Leadership and cooperation: 25 years of mission as a WHO collaborating center

ABSTRACT

Objective:

analyse the evolution in the mission and vision of a World Health Organization Collaborating Centre in Nursing in Brazil in the context of the implementation of its terms of reference.

Method:

Historical-social documentary research with a qualitative approach.

Results:

During the 25 years of its activities as a Collaborating Centre, its mission to "promote and stimulate the development of nursing research in the region, with a focus on Latin America" triggered activities in the context of its terms of reference in four areas: Human Resource Formation for Research, Knowledge Production, Knowledge Dissemination, Encouragement of Exchange and Stimulus of Partnerships.

Conclusion:

The activities developed were consolidated through the strengthening of Brazilian and international partnerships, further stimulated by the five redesignations of the Collaborating Centre in the period analysed. Thus, its vision of becoming leader and driving agent of innovations in the academic, care and political context of nursing could be put in practice.

Descriptors:
Nursing Research, Leadership; World Health Organization; Health Management; Diplomacy

RESUMO

Objetivo:

analisar a evolução da missão e visão de um Centro Colaborador da Organização Mundial da Saúde na área de Enfermagem no Brasil no contexto de implementação de seus termos de referência.

Método:

pesquisa histórico-social de cunho documental e abordagem qualitativa.

Resultados:

nos 25 anos de atuação do Centro Colaborador, sua missão de "promover e incentivar o desenvolvimento da pesquisa em enfermagem na região, com foco na América Latina" foi propulsora de atividades no contexto de seus termos de referência em quatro áreas: Formação de Recursos Humanos para a Pesquisa, Geração de Conhecimento, Disseminação de Conhecimento, Incentivo ao Intercâmbio e Fomento de Parcerias.

Conclusão:

as atividades desenvolvidas consolidaram-se com o fortalecimento de parcerias nacionais e internacionais, fomentadas também pelas cinco redesignações do Centro Colaborador no período analisado, permitindo a concretização de sua visão de tornar-se líder e agente propulsor de inovações nos contextos acadêmico, assistencial e político da enfermagem.

Descritores:
Pesquisa em Enfermagem; Liderança; Organização Mundial da Saúde; Gestão em Saúde; Diplomacia

RESUMEN

Objectivo:

analizar la evolución de la misión y visión de un Centro Colaborador de la Organización Mundial de Salud en el área de Enfermería en Brasil en el contexto de la implementación de sus términos de referencia.

Método:

investigación histórico-social documental, de abordaje cualitativo.

Resultados:

en los 25 años del Centro Colaborador, su misión de "promover e incentivar el desarrollo de la investigación en enfermería en la región, con foco en América Latina" fue propulsora de actividades en el contexto de sus términos de referencia en cuatro áreas: Formación de Recursos Humanos para la Investigación en Enfermería; Generación de Conocimiento; Diseminación de Conocimiento; Incentivo al Intercambio y Fomento de Parcerías.

Conclusión:

las actividades desarrolladas se consolidaron con el fortalecimiento de parcerías nacionales e internacionales, fomentadas también por las cinco redesignaciones del Centro Colaborador, permitiendo la concretización de su visión de se tornar líder y agente propulsor de inovaciones en el contexto academico, del cuidado y político de enfermería.

Descriptores:
Investigación en Enfermería; Liderazgo; Organización Mundial de la Salud; Gestión en Salud; Diplomacia

INTRODUCTION

On December 9^th 2013, the University of São Paulo (EERP-USP) at Ribeirão Preto College of Nursing celebrated its 25^th anniversary as a World Health Organization (WHO) Collaborating Centre for Nursing Research Development⁽¹⁾. The Collaborating Centres represent cooperation mechanisms and are institutions designated by the WHO Director-General to be part of an international collaborative network that executes activities to support organizational programs at all levels. Through the Collaborating Centres, WHO optimizes resources, using institutional capacity to guarantee the scientific feasibility of its actions⁽²⁾.

In 1988, the first designation date, EERP-USP was designated the 11^th WHO Collaborating Centre in Nursing in global terms. By 2013, the Centre had been redesignated five times¹. Its terms of reference were altered in accordance with the evolution in the health policies and needs of the Nursing area detected by the Centre and evidenced by WHO. Throughout these 25 years, its management valued the strategic continuity of its activities, maintaining its mission and adapting its vision to the changes experienced and to the prospection of different scenarios for nursing and health⁽³⁾.

In that sense, the mission of an organization can be understood as its reason for being, making its objective clear and realistic. Its vision, on the opposite, corresponds to a desirable and possible future state for the organization.

