North American nurse educators in the HOPE Earth Project and Nursing teaching

Objective: analyze the activities of the North American nurse educators of the Project Health Opportunity for People Everywhere Earth (HOPE Earth Project) in Natal, state capital of Rio Grande do Norte, Brazil (1974-1981). Method: sociohistorical, qualitative study, resulting from fi led documents and ten semistructured interviews. These sources were processed and analyzed using Oral History and Thematic Analysis. Results: the following categories emerged: The North American nurse educators of the HOPE Earth Project and Educator Mary Anne Small through the memories of who had contact with her. Final considerations: the HOPE Earth Project contributed to higher education in health at the Federal University of Rio Grande do Norte, guaranteeing the coming of qualifi ed and experienced lecturers, and the North American educators cooperated towards the qualifi cation of the Nursing Course, even when it was already structured and fully functioning. Descriptors: History of Nursing; Education; Education, Higher; Teaching; International Cooperation. RESUMO Objetivo: analisar a atuação das enfermeiras professoras norte-americanas do Project Health Opportunity for People Everywhere Earth (Projeto HOPE Terra), em Natal, capital do Rio Grande do Norte, Brasil (1974-1981). Método: estudo sócio-histórico, qualitativo, resultante de documentos pertencentes a arquivos e da realização de 10 entrevistas semiestruturadas. O tratamento e a análise dessas fontes realizaram-se por meio do recurso à História Oral e à Análise Temática. Resultados: emergiram as seguintes categorias: As enfermeiras professoras norte-americanas do Projeto HOPE Terra e A professora Mary Anne Small pelas memórias de quem conviveu com ela. Considerações fi nais: o Projeto HOPE Terra contribuiu para o ensino superior de cursos da área da saúde na Universidade Federal do Rio Grande do Norte, assegurando a vinda de docentes qualifi cados e experientes, e as professoras norte-americanas colaboraram para a qualifi cação do Curso de Enfermagem, mesmo quando este já se encontrava estruturado e em pleno funcionamento. Descritores: História da Enfermagem; Educação; Ensino Superior; Docência; Cooperação Internacional. RESUMEN Objetivo: analizar el rendimiento de las enfermeras profesoras norteamericanas del Project Health Opportunity for People Everywhere Earth (Proyecto HOPE Tierra) en la ciudad de Natal, capital del Rio Grande do Norte, Brasil (1974-1981). Método: estudio sociohistórico, cualitativo, resultante de documentos pertenecientes a archivos y de la realización de 10 entrevistas semiestructuradas. El tratamiento y el análisis de esas fuentes se realizaron por medio del recurso a la Historia Oral y al Análisis Temático. Resultados: han surgido las siguientes categorías: Las enfermeras profesoras norteamericanas del Proyecto HOPE Tierra y la profesora Mary Anne Small por las memorias de las personas que convivieron con ella. Consideraciones fi nales: el Proyecto HOPE Terra contribuyó a la enseñanza superior de cursos del área de la salud en la Universidad Federal de Rio


