Strategic directions for strengthening nursing and midwifery: potentialities and connections in the complex perspective* * The publication of this article in the Thematic Series “Human Resources in Health and Nursing” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil.

Ítalo Rodolfo Silva Isabel Amélia Costa Mendes Carla Aparecida Arena Ventura About the authors

Abstracts

Objective:

to understand from the complex perspective the connections established between the Strategic Directions for Strengthening Nursing and Midwifery, delimited by the World Health Organization; to discuss the implications of these strategies for the investment of human resources in nursing and midwifery, with a view to strengthening the technical health capacity to face global health demands.

Method:

a documentary research, carried out from official WHO documents, from September to October 2019. A categorical analysis technique was performed, and the interpretation of the data was achieved based on the theoretical framework of Complexity.

Results:

three interdependent categories were defined, namely: challenges for the training of human resources in nursing and midwifery in order to meet the needs for global health; challenges for the development of the work of nursing and midwifery professionals in different contexts of practice; challenges for governments, leaders and health services to strengthen human resources in nursing and midwifery.

Conclusion:

the strategic directions corroborate the complex perspective because they value multidimensionality in the challenges for the professional practice of nurses and obstetricians. However, these challenges are also related to contextual, political, and leadership factors.

Descriptors:
Nursing; Global Health; Health Personnel; Staff Development; Education, Nursing; Education, Nursing, Continuing


Objetivo:

compreender, a partir da perspectiva complexa, as conexões estabelecidas entre as Orientações Estratégicas para o Fortalecimento da Enfermagem e Obstetrícia, delimitadas pela Organização Mundial da Saúde; discutir as implicações dessas estratégias para o investimento de recursos humanos da enfermagem e obstetrícia, com vistas ao fortalecimento da capacidade técnica de saúde para o enfrentamento das demandas de saúde global.

Método:

pesquisa documental, realizada a partir de documentos oficiais da OMS, no período de setembro a outubro de 2019. Foi realizada técnica de análise categorial, sendo a interpretação dos dados alcançada a partir do referencial teórico da Complexidade.

Resultados:

foram delimitadas três categorias, interdependentes, a saber: desafios para a formação de recursos humanos em enfermagem e obstetrícia com vistas ao atendimento das necessidades para a saúde global; desafios para o desenvolvimento do trabalho dos profissionais de enfermagem e obstetrícia nos diferentes contextos de atuação; desafios para os governos, lideranças e serviços de saúde para o fortalecimento de recursos humanos em enfermagem e obstetrícia.

Conclusão:

as orientações estratégicas corroboram a perspectiva complexa porque valorizam a multidimensionalidade nos desafios para o exercício profissional de enfermeiros e obstetrizes. Todavia, esses desafios estão relacionados, também, aos fatores contextuais, políticos e de liderança.

Descritores:
Enfermagem; Saúde Global; Pessoal de Saúde; Desenvolvimento de Pessoal; Educação em Enfermagem; Educação Continuada em Enfermagem


Objetivo:

comprender, desde una perspectiva compleja, las conexiones establecidas entre las Orientaciones Estratégicas para el Fortalecimiento de la Enfermería y la Partería, delimitadas por la Organización Mundial de la Salud; discutir las implicaciones de estas estrategias para la inversión de recursos humanos en enfermería y partería, con miras al fortalecimiento de la capacidad técnica de salud para afrontar la demanda global de servicios de salud.

Método:

investigación documental, realizada con base en documentos oficiales de la OMS, de septiembre a octubre de 2019. Se llevó a cabo un análisis categorial y la interpretación de los datos se logró a partir del marco teórico de la Complejidad.

Resultados:

se definieron tres categorías interdependientes, a saber: desafíos para la capacitación de recursos humanos en enfermería y partería a fin de satisfacer las necesidades de la salud global; desafíos para el desarrollo del trabajo de los profesionales de enfermería y partería en diferentes contextos de actuación; desafíos para los gobiernos, las direcciones y los servicios de salud para fortalecer los recursos humanos en enfermería y partería.