The objective in this study is to recover the evolution in the mission and vision of this Collaborating Centre in the implementation context of its terms of reference.

METHOD

Ethical aspects

The study development complied with the standards of research ethics. Approval was obtained from the Research Ethics Committee at EERP-USP.

Design, place of study and period

A historical-social documentary study was undertaken between September 2013 and February 2015 at EERP-USP.

Sample

The data for this study were collected in the files of the WHO Collaborating Centre for Nursing Research Development^(1,3), based on the following primary sources: letters, processes and reports generated or received by the institution under analysis and specifically forwarded by WHO, PAHO, PAHO-Brazil, the University of São Paulo and other Collaborating Centres, from institutional partners, whose content was aligned with the research objective.

Study protocol

The collected data were obtained through a script the authors had elaborated, focusing on the vision, mission and terms of reference of the Collaborating Centre, as well as a synthesis of the strategic actions planned and developed during the period analysed. All authors participated in the analysis process of the documents collected and the terms of references, looking for shared meanings and grouping them into categories. The treatment and interpretation of the results was based on the literature on global health policies in nursing.

Analysis of the results

To interpret the data, thematic analysis was used, exploring the content of the terms of reference and identifying shared thematic categories^(4,5).

RESULTS

Motivations for the designation of EERP-USP as a Collaborating Centre

Created in 1953, from the start, EERP-USP demonstrated its pioneering role in nursing teaching and research. With an innovative curriculum, the institution valued interdisciplinarity in nursing education, allied with an environment dedicated to its faculty members' research, unedited in the context of teaching institutions' policies in Brazil in the mid-20^th century. At the end of the first decade, the school had already started investing in the Master's education of four faculty members at the Universities of Michigan, Cleveland and Detroit⁽¹⁾.

To enhance the development of research competencies, in the 1960's, Brazilian and interprofessional partnerships started to be set up. As a result of these efforts to train faculty members for research, EERP-USP gained national projection, in accordance with documents from the Congresses organized by the Brazilian Nursing Association⁽⁶⁾.

In the 1970's, this movement was intensified, encouraged by changes in the university policy in terms of requirements for faculty members to hold post-graduation degrees. At that time, the teaching staff consisted of M.Sc. graduates from other Brazilian universities and from EERP-USP itself, which in 1975 had set up the Master's Program in Psychiatric Nursing, the third program at this level and the first in the specialty in Brazil⁽¹⁾.

The fact that, during the period highlighted, faculty from EERP-USP sought other Master's programs in nursing and in other health areas, was healthy for the development of a culture of internal entrepreneurism, open to changes and innovations, generating an intellectual effervescence that induced the self-motivation of its intellectual capital, in search of distinguished targets in nursing teaching and research.

In the natural evolution of this movement, the 1980's were marked by EERP-USP's creation of the first Ph.D. program in Nursing in Brazil, in partnership with the University of São Paulo School of Nursing⁽¹⁾.

Doctoral education also triggered the emergence at EERP-USP of the first Brazilian nursing research groups⁽⁷⁾, further enhancing its mission as a reference in nursing research and its vision to move beyond national frontiers, also seeking international partnerships with universities and organizations. Among these, in the decade mentioned, the inclusion of some faculty members as researchers registered in the Sigma Theta Tau International Directory of Nursing Researchers also stands out⁽¹⁾.

Regarding its projection in simulated teaching, in the 1980's, representatives from institutions in different states, who wanted to get to know the organization of the teaching laboratories at EERP-USP, further strengthened Brazilian exchange⁽¹⁾.

Internally, to enhance exchange in Brazil and internationally, in 1986, the management of EERP-USP set up a Commission to stimulate collaborative actions in teaching and research. This group of faculty members played a significant role in the internationalization process of EERP, which was further strengthened. In 1987, the management of EERP-USP presented its proposal to the Pan American Health Organization (PAHO)-Brazil to serve as a WHO Collaborating Centre for the Development of Nursing Research. Until December 9^th 1988, the college served as a Centre under designation^(1,3,8).

Vision and Mission of the Collaborating Centre in its 25 years of existence

After the first designation in 1988, EERP-USP earned its redesignation as a Collaborating Centre⁽³⁾ in 1992, 1997, 2002, 2006 and 2010.

In this period, the mission of the Collaborating Centre was to "promote and stimulate the development of nursing research in the region, with a focus on Latin America". Its vision was to "become a leader and driving agent of innovations in the academic, care and political context of nursing".