INTRODUCTION
The institutionalization of the teaching of Modern Nursing in Rio Grande do Norte (RN), Brazil, is marked by the beginning of the operation in 1956 of the Natal School of Auxiliary Nurses, current School of Health of the Federal University of Rio Grande do Norte (ESUFRN), at the Hospital Universitário Onofre Lopes (HUOL), for mid-level training (1) .
In the 1970s, the first initiatives towards the institutionalization of higher nursing education in RN were registered in the cities of Mossoró (1971) and Natal (1974), the capital of the state.The creation and operation of these institutions served different interests, although justified by the same need, the formation of skilled labor for the health services in the state.This movement was particularly important for local education because, before the existence and functioning of these institutions, those interested in the Nursing career had to go to neighboring states to study.
In Natal, the Nursing Course at the Federal University of Rio Grande do Norte (UFRN) obtained a favorable opinion (2) , approval (3) and 30 vacancies for the entrance exam in January 1974 (4) .The course permitted the structuring of the Nursing Department, which, together with the departments of Medicine, Pharmacy, Dentistry, Physical Education and Biological Sciences, became part of the Health Sciences Center.
The operation of the Nursing Course was made possible by ESUFRN's assignment of its physical facilities -classrooms, teaching materials, laboratory, library -and staff -teachers and staff.Thus, the same physical space started to harbor three levels of Nursing education: auxiliary (1956), technical (1972) and superior (1974).At that time, the few nurses in Natal worked almost all in university hospitals -HUOL and Teaching Maternity Hospital Januário Cicco -and in ESUFRN, attached to the Faculty of Medicine, in 1964, as teachers or supervisors of curricular internships (5) .
Thus, for the effective functioning of the Nursing Department, a selection was needed to hire new nurse educators, which resulted in the composition of a group of professionals from the states of Ceará, Paraíba, Pernambuco and the city of Mossoró / RN.In addition to these, we highlight the presence of female North American nurse educators from the HOPE Earth Project (1973-1985), the focus of this manuscript, hired by UFRN as visiting professors, to work exclusively in the subjects of the Vocational Cycle of the Nursing Course.
The HOPE Earth Project corresponds to a development of the agreement signed among UFRN, State Government / RN and the People to People Foundation, based in Washington / USA, in which the forwarding of the SS HOPE hospital ship was guaranteed in 1972, with the purpose of promoting professional exchange and providing health care to the population.In this new version, the cooperation between Brazil (UFRN) and the USA (People to People Foundation) ensured the sending of US professionals with teaching experience to leverage higher education in the Medicine, Dentistry, Pharmacy and Nursing courses (6)(7) .

OBJECTIVE
To analyze the activities of the North American nurses of the HOPE Earth Project in Natal / RN, from 1974 to 1981.The start of the interval corresponds to the arrival of the first female nurse educators, and the end to the departure of Mary Anne Small, the last nurse educator to return to the United States.

Ethical aspects
This article was elaborated according to the current legislation on research involving human beings, and its project received approval from the Ethics Committee for Research involving Human Beings at the Federal University of Santa Catarina.

Theoretical framework and study design
Sociohistorical study with a qualitative approach, based on the New History.This research modality contributes to the understanding of the history of health care and supports interpretations of the development of the profession, its actors and social contexts.In the case of Nursing, it is intended to understand the nature and daily life of work, prejudices, stereotypes, misconceptions, truths, untruths and their meanings (8)(9)(10) .

Study scenario
The study was based on the expansion of higher education in Nursing in Rio Grande do Norte, which occurred in the 1970sthe height of the military regime -resulting from the University Reform of 1968.During this period, the School of Nursing in Mossoró (1971) and Natal (1974), both initiatives justified by the need for professional qualification and improved health care.

Collection and organization of data
The documents were collected between January and April / 2013, and the oral sources were collected between January and July / 2014.Ten interviews were held with collaborators -three nurse educators, founders of the Nursing Department / UFRN; three nurse educators, cooperators, and four former students of the Nursing Course / UFRN -who complied with the voluntary participation criteria and who had contact with the North American nurses who served as visiting educators.Therefore, the methodological resources of the Oral Thematic History were used.
The interviews took place after the presentation and signing of the Free and Informed Consent Form, with an average recording of 86 minutes.After being transcribed and transcreated, they were returned to the collaborators for the validation of the information.After this stage, the Oral Testimony Assignment Term was presented, read and signed.Finally, it was agreed to identify the statements by the collaborators' surnames.

Data analysis
The aim of the thematic analysis was a meticulous interpretation of the data to obtain an objective and systematic understanding of the meanings derived from documentary and oral sources.At the end of this process, two categories emerged: The North American nurse educators of the HOPE Earth Project and Educator Mary Anne Small through the memories of who had contact with her.

RESULTS
The North American Nurse Educators of the HOPE Earth Project Based on the following testimonies, the insertion and activities of the North American nurse educators in the Nursing Course / UFRN can be reconstructed, based on the detailing of their professional characteristics and work activities.The stories permitted reconstructing part of the history of the Nursing Department / UFRN in its first years of operation and to record some impressions on the visiting educators, all North American nurses of the HOPE Earth Project.The statements showed feelings of affection and admiration, with emphasis on professional recognition through the valuation of qualification, technical competence, availability and good relationship, despite the seriousness, rigor and demand with which they are also recalled.As persons, they are reminded for their simplicity and humanity.Although their contributions are undeniable, none of the contributors specified the date of their departure, nor mentioned/recalled gestures and/ or attitudes of farewell, even less to maintain contact and keep up the friendship.Nevertheless, these professionals stay alive in the memory of who had contact with them.
Professor Mary Anne Small through the memory of who had contact with her In this section, memories of students and fellow educators are presented about the physical and personality characteristics that permitted reconstructing this character's image, whose professional activities many research collaborators highlighted enthusiastically.According to her students:    The testimonials also connote Mary Anne Small's excessive dedication to work and suggest signs of stress as she was always carrying heavy books and folders, just as her large steps demonstrate that she is in a hurry and / or overloaded.Even so, her attributes earned her a special homage from the graduating class of 1979.
What matter is that, after all these years, Mary Anne Small lives on in the memory of those she had contact with.Regarding the data presented here, it is important to note that they were not intended to elaborate her biography, but merely to value the memories about their personality, after all, according to the collaborators, her experience and resourcefulness at work made her be considered as a differential at the time.

DISCUSSION
The HOPE Earth Project (1973-1985) was an expansion of the international cooperation contract between Brazil (UFRN) and the United States (People to People Foundation), initiated in 1972, with the stay of the hospital ship SS HOPE, for ten months, in Natal / RN.The continuation of this partnership was marked, above all, by the activities of the North American professionals serving as visiting educators in the courses of the health area at the Center of Health Sciences / UFRN.
In the case of the Nursing Course, the statements guaranteed that the structuring of the subjects and the operation of the Nursing Department happened before those nurses' insertion in the course, and that their arrival coincides with the start of the subjects in the Vocational Cycle.What these professionals are concerned, the cooperators highlighted their importance and contribution to the teaching, but clarified one detail: the existence of a strong and experienced group of Brazilian nurse educators, responsible for the creation, organization and functioning of the course and the Nursing Department / UFRN, which did not depend on the North American Group.At that time, higher education structured in cycles -basic (subjects shared by the areas) and vocational (specific to each course) -was one of the innovations of the 1968 university reform, which was intended to organize teaching based on the unified adoption of a model.Despite the objections, what Nursing is concerned, this structure caused a positive impact, bringing about the growth of teaching with an increased number of places resulting from the emergence of new schools (11) .This detail was proven in RN by the functioning of the Mossoró School of Nurses, the current School of Nursing of the State University of Rio Grande do Norte (FAEN / UERN) and the Nursing Department / UFRN, in 1971 and 1974, respectively (12) .
The collected material showed that the nurses of the HOPE Earth Project -Mary Anne Small, Margareth Mein da Costa, Jane Marie Shima, Tyana Payne and Shirley Myers Snowe -served as visiting educators at the Nursing Department / UFRN (13) .Nevertheless, the students and fellow educators strongly mentioned Sheron Redding, the educator on whom no documents were found that referred to her hiring.This demonstrates the quality of her work and her influence in these groups.
The presence of North American nurses at UFRN for human resource training in Nursing is yet another experience between Brazil and the United States.In this respect, the following can be highlighted: the Parsons Mission (1922-31), surveying the situation of Nursing in the country, the creation of the Nursing Service and the School of Nurses of the National Department of Public Health; the operation of the Division of Nursing (1942-61) of the Special Public Health Service; and the participation in the creation of Nursing Schools, such as the School of Nursing in the states of Pará (1944) and Alagoas (1974) (14)(15) .
The activities of the visiting nurse educators studied here were not limited to the Nursing Department.Although this detail may cause estrangement or show a work overload, it is in line with the agreement between UFRN and the People to People Foundation about sending professionals -physicians, dentists, pharmacists, pathologists and nurses -to hospitals, health institutions and clinics, with prior authorization (6) .
With regard to the teaching activities, it was revealed that these teachers worked in the subjects of the Maternal-Infant, Public Health and Medical-Surgical areas, teaching theoreticalpractical classes, and as supervisors in the curricular practicums.The care activities carried out at the Children's Hospital Varela Santiago and at the Health Services, in the neighborhoods Cidade Nova and Cidade da Esperança, were community services and are seen as an effort to keep theory and practice close.Thus, the North American nurse educators of the HOPE Earth Project conquered prestige and acknowledgement through the accomplishment of the teaching and care activities.It is worth stressing the commitment to overcome the different working conditions in the country and the awakening to the "Brazilian way" -creative -of improvising to solve labor adversities.This situation suggests that, despite the different realities, there was an exchange of experiences and knowledge.
In the particular case of Nursing, it is of fundamental importance to develop information systems based on the understanding of the relationship between theory and practice, in order to reduce the care gaps.Although this relationship is absent in some circumstances, it needs to be valued, as the dissociation between one and the other implies an outdated education and, consequently, an outdated future professional.Likewise, the overvaluation of one over the other ends up compromising the education in line with the social changes (16) .It is believed, therefore, that this contextualized articulation between teaching and service facilitates learning and leads the student to a reflective practice based on a realistic experience in the different environments of the health services (17)(18) .
As far as Professor Mary Anne Small is concerned, her former students presented some features that made it possible to project the image of a tall, wide-eyed, smiling, dark and curly-haired woman with educated, discrete, introverted and respectful personality traits.As a teacher, she is remembered for wearing the light blue striped lab coat and for being a determined, committed, ethical, competent and skillful professional, to the extent of being considered a model.
The neighborhoods of Cidade da Esperança, Cidade Nova and Felipe Camarão are designated as places where Mary Anne Small developed and implemented measures to combat maternal and child health problems through the practice of home visits and interventions in schools.This practice gave her the assumption of being responsible for the beginning of Nursing action planning and of the prenatal consultation in health services in Natal.These attitudes are close to what is nowadays advocated by the Systematization of Nursing Care (SAE) as a technicalscientific strategy used to ensure the -responsible, appropriate and individualized -management of care and as a perspective to guarantee nurses' autonomy (19) .
These procedures, exclusive to nurses, concern the Nursing Process and are intended to formalize the organization and registration of care practice.Its development involves through the following steps: data collection or Nursing history; Nursing diagnosis; Nursing planning; implementation; and Nursing assessment (20) .As regards Mary Anne Small's work on the outskirts of Natal / RN, it is assumed that she possessed background information, possibly surveyed during the stay of the hospital ship SS HOPE in 1972, in view of the reported funding of expenses, availability of vehicles and a driver, supply of (usage and consumption) material, distribution of scholarships to Nursing students, preparation of Health Promoters -similar to the current community health agents.It is a fact that this action was deliberate, as this work turned into a Community Service Project of 20 hours per week, and the collected data supported Mary Anne Small's Master's Thesis, as one collaborator affirmed.
These details may justify the intensity of her work.In this respect, her image is of an obstinate professional, focused on basic care and on public health teaching, to the extent of gaining prestige at the State Health Department of RN.
Regarding the data of her research, the results were published in manuscript form, entitled: Evaluation of a primary health care program in the peri-urban area, in partnership with the scholarship student Rosana Lúcia Alves de Vilar, now Full Professor at the Nursing Department / UFRN.This is a comparative study between two communities on the outskirts of Natal, where the primary health care program had been implemented.Its publication served to disseminate the health indices and to evaluate the impact of the actions developed by the Health Promoters (21) .
Among the visiting female nurse educators, Mary Anne Small was the last to leave the Nursing Department / UFRN and who spent the longest period there (1974-1981).During this period, her contact seems to have "contaminated" her students with the passion for Public Health Nursing.Many of them were able to get a job at the State Department of Health shortly after graduating.
Finally, it is important to reaffirm that the HOPE Earth Project (1973-1985) was intended to leverage higher education in the health area of UFRN but, in the case of Nursing, the departure of Professor Mary Anne Small in 1981 ended this international cooperation.About her, at present, she supposedly lives in California / USA.For this study, several attempts were made to contact her -letters, e-mails and phone calls -all without success.

Limitations of the study
Lack of documentation about the HOPE Earth Project and the North American nurse educators, leading to imprecision as to how many and how long they worked at the Nursing Department / UFRN.Failure to contact Mary Anne Small to serve as a contributor to this study.
Contributions to the area of Nursing, health or public policy This is the record of another important episode of technical cooperation between Brazil and the United States, this time intended to enhance the courses in the health area / UFRN.It corresponds, therefore, to the intention to contribute to the memory and the history of nursing and higher education in RN, as well as to serve as a stimulus for new productions on the subject, considering that the HOPE Project also happened in another Brazilian state.

CONCLUSION
This study was aimed at analyzing the performance of the North American nurses of the HOPE Earth Project in the Nursing Course of UFRN, from 1974 to 1981.The presence of these professionals was the result of the agreements signed between UFRN and the People to People Foundation, responsible for sending health professionals with teaching experience to work as teachers, as visiting educators, in the health courses, in this case at the Nursing Department of UFRN.
It is important to point out that the arrival of the North American nurse educators coincides with the start of the Vocational Cycle, that is, with the Nursing Course being fully operational.It is known, therefore, that they contributed by teaching classes and accompanying students in the curricular practicums of the disciplines in Maternal-Infant Nursing, Medical-Surgical Nursing and Public Health Nursing.Still, they worked simultaneously in hospitals and public health institutions in Natal, as the collaborators reported.
Finally, these visiting nurse educators remain alive in the memories of the people they had contact with, being remembered with fondness for the simplicity, skills, competence and professionalism, with special attention to the teacher Mary Anne Small.Thus, it is legitimate to pay tribute to both the HOPE Terra Project and those North American nurse educators for their exchange.
Perhaps the idea of inviting North American nurses to work in the NursingDepartment came from Prof. Leide Morais [...] when they arrived in Natal, the hospital ship HOPE had already left, and the Project was called HOPE Earth [...] they were hired by UFRN as visiting educators [...] in my view, their stay was very useful, but some people disagree [...] all were experienced in higher education.(BARRETO) These visiting educators collaborated with the Nursing Course / UFRN, but they were not essential for its operation [...] there was a strong and experienced group of nurse educators at the School of Auxiliary Nurses, responsible for the organization, planning and execution.(OLIVEIRA) I remember the educators Sharon Redding [Pediatrics], Linda [Medical-Surgical], Jane Shima [Neonatology], Shirley [I do not remember her last name and area] and Mary Anne Small [Public Health].(VILAR) Even though they spoke Portuguese poorly, they contributed to us [...] some even participated in the Brazilian Nursing Association, section Rio Grande do Norte [...] I am referring to Sharon Redding and Mary Anne Small.(GERMANO) Regarding the participation of these educators in the Nursing Course / UFRN, this is what the collaborators reported: The North American nurse educators were active in the disciplines of Maternal-Infant Nursing, Medical-Surgical Nursing and Public Health Nursing [...].They contributed theoretical-practical classes and the supervision of curricular internships.(COELHO) They were amazed at how we Brazilians could work with few resources, having to improvise and solve problems [...] if they lacked some things, they would stop doing the procedure or ask us for help [...] they faced limitations with the language and, sometimes, difficulties arose, but everything was solved with tranquility.(MARTINS VIEIRA) They were skillful and prestigious [...] Sharon Redding accumulated functions at the Nursing Department and the Varela Santiago Children's Hospital [...] Mary Ann Small as well, in the Department and at Health Centers in Cidade da Esperança and Cidade Nova.(DINIZ) Their technical competence, knowledge and professional commitment stood out [...] they were experienced and excellent teachers [...] gave importance to the interaction between theory and practice, always [...] they worked in the perspective of Nursing as a science [...].brought a visual model that also influenced us [...] they wore light blue coats with stripes for Public Health and white for the hospitals [...] use of the closed white shoe and identification with the badge [...] common things today, but not at that time [...] their departure was gradual and, in my opinion, very well organized, because they took care to leave qualified people to take their places.(VILAR) They were qualified teachers and transmitted the image of professional excellence with the profile of simplicity and humanity [...] we knew that they had to pass through other countries [...] they seemed simple in their clothing and without vanity, but focused on the professional posture [...] they made every possible effort to transmit their knowledge [...] they were interactive and well accepted in the environments where they circulated [...] the Portuguese was understandable [laughs] [...] I regretted their return to the United States.(FILGUEIRA)

North
American nurse educators in the HOPE Earth Project and Nursing teaching Carlos DJD, Padilha MICS, Peres MAA, Bellaguarda MLR, Vesco SNPD.Source: Private collection of nurse Francineide Silva dos Santos, former student.

Figure 1 -
Figure 1 -Mary Anne Small She was a prominent teacher, and she stayed the longest at the Nursing Department / UFRN [...] an expert on Public Health issues [...] in my undergraduate training, she is one of my references [...] skilled and dedicated teacher who knew how to pass on the knowledge [...] she wore a pale blue lab coat with stripes, which was adopted by the Public Health Nursing discipline [...] she made all possible efforts to attend to the students, but she was extremely demanding [...] we learned a lot from the educator Mary Anne Small.(OLIVEIRA) According to her peers: I met Mary Anne Small developing a primary health care project in the neighborhoods of Cidade Nova, Cidade da Esperança and Felipe Camarão, funded by the HOPE Project [...] she had a vehicle, driver, material for use and consumption and she paid for the health promoters and scholarship students' expenses [...] this project consisted of childcare activities and was executed in partnership with the educator Normélia Maria Freire Diniz in prenatal care [...] to justify the workload and ensure the continuity of these actions, a project of 20 hours per week was created at the Pro-Rectory of Community Services [...] Mary Anne Small also played an important role in the planning and accomplishment of the first Specialization Course in Public Health Nursing at UFRN. (BRITO) As a colleague, Mary Anne was determined, committed and responsible [...] as a professional, she was also affiliated with the State Department of Health and, in the services, she enjoyed a lot of prestige and respect [...] she was a differential at the time and, therefore, a target of jealousy [...] very experienced, had already worked with needy populations [...] remained attentive and defended the planning of nursing actions [...] we worked together identifying severe cases of anemia in pregnant women and children, and we took them to the competent services within an information system similar to the references and counterreferrals, established by SUS [...] those actions aimed at combating and controlling maternal and child health problems.(DINIZ) She collaborated a lot with teaching in Public Health Nursing [...] her home and the work were the Nursing Department / UFRN [...] she was a doer, and, politically, I thought she did not collaborated, no [...] she was obsessed with work, could not stop for a moment to think a little [...] in the 1980s, Brazil lived a more democratic political perspective [...] she was very rigid and authoritarian, too authoritarian [...] we had some incompatibilities [...] if, on the one hand, Mary Anne Small contributed to basic care, on the other hand, she criticized Brazil very much [...] I soon got angry.(GERMANO) Our educator Mary Anne Small was lean, tall, smiling, with dark curly hair, a large mouth and lively eyes[...]she talked from her heart and with emotion [...] she was humane, understanding and very ethical [...] sometimes, she seemed apprehensive and looked at us as if she wanted to guess what we were thinking [...] she transmitted the image of an extremely focused professional [...] an independent woman and ahead of her time [...] she seemed introverted, shy and without further social participation [...] she was always occupied with the work, giving the impression that she was working all the time, looking like a machine and who never rested [...] she walked fast, with large steps, carrying folders, books and bags.(FILGUEIRA) According to her, her surname, Small, was incongruous with her height [...] shoulder-length hair, always misaligned [...] she had an easy and wide smile [...] without vanity, her nails were very short, she wore a ring and a necklace ... worked hard, all day long [...] she drank a lot of coffee and hardly ate [...] she wore big sandals, nothing pretty [...] very ethical, polite and careful in dealing with people [...] I never saw her call anyone's attention except in secrecy and discretely [...] we perceived in her gaze the call of attention but never a lack of education [...] our class paid her special homage at graduation [...] she was decisive in my choice of Public Health [...] I last saw her at the State Department of Health, presenting some data about her research.(FERREIRA)