Facilitators and barriers to competence development among students and newly qualified nurses, midwives and medical doctors: a global perspective

Abstract

Background The availability of a skilled health professional (nurse, midwife or doctor) who has been trained and is fit for practice to provide maternity care is fundamental in scaling down and ending preventable maternal and child deaths. Knowing the determinants of the development of ideal skills for effective practice ensures that women and their babies receive quality maternity care services from skilled birth attendants who are fit for practice. This study aimed to find and build on the existing evidence addressing aspects linked to competence and confidence development during training among students, newly qualified nurses, doctors and midwives from a global perspective. Methods A literature review was undertaken, using the ‘SPIDER’ search strategy to identify relevant papers from multiple databases. Studies were included if they were written in English and related to midwives, nurses and medical doctors when they were students, newly qualified professionals or after they had been working for 3-4 months. Opinion or non-empirical papers, editorials, conference papers and empirical articles with abstracts were excluded. Search words were used to identify papers that examined competence and confidence development while training these health professionals. A total of 2281 papers were identified, from countries in Europe, Australia, Asia, America and Africa. Overall, 62 papers were analysed. Results One core category, ‘learning environment’, emerged, with two overarching subcategories, ‘internal environment’ and ‘external environment’ when examining facilitators and barriers to competence and confidence development. Conclusions Facilitators and barriers to competence and confidence development are centred on the learning and practice environment. These are difficult to separate, as they are driven by either the student's or the newly qualified professional's experience with the learning and practice environment. This highlights the need for diversity and open mindedness among mentors and administrators in manipulating the environment to the benefit of either the student or the newly qualified professional so that mothers and their babies receive quality care.