Identification of factors influencing core competence promotion among professional nurses and midwives: a qualitative study using the COM-B model

Women's reproductive, maternal, new-born, child and adolescent health (RMNCAH) is a cornerstone for sustainable human development and a driving force for the progress of the whole society, especially among the ageing and low fertility population in China (Qiao et al., 2021). Because of this, the United Nation’s Sustainable Development Goals (SDGs) have focused on this (United Nations Population Fund, 2021). In the past decades, China's RMNCAH has made remarkable achievements in the SDGs by reducing maternal and child mortality (Alkema et al., 2016). However, China also faces many challenges. For example, the indirect obstetric causes of maternal death increased from 28.7% in 2000 to 54.1% in 2018 (Department of Maternal and Child Health, National Health Commission of China, 2019).

According to one review that examined 556 maternal deaths caused by obstetric haemorrhage, among factors related to health care, 71.8% were associated with healthcare professionals' insufficient knowledge about haemorrhage risk or inadequate skills to respond to it (World Health Organization, 2013). Numerous studies have indicated that high-quality nursing and midwifery could prevent two-thirds of maternal and new-born deaths, save 4.3 million lives every year, increase breastfeeding and immunisation rates and reduce postnatal depression and caesarean section rates (Nove et al., 2021; World Health Organization, 2019). In mainland China, midwifery is considered a branch of nursing (Huang et al., 2020) and midwives are registered nurses who have obtained the ‘Maternal and Newborn Care Technical Examination Certificate’ (Yu & Chen, 2017). In recent years, the government and universities have made plans for the development of the midwifery profession, but the development of the midwifery profession has been limited due to the late start and the imperfect management system for midwives (Jiang et al., 2018). Although nurses and midwives have different clinical functions (Zhu et al., 2018), they have both made significant contributions to Chinese birth-care (Liu et al., 2021, Jiang et al., 2018). Therefore, it is necessary to strengthen knowledge and skills among nurses and midwives of the Maternity and Child Health Care Hospital. However, the State of the World's Nursing 2020 report underlines the lack of global investment in the quality of nursing education, especially in low- and middle-income countries, including China. China needs to increase their investment in nursing education to attain health goals, such as universal health coverage, emergency preparedness and response, patient safety and the provision of integrated person-centred care (World Health Organization, 2020).

Among all the goals, improving core nursing competence is at the centre stage of nursing education plans. Core nursing competence, which is a combination of knowledge, skills and professional behaviours, is essential to professional careers and directly affects the quality and safety of care (Yaqoob Mohammed Al Jabri et al., 2021). In 2003, the International Council of Nurses proposed a core competency framework for registered nurses, stating that the core competencies of nursing are “the skills necessary for nursing staff to provide safe, ethical care to populations” (Alexander & Runciman, 2003). Based on this, Liu et al. (2007) developed a competency framework for Chinese nurses in 2005, which divided the core competencies into legal/ethical practice, clinical care, interpersonal relations, critical thinking and research aptitude, leadership, professional development and teaching-coaching (Liu et al., 2007). In China, while the core competencies of nurses and midwives are at an intermediate level (Dai et al., 2018, Li et al., 2022; R. Wang et al., 2022), there is still room for improvement. Although previous studies have developed many interventions to improve nurses’ core competencies, such as scenario-based simulation teaching and tiered training (Hsu et al., 2015, Zhang et al., 2021; mingli Zhao et al., 2019), they have the following drawbacks: they do not analyse which theory to choose that will guide the formulation of interventions, they do not fully consider the internal and external factors that influence the behaviour change of the individuals before the intervention is developed and they ignore nurses and midwives in the Maternity and Child Health Care Hospital. Therefore, even though the abovementioned interventions are effective, their scientific nature and comprehensiveness are inadequate. Improving the core competencies of nurses and midwives in in an effective and targeted manner is a challenge for achieving the SDGs.

On this basis, this study aimed to use the capability, opportunity, motivation and behaviour (COM-B) model as a theoretical model, which is at the centre of the behaviour change wheel and a comprehensive tool for guiding intervention development (Michie et al., 2011). The COM-B model posits that all three components affect behaviour (Madden et al., 2021). This model contends that an individual's behaviour results from the interaction of three components: the capability to carry out the behaviour, opportunity to engage in the behaviour and motivation underlying the behaviour at the moment (Michie, 2014, Michie and West, 2013). Capability refers to the physical (skills, functional status, etc.) and mental (memory, intentions, etc.) capabilities of an individual to engage in a behaviour. Likewise, opportunity includes both physical (free time, economic level, etc.) and social opportunities (peer support, customs, etc.), referring to all external factors that enhance behaviour. Motivation has two subcomponents: automatic motivation (such as habits and emotional reactions) and reflective motivation (such as plans and evaluations) (Michie, 2014, Michie et al., 2011). A significant advantage of the COM-B model is that it provides a comprehensive and systematic understanding of the barriers and facilitators of the behavioural model. Researchers can use this model to diagnose how to achieve a desired behaviour, which provides a basis for designing behavioural interventions (Buchanan et al., 2021, Michie, 2014, Timlin et al., 2021). Therefore, the UK National Institute for Health and Care Excellence cited the COM-B model as a key theory for understanding and supporting behaviour change (National Institute for Health and Care Excellence, 2014). Therefore, this study used this model to identify the multiple factors influencing nurses’ and midwives’ behaviour to guide the development of better intervention strategies. Additionally, qualitative research can help develop a theoretical understanding of target behaviours (Cadogan et al., 2016, Rubinstein et al., 2015). Although the COM-B model has been applied to behaviour change interventions in multiple studies (Flannery et al., 2018, Law et al., 2021), it has not yet been applied to qualitative studies designed to improve the core competencies of nurses and midwives.

Therefore, this study aimed to explore the factors influencing improvement in the core competencies of nurses and midwives in the Maternity and Child Health Care Hospital using the COM-B model as a guide. This study will be used to develop interventions to improve the core competencies of nurses and midwives in the Maternity and Child Health Care Hospital and in order to reach SDGs.

留言 (0)

沒有登入
gif