Conclusión:

las orientaciones estratégicas corroboran la perspectiva compleja porque valoran la multidimensionalidad en los desafíos para la práctica profesional de enfermeros y obstetras. No obstante, estos desafíos también se hallan relacionados con factores contextuales, políticos y de liderazgo.

Descriptores:
Enfermería; Salud Global; Personal de Salud; Desarrollo de Personal; Educación em Enfermería; Educación Continua em Enfermería


Introduction

The development of the nations is in line with the complex and dynamic health demands of their peoples, which establish implications in different social, economic, and political contexts for guaranteeing human dignity based on people’s quality of life(11 Mendes IAC, Ventura CAA, Fumincelli L, Souza-Júnior VD, Godoy S. Nursing and Global Health: social determinants of health in the training of nurses. Rev Bras Enferm. 2018;71 Suppl 4:1700-5. doi: 10.1590/0034-7167-2017-0631
https://doi.org/10.1590/0034-7167-2017-0...

2 Preto VA, Batista JMF, Ventura CAA, Mendes IAC. Reflecting on nursing contributions to global health. Rev Gaúcha Enferm. 2015;36(Sp. Iss):267;70. doi: 10.1590/1983-1447.2015.esp.56643
https://doi.org/10.1590/1983-1447.2015.e...
-33 Sampaio JRC, Ventura M. The emergency of concept global health: perspectives for the fild of public health. Cad Ibero-Amer Dir Sanit. 2016;5(4):145-55. doi: 10.17566/ciads.v5i4.319
https://doi.org/10.17566/ciads.v5i4.319...
).

In this context, it is necessary to consider the importance of human health resources so as to implement and strengthen strategic actions that guarantee efficient health and care practices to people in the face of current and coming challenges for local and global health, estimated from the epidemiology of aging population, chronic health conditions, emerging and neglected diseases, mental health, and social inequities, among others(44 Buss PM, Chamas C, Faid M, Morel C. Development, health, and international policy: the research and innovation dimension. Cad Saúde Pública. 2016;32(Sup.2):e00046815. doi: 10.1590/0103-311X00046815
https://doi.org/10.1590/0103-311X0004681...
-55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
).

Thus, nursing and midwifery must be understood as professions that, within the scope of human resources for health, assume and practice valuable contributions to ensure access to health services and practices for people and their families in different care contexts(66 Portela GZ, Fehn AC, Ungerer RLS, Poz MRD. Human resources for health: global crisis and international cooperation. Ciênc Saúde Coletiva. 2017;22(7):2237-46. doi: 10.1590/1413-81232017227.02702017
https://doi.org/10.1590/1413-81232017227...
-77 Frota MA, Wermelinger MCMW, Vieira LJES, Ximenes Neto FRG, Queiroz RSM, Amorim RF. Mapping nursing training in Brazil: challenges for actions in complex and globalized scenarios. Ciênc Saúde Coletiva. 2010;25(1):25-35. doi: 10.1590/1413-81232020251.27672019
https://doi.org/10.1590/1413-81232020251...
). However, it is essential to understand it beyond the profession itself and its reach, significantly, different leaders, which can result in unfolding actions performed by nursing and midwifery, so that they can reach the understanding that investing in these professionals is equivalent to investing in people’s quality of life, as well as efficient management of resources to reduce expenses with the fight against diseases(88 Mendes IAC, Ventura CAA, Trevizan MA, Marchi-Alves LM, Souza-Júnior VD. Education, leadership and partnerships: nursing potenctial for Universal Health Coverage. Rev. Latino-Am. Enfermagem. 2016;24:e2673. doi: 10.1590/1518-8345.1092.2673
https://doi.org/10.1590/1518-8345.1092.2...
-99 Almeida LMWS, Santos RM. The nursing work and the construction of a democratic society. Rev Bras Enferm. 2017;70(5):939-40. doi: 10.1590/0034-7167.2017700501
https://doi.org/10.1590/0034-7167.201770...
).