Based on the analysis of the evolution in its Terms of Reference during this period, the following thematic categories are highlighted: "human resource formation for nursing research", "knowledge production", "knowledge dissemination" and "encouragement of exchange and stimulus of partnerships".

The category Human Resource Formation for Nursing Research emerged in the following Terms of Reference:

• Facilitation of developing a critical mass of nurse researchers involved in health services research, specially those that are decision-linked, and those that will contribute to more effective and improved nursing practice (1988 and 1992).

• Support of the development of continuing education program for nursing research, geared to bring changes in which hospitals serve as effective referral points and support for primary health care (1988 and 1992).

• Formation of nurse researchers and leaders of health and teaching institutions as well as community organizations, who are able to contribute in decisions on health and nursing policies, aiming at the improvement of health care (1997).

• Support the development of continuing education programs directed to introduce changes in institutions, being points of reference to health care (1997).

• Training for nurse leaders of health and teaching institutions as well as community organizations, who are able to contribute in decisions on health and nursing policies, to improve health care (2002).

• Serve as a research and training Centre for Latina America in priority areas (2002).

• Cooperate with different agents in the formation and development of nursing human resources in priority levels and areas in the Americas and Africa (2006).

• Collaborate with WHO in strengthening nursing research for the development of nursing human resources and nursing practice in priority areas (2010).

• Contribute with PAHO/WHO to strengthen nursing faculty development through research training and updating to improve scientific quality and improve the nursing curriculum (2010).

The category Knowledge Production emerged in the following Terms of Reference:

• Promotion and stimulation of nursing research toward the primary health care approach in all areas of nursing practice such as mental health, school health, occupational health, women´s health and other programs directed at the community (1988 and 1992).

• Development of activities in nursing research supportive of the program of work of units pertinent to WHO (1988 and 1992).

• Development of nursing activities in support to Programs of Work and units linked to WHO (1997).

• Incentive and development of nursing research oriented to criteria of health promotion and attention in different levels of practice and in several areas of nursing (1997).

• Promote and develop Nursing research and disseminate the produced knowledge to contribute to the advancement of Nursing and Midwifery practice in priority areas and in nursing human resources (2006).

• Contribute to the formation and updating of nursing and health information and knowledge in nursing (2006).

The category Knowledge Dissemination emerged in the following Terms of Reference:

• Development of mechanisms for dissemination of research findings as appropriate, nationally, regionally, and interregionally (1988 and 1992).

• Establishment of a Centre of bibliographic resources through the integration of a network for the sharing and distribution of teaching/learning materials for nursing research (1988 and 1992).

• Organization of preparation meeting between graduate and graduating students, in important measures within the context of the Terms of Reference (1988 and 1992).

• Strengthening strategies to disseminate research results regionally, nationally, and internationally (1997).

• Promote, carry out and disseminate nursing research oriented to demonstrate the nursing and midwifery contribution to family and community health (2002).

• Strengthen and expand the dissemination of nursing and health information and knowledge to improve access to these resources and foster nursing practice and education (2006).

• Collaborate with WHO in strengthening and expanding dissemination of health information and knowledge with emphasis on nursing and midwifery (2010).

The category Encouragement of Exchange and Stimulus of Partnerships emerged from the following Terms of Reference:

• Stimulation and promotion of the exchange of researchers in education and services between institutions (1988 and 1992).

• Incentive and promotion of interinstitutional exchange among researchers linked to teaching and care (1997).

• Maintaining a centre of bibliographical resources with appropriate technologies, aiming at increasing the exchange among researchers and institutions (1997).

• Promotion of strategies to integrate undergraduate and graduate students and ex-students in order to study actions in the context of the Terms of Reference (1997).

DISCUSSION

Human Resource Training for Nursing Research

The terms of reference in the axis valued human resource training for nursing research, revealed WHO's expectation for the creation of measures to "facilitate the development of a critical mass of nurse researchers involved in health services research, specially those that are decision-linked, and those that will contribute to more effective and improved nursing practice"⁽³⁾.

In the first four designations, the required human resource training focused on training in research that would lead to improvements in service quality, in nurses' participation in decision processes and in nurses' leadership in evidence-based practical processes^(9,12).

The fact that health policies in general are mostly implemented by nurses and nursing team members, who represent the largest group in the health workforce among the member countries of this international organization, justifies the importance WHO attributes to the development of people capable of leading changes with a view to providing services with better problem-solving ability and efficiency.

This term of reference changed in the most recent two redesignations (2006 and 2010), when the focus moved to faculty training in research to strengthen the scientific base of nursing and modify the curricula. As a Collaborating Centre in the Americas and as WHO considers that its mission should cover the needs of Latin America, it is understandable that, in these two redesignations, these terms of reference engaged the faculty members to fill gaps in nurses' research training process.

In this context, it is highlighted that the changes in the terms of reference were also induced by the answers the Centre, through EERP-USP, offered in terms of the preparation of researchers in the Graduate Programs that were expanded and gained further distinctions. If, at the start of the 1980's, a range of specialization courses could be offered, as the demand for the three Master's programs (Psychiatric Nursing, Nursing Fundamentals and Public Health Nursing) and four Doctoral programs EERP-USP started to offer increased (Interunit Program, Nursing Fundamentals, Psychiatric Nursing and Public Health Nursing), the faculty members' action had to be focused on the orientation of stricto sensu research projects. Thus, clients from services interested in specializations were no longer attended to, starting to attend to those nursing service leaders who sought Master's and/or Doctoral education^(9,12). On the other hand, as from 1991, the Graduate Programs at EERP-USP gradually expanded their clientele, starting to receive professionals from other knowledge areas⁽¹⁾, which resulted in the strengthening of interdisciplinarity in the development of nursing and health research. In 2012, the Centre rescued its mission to contribute to the development of nursing professionals linked to the clinical area and created the Professional Master's program, as a result of the new graduate policy adopted by the entity competent for this area at the Brazilian Ministry of Education⁽¹⁾.

The 25 years of the Collaborating Centre confirm the orientation of its mission towards research, through different indicators, including the leadership of its post-graduation programs in the assessment ranking of the Brazilian entity responsible for verifying the quality of post-graduate education⁽¹³⁾.

Knowledge Production

Throughout the trajectory of this Collaborating Centre, knowledge production figures as the first term of reference, inducing research development in strategic health areas, in line with international organizations' political agenda constructed as from the year 2000, especially focused on the Millennium Development Goals.

Thus, research productivity indicators, such as the number of Brazilian and international publications, their impact factor, the number of Research Productivity grantees at CNPq, the expansion in the number and composition of the research groups led by members of this Centre, increased funding for research projects from public agencies, increased number of Scientific Initiation, Master's, Doctoral and Post-Doctoral^(1,3) grantees underline this Collaborating Centre's commitment to knowledge production.

As a strategy to induce the compliance of newly-graduated faculty members with the target of competency development at post-doctoral level, aiming to strengthen the quality of the knowledge produced, in 2005, a Post-Doctoral Program started, which was developed at the Faculty of Nursing of the University of Alberta, Canada. In the framework of this Cooperation Agreement, some Sandwich Doctoral Programs were developed at the same university. This initiative gained intensity and support from local decision makers based on the development of a strategy to replace vacant faculty functions, generating a win-win movement for all stakeholders. The program with the University of Alberta levered the valuation culture of international exchange programs and the possibility for faculty members to develop their post-doctoral programs at other Universities⁽¹⁾.

The knowledge production that used to be restricted to the local partners was further developed through international partnerships.

Knowledge Dissemination

As a core component of the research process, the knowledge dissemination phase has been included as a fundamental requisite to comply with this Collaborating Centre's mission, being explicitly present in the terms of reference for all of its designations.

Whether through the creation and development of spaces of exchange among researchers, especially during scientific events, led by the Collaborating Centre, or through the creation of mechanisms for the dissemination of printed or electronic publications, high standards of quality have been acknowledged in the Centre's achievement of this requisite.

The Latin American Journal of Nursing (RLAE) received this name to comply with these requisites within its regional and cultural range⁽¹⁴⁾. Since its launch⁽¹⁾, in 1992, the journal has pursued and achieved quality criteria and represents a piece of intellectual heritage for Brazilian nursing, not only because it contributes significantly to the post-graduation programs, through the successive evaluations they have conquered, but also through the successes achieved, representing an example for other Brazilian journals: it was the first nursing journal to be included in the Scielo Collection Brazil⁽¹⁵⁾ and to integrate the Web of Science⁽¹⁶⁾ and the first to publish its issues in three languages (Portuguese, English and Spanish), thus complying the role of this Centre in the dissemination of nursing knowledge in Latin America⁽¹⁴⁾.

Also aiming for knowledge dissemination, in 2004, the Journal of Mental Health, Alcohol and Drugs was created (SMAD)⁽¹⁾, responding to international and national policy guidelines to promote the prevention, demand reduction and social rehabilitation of licit and illicit drugs.

Complying with their role as researchers, the members of this Centre also keep with the target of increasing their publications, disseminating the knowledge produced in their research groups.

Encouragement of Exchange and Stimulus of Partnerships

The promotion of exchanges and partnerships among institutions and researchers is a term of reference in all designations of this Centre, representing a strategic activity to achieve its mission.

In the quarter of a century analysed, the number of local, national, regional and international partnerships has increased, which resulted from institutional or individual initiatives among its members.

Among its partnerships, it is highlighted that this Centre participated in the creation⁽³⁾ of the Global Network of WHO Collaborating Centres for the Development of Nursing and Midwifery in 1988, remaining active in all activities the Secretary-General of this Network has developed throughout these 25 years. In the last seven years, the Centre hosted the Global Network and led the Secretary's activities, mobilizing all member Centres. In this position, this Centre intensified its proximity and partnership with the Nursing representative at WHO headquarters in Geneva and also with the six regional representatives⁽¹⁷⁾. In the same condition, it started to participate in strategic meetings, such as the meetings of the Global Advisory Group for Nursing and Midwifery. In these forums, it strengthened its partnership with the International Council of Nurses (ICN) and the International Confederation of Midwives (ICM).

In the context of the Americas, this Centre also participated in the creation, in 1993, of the Pan American Network of WHO Collaborating Centres for the Development of Nursing and Midwifery (PANMCC Network). As they belong to the same geographical region and have objectives in common, these Centres frequently engage in partnerships⁽¹⁸⁾, generating important results for the stakeholders. Between 2003 and 2005, this Centre coordinated this regional network⁽³⁾.

Since the 1990's, this Collaborating Centre, through EERP-USP, is a member of the Latin American Association of Nursing Schools and Colleges (ALADEFE) and has participated in its decision-making bodies⁽¹⁾.

In 1998, this Collaborating Centre started the establishment of a Chapter of the Honor Society of Nursing Sigma Theta Tau International⁽¹⁾, consolidated in 2002. The composition of this chapter favours exchanges among the members of the society, enhancing the visibility of EERP-USP and its researchers.

Thus, as a Collaborating Centre, the institutional cooperation agreements with foreign universities and colleges of nursing have multiplied.

Besides the international initiatives appointed, the researchers of this Collaborating Centre are members of different Brazilian and international networks. Among these, the networks in the PAHO Network of Collaborating Centres^(19,20) and the Network EnfAmericas are highlighted, supported by PAHO⁽²¹⁾. In the context of these Networks, this Collaborating Centre's terms of reference mention its partnership with the Ibero American Network of Scientific Editing in Nursing - RedEdit and with the Network BVS Nursing. In 2003, this Centre linked up with nursing schools^(1,3), BIREME/PAHO/WHO and the Brazilian Ministry of Health to create and develop BVS Nursing Brazil, whose objective is to contribute to the production, organization and dissemination of scientific and technical information in Nursing produced by Brazilian higher education institutions, taking responsibility for the creation and development of Rev@Enf ^(1,3), a catalogue of Brazilian Nursing journals.

The different partnerships mentioned played a fundamental role in the consolidation of this Collaborating Centre's activities. In fact, the human resource training, knowledge production and dissemination were only made feasible and successful through the existence of Brazilian and international partnerships.

Therefore, recovering the history of this Collaborating Centre means attempting to understand different partnerships that are strengthened over time, allowing this organization to achieve its mission of valuing a culture that drives the development of nursing research through the establishment of local, regional and international collaborative networks.

Through these activities, the Centre has remained aligned and in tune with the global policy to enhance cooperation in order to induce human development, producing gains in the nursing area for professionals from groups of developed and developing countries⁽²²⁾.

FINAL CONSIDERATIONS

In its 25 years of activities as a Collaborating Centre, its mission to "promote and stimulate the development of nursing research in the region, with a focus on Latin America" triggered activities in the context of its terms of reference in four areas: Human Resource Training for Nursing Research, Knowledge Production, Knowledge Dissemination and Encouragement of Exchange and Stimulus of Partnerships.

The activities developed were further consolidated through the strengthening of Brazilian and international partnerships, also encouraged by the Collaborating Centre's five consecutive redesignations, which put in practice its vision of becoming a leader and driving agent of innovations in the academic, care and political contexts of nursing.

• *
  The Collaborating Centre was redesignated for the sixth time in 2014. This study focuses on the excerpt from 1988 till 2013.

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Publication Dates

• Publication in this collection
  Nov-Dec 2016

History

• Received
  22 Mar 2016
• Accepted
  20 Apr 2016