title: Transforming the obstetric nursing workforce in NE Brazil through international collaboration.
abstract: OBJECTIVE
  This paper seeks to analyse the content, people and process of transformational change to introduce new ways of working for specialized obstetric nurses in northeast Brazil, and identify the lessons learned.
  
  
  BACKGROUND
  Countries across the globe are beginning to focus on improving the nursing workforce through new ways of working. High numbers of caesarean sections coupled with high indices of maternal mortality in northeast Brazil prompted the introduction of a British Council Higher Education Links scheme to work collaboratively to transform the role of the specialist obstetric nurse and introduce the principles of Safe Motherhood. The concept of a normal birth had not been widely accepted, with the birth process viewed as a medical condition requiring pharmaco-therapeutic interventions rather than as a natural process.
  
  
  METHODS
  Between 2000 and 2003, a more woman-centred approach to childbirth was introduced through the local delivery of two in-house education programmes and the qualification of 38 nurse-midwives.
  
  
  CONCLUSIONS
  In spite of its slow progress, the success of the Higher Education collaboration has been recognized nationally, a new philosophy is guiding practice and new ways of working have been established.
  
  
  CONCLUSIONS
  Lessons learned include the need to set achievable goals (content), respond to the emotional needs of those involved in the change (people) and make best use of reciprocal visits to rally the teams and sustain the focus for change (process). Although the Higher Education link is complete, funds are being sought for formal evaluation and dissemination. Overall, the process and outcomes of this collaboration suggest that to embrace such an opportunity to learn from each other can lead to real improvements in service and the lives of women.
authors.affiliation: Faculty of Health and Social Care, University of the West of England, Bristol, UK. elizabeth.rosser@uwe.ac.uk
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Girot
authors.forename: Bertha Cruz
authors.initials: BC
authors.lastname: Enders
authors.forename: Joyce
authors.initials: J
authors.lastname: Wright
mesh_terms: D001291:Attitude of Health Personnel; D001938:Brazil; D003142:Communication; D003469:Culture; D003479:Curriculum; D004644:Emotions; D005260:Female; D006801:Humans; D007391:International Cooperation; D007400:Interprofessional Relations; D008880:Midwifery; D009740:Nursing Staff / Q000193:education / Q000523:psychology; D009773:Obstetric Nursing / Q000193:education / Q000458:organization & administration*; D009936:Organizational Innovation; D009937:Organizational Objectives; D010348:Patient Care Team; D018802:Patient-Centered Care