Furthermore, by guaranteeing decent conditions for the maintenance of the economically active population, based on the health and care actions performed by nursing and midwifery, it is possible to conceive the interdependence relationship between these professionals and the economic development of nations. Therefore, in this relationship, there is the principle of the recursive circuit of complexity, “in which products and effects are themselves producers and causes of what produces them”(1010 Morin E. A cabeça bem-feita: repensar a reforma, reformar o pensamento. 18ª ed. Rio de Janeiro: Bertrand; 2010.).

On the other hand, it must be considered that the development of the nursing and midwifery work process with a view to universal access to health is conditioned to the political context for the exercise of the autonomy of these professionals, as well as the development of skills to better intervene(55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
,1111 Mendes IAC, Trevizan MA, Mazzo A, Godoy S, Ventura CAA. Professional marketing and social visibility in nursing: a strategy to value human resources. Texto Contexto Enferm. 2011;20(4):788-95. doi: 10.1590/S0104-07072011000400019
https://doi.org/10.1590/S0104-0707201100...
). Despite this reality, the connections between macro- and micro-politics, which are positioned in multidimensional perspectives, are fundamental to guarantee strategies for strengthening human resources of nurses and obstetricians, with regard to the commitment of these professionals to consolidated training, as well as of the health institutions to implement dignified conditions so that they act with the necessary autonomy to reach their full potential.

Therefore, the World Health Organization (WHO) launches the set of Strategic Directions for Strengthening Nursing and Midwifery Services(55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
,1212 Organización Mundial de la Salud. Orientaciones estratégicas para el fortalecimiento de los servicios de enfermería y partería 2002-2008. Genebra: OMS; 2002 [Acceso 21 abr 2020]. 58 p. Disponible en: https://apps.who.int/iris/handle/10665/42610?locale-attribute=es&-1313 World Health Organization. Strategics directions nursing and midwifery services 2011-2015. Geneva: WHO; 2010 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/resources/nmsd/en/
https://www.who.int/hrh/resources/nmsd/e...
) and recently, in partnership with the International Nurses Council, the global program for the valorization of Nursing and Midwifery, Nursing Now(1414 Kennedy A. Wherever in the world you find nurses, you will find leaders. Rev. Latino-Am. Enfermagem. 2019;27:e3181. doi: 10.1590/1518-8345.0000.3181
https://doi.org/10.1590/1518-8345.0000.3...
), with a focus on leadership for care practices that advance new and distinct health scenarios, among other purposes.

On the other hand, it is advocated that these strategies should be perceived in their complexities, that is, interconnected in their contextual, multidimensional and dynamic perspectives. It follows from this logic the ability of these strategies to be conceived as guiding axes for the connections between macro- and micro-politics that involve investment and development for the human resources of health, with a view to expanding conditions of understanding by the formulators of public policies on the importance of nursing and midwifery to the world. Therefore, it is envisaged that civil society, politicians, and health employers appreciate the understanding that investment in these professionals is essential to respond to current and future epidemiological challenges(55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
).

In this sense, the question is the following: How can the complex perspective favor the necessary understanding of the challenges related to the strengthening of human resources in nursing and midwifery based on the strategic directions defined for the strengthening of these professionals?

Therefore, the objectives of the research were the following: to understand from a complex perspective the connections established between the Strategic Directions for Strengthening Nursing and Midwifery delimited by the WHO; to discuss the implications of these strategies for the investment of human resources in nursing and midwifery, with a view to strengthening the technical health capacity to face the global health demands.

Method

A documentary research, carried out based on official WHO documents. For the analysis process, the categorical analysis technique was performed and the interpretation of the data was achieved based on the theoretical framework of Complexity, in the perspective of Morin(1010 Morin E. A cabeça bem-feita: repensar a reforma, reformar o pensamento. 18ª ed. Rio de Janeiro: Bertrand; 2010.,1515 Morin E. Ciência com consciência. 13. ed. Rio de Janeiro: Bertrand; 2010.).

