分比为0.438~1。最终形成我国母乳喂养咨询护士培养方案，包括4个一级条目(培养目标、培养内容、考核评价、培养管理)，29个二级条目，90个三级条目，一级条目的权重赋值最高为：培养目标(0.375)和培养内容(0.375)；培养目标维度下权重赋值最高为：核心知识与技能目标(0.185)、母乳喂养评估能力目标(0.185)、咨询沟通能力目标(0185)，培养内容维度下权重赋值最高为：正常母乳喂养支持策略(0.147)，培养管理维度下权重赋值最高为：师资准入标准(0.360)，考核评价维度下“过程性评价”与“终结性评价”权重赋值一致(0.500)。

结论：本研究紧扣母乳喂养咨询护士核心胜任力，设置符合我国国情的培养目标，基于培养目标设置培养内容，并综合考虑考核评价方式以及培养过程中教学方法、准入标准、培养方式等培养管理内容，所构建的母乳喂养咨询护士培养方案内容系统且较为全面，能为我国母乳喂养咨询护士的培养提供理论参考。

Background: Breast milk is the most ideal food for infants, but China's current exclusive breastfeeding rate is lower than the world average, and at its current rate of growth it will be difficult to achieve the 2025 target for China's exclusive breastfeeding rate as well as the 2030 target for the global exclusive breastfeeding rate. Breastfeeding support provided by medical and health personnel can effectively promote breastfeeding rates, and there is a high demand for professional breastfeeding guidance and extended breastfeeding care services from medical and health personnel; however, the overall consultation capacity of breastfeeding counsellors in China is insufficient, and there is a lack of uniform, scientific training programs for breastfeeding counselling professionals.

Objectives: We aim to construct the training program of breastfeeding consulting nurses in China.

Methods: In this study, we used literature analysis to search for the literature on the training programs for breastfeeding counselling practitioners at home and abroad in eight databases firstly , including PubMed, Web of Science, and CNKI, from the establishment of the database to September 2023, and extracted the entries of the training programs; Secondly, semi-structured interviews were conducted with nurses  working in breastfeeding counselling(n=9) as well as maternal and child care managers (n=11) to supplement the training programme entries, and establish a framework for the training programme for breastfeeding counselling nurses in China. Finally, after two rounds of expert consultation, 16 experts in the field of breastfeeding were invited to determine the contents and weights of the training programme for breastfeeding counselling nurses.

Results: 

1. Through literature analysis, this study included 17 pieces of literature, 1 website, and 3 books, which were combined with the core competencies of breastfeeding counselling nurses, resulting in a pool of entries containing 4 first-level entries, 31 second-level entries and 106 third-level entries; 10 third-level entries were added through semi-structured interviews, and the contents of the existing 9 entries were modified and supplemented in accordance with China's national conditions, which formed the preliminary draft of China's breastfeeding counselling nurses' training programme after collation and summarization, including 4 first-level, 31 second-level and 116 third-level entries.

2. Through two rounds of Delphi, the positive coefficient of experts in both rounds was 100%; the coefficient of expert authority was 0.89; the Kendall's W coordination coefficient of the second-level entries increased from 0.214(χ²=83.280) to 0.495(χ²=115.196), and that of the third-level entries increased from 0.200(χ2=322.173) to 0.509(χ²=435.421),  which were statistically significant by the χ² test (P<0.01), indicating that the synergistic nature of the expert opinions was better and convergence; the average importance of each entry of the first-round correspondence score was 4.66 (4.06~5.00)±0.233, and the full score ratio was 0.375~1; the average score of the importance of each entry in the second round of correspondence was 4.77 (4.25~5.00)±0.175, and the full score ratio was 0.438~1. Finally, the breastfeeding counseling nurses' cultivation program was formed in China, which included 4 first-level entries (cultivation goal, cultivation content, assessment, cultivation management), 29 second-level and 90 third-level entries. The highest weights were assigned to the first-level entries: cultivation objectives (0.375) and cultivation contents (0.375); the highest weights were assigned under the cultivation objectives dimension: core knowledge and skills objectives (0.185), breastfeeding assessment competence objectives (0.185), and counselling and communication competence objectives (0185), and the highest weights were assigned under the cultivation contents dimension: normal breastfeeding support strategies (0.147), the highest weight assignment under the dimension of training management was: faculty access criteria (0.360), and the weight assignment of process evaluation and last evaluation under the dimension of assessment and evaluation was the same (0.500).

Conclusions: The training program for breastfeeding counselling nurses in China constructed in this study focuses on the core competencies of breastfeeding counselling nurses, sets training objectives in line with China's national conditions, sets training content based on the training objectives, and comprehensively considers the assessment and evaluation methods as well as the teaching methods, admission standards, training methods and other training management contents in the process of cultivation, which is systematic and comprehensive, and is of a certain degree of scientificity and reliability. The programme is systematic and comprehensive, scientific and reliable, and can provide theoretical reference for the training of breastfeeding counselling nurses in China.