Complex Thinking aims at understanding phenomena from the interactions among the parts that constitute them, in a dynamic, procedural, and non-linear perspective. For that, it uses principles that allow understanding the complexity inserted in the dynamics of operation of the analyzed phenomenon, such as the recursive organizational principle, which considers that a phenomenon is at the same time a product and producer of itself(1010 Morin E. A cabeça bem-feita: repensar a reforma, reformar o pensamento. 18ª ed. Rio de Janeiro: Bertrand; 2010.,1515 Morin E. Ciência com consciência. 13. ed. Rio de Janeiro: Bertrand; 2010.). In this sense, the strengthening of nursing and midwifery is now understood from internal and external mechanisms to the work process of these professionals.

In the complex perspective, the principles complement each other to better explain the phenomenon in its living dynamics of operation. This way, for example, another principle can be added, namely: autonomy-dependence(1515 Morin E. Ciência com consciência. 13. ed. Rio de Janeiro: Bertrand; 2010.), which allows systems to self-organize their parts for the balance and maintenance of the whole. Other principles for conceiving complexity are approached in the discussion of the results of this research.

The documents used as data sources were the following: Strategic Directions for Strengthening Nursing and Midwifery Services (2002-2008)(1212 Organización Mundial de la Salud. Orientaciones estratégicas para el fortalecimiento de los servicios de enfermería y partería 2002-2008. Genebra: OMS; 2002 [Acceso 21 abr 2020]. 58 p. Disponible en: https://apps.who.int/iris/handle/10665/42610?locale-attribute=es&), Strategic Directions for Nursing and Midwifery (2011-2015)(1313 World Health Organization. Strategics directions nursing and midwifery services 2011-2015. Geneva: WHO; 2010 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/resources/nmsd/en/
https://www.who.int/hrh/resources/nmsd/e...
), Global Strategic Directions for strengthening Nursing and Midwifery (2016-2020)(55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
).

The analysis of the documents was carried out based on three defining questions for the categorization process, namely: a) What are the challenges for the training of human resources in nursing and midwifery in order to meet the needs for global health? b) What are the challenges for the development of nursing and midwifery work in the different contexts of professional practice? C) How can governments, leaders and health services favor the development of human resources for nursing and midwifery?

The analytical process of the documents based on the questions that led to analysis took place from the transcription of the data in figures with four columns in a Word file and compared with each other, grouped by similarities, in order to form explanatory categories of the phenomenon under study. The entire categorization process was carried out based on the complexity framework and analyzed by three independent researchers. Data was collected directly from the official WHO websites, from September to October 2019.

As this is a documentary research with data in the public domain, the research was not submitted to the Human Research Ethics Committee.

Results

The grouping of the results is presented by categorization in three figures, from the questions that induce analysis. To identify the WHO official documents, the following denomination was used: Directions 2002-2008; Directions 2011-2015; Directions 2016-2017.

It should be highlighted that the strategic directions for strengthening nursing and midwifery, in their first versions, that is, 2002-2008 and 2011-2016, listed the set of spheres of main results, with the respective objectives for each sphere. On the other hand, the 2016-2020 version addressed themes with objectives, strategies, and their contextual relations (global, national, regional, and partnership). However, for the presentation of the results, in this article the analyzed material is presented in actions and related factors for each generated category.

Thus, Figure 1 reveals the connections established between actions and related factors present in the strategic directions for the training of human resources in nursing and midwifery, with a view to meeting the needs for global health.

Figure 1
Challenges for the training of human resources in nursing and midwifery with a view to meeting the needs for global health

Figure 2 shows the connections established to face the challenges with a view to the development of the work of nursing and midwifery professionals.

Figure 2
Challenges for the development of the work of nursing and midwifery professionals in different work contexts

Figure 3 shows the results regarding the challenges that must be assumed by the governments, leaders, and health services to strengthen human resources in nursing and midwifery.

Figure 3
Challenges for the governments, leaders, and health services to strengthen human resources in nursing and midwifery

Discussion

For Complex Thinking, strategy means a mechanism to better deal with the objective reality, because reality itself is permeated by uncertainties, risks, and illusions that may not be controlled in its entirety by the action mechanisms defined by man(1515 Morin E. Ciência com consciência. 13. ed. Rio de Janeiro: Bertrand; 2010.). However, it is up to the strategies to predict better conditions to deal with the dynamic phenomena of reality(1616 Mariotti, H. Pensando diferente - para lidar com a complexidade, com a incerteza, com a ilusão. São Paulo: Atlas; 2010.).

Therefore, in the health context in which nursing and midwifery play important roles(55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
), the strategies for strengthening them must contemplate the possibilities to intervene based on current and future challenges. For this reason, the strategic directions, especially their most recent version(55 World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
https://www.who.int/hrh/nursing_midwifer...
), are supported by a contextual perspective in a global logic, based on evidence that calls for the strengthening of these professionals to exercise their competences.

The following documents emerge from this reality: The WHO 2013 directions to transform and expand the education and training of the health professionals, namely: the World Midwifery Study Report(1717 World Health Organization. The state of the world's midwifery. Geneva: WHO; 2014 [cited Apr 21, 2020]. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/EN_SoWMy2014_complete.pdf
https://www.unfpa.org/sites/default/file...
); the 2013-2020 Mental Health Action Plan(1818 World Health Organization. Comprehensive mental health action plan 2013-2020. Geneva: WHO; 2019 [cited Apr 21, 2020]. Available from: https://www.who.int/mental_health/action_plan_2013/en/
https://www.who.int/mental_health/action...
); the 2016-2030 Global Strategy for the Health of Women, Children and Adolescents(1919 World Health Organization. Global Strategy for Women's, Children's and Adolescent's Health (2016-2030). Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/life-course/partners/global-strategy/en/
https://www.who.int/life-course/partners...
); the Strategy to End Preventable Maternal Mortality; and the World Report on Aging and Health(2020 World Health Organization. World report on ageing and health 2015. Geneva: WHO; 2015 [cited Apr 21, 2020]. Available from: https://www.who.int/ageing/events/world-report-2015-launch/en/
https://www.who.int/ageing/events/world-...
), among others.

For all these issues, nursing and midwifery perform fundamental actions to effectively develop these strategies and recommendations for global health. Thus, as highlighted by Complex Thinking in signaling the contextual importance of interactions established for the development of a given phenomenon, the strategic directions for strengthening nursing and midwifery were throughout its editions, reinforcing the importance of the context for the efficient planning and execution of strategies to strengthen these professionals.

From this perspective, the three categories highlight the relevance of the context for the implementation of the necessary actions adopted by the WHO Member States to implement their directions for coverage and universal access to health, for example(2121 Organización Mundial de la Salud. Cobertura Sanitaria Universal. Genebra: OMS; 2019 [Acceso 21 abr 2020]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
https://www.who.int/es/news-room/fact-sh...
). Thus, the development of professional competences, the improvement of the working conditions, and the encouragement of leaders, governments, and institutions for nursing and midwifery conceive the contextual perspective as indispensable to the full reach of the strategic directions.

It is in the work context that nurses and midwives face challenges of cultural origin, codified in power relations that imply limitations for the full development of these professionals. From the above, the strategic directions have advanced towards the signs referring to the exercise of leadership, professional training, and occupation of decision-making spaces so that nursing and midwifery can increasingly achieve their goals with the different groups with which they work.

Nevertheless, the contextual interactions are necessary for the production of efficient care. For this reason, the focus of complex thinking is the ability to know reality in a multifaceted logic of knowledge and actions(1515 Morin E. Ciência com consciência. 13. ed. Rio de Janeiro: Bertrand; 2010.). From this reality, the valorization of inter-disciplinarity and inter-sectoriality can be seen, as highlighted by the most current version of the strategic directions.

Although in several countries nursing and midwifery make up more than 50% of the human health resources, the work process of these professionals is articulated in a broader objective, which requires a multidimensional approach based on the interdisciplinary strategy in the context of health. With this, it can be revealed that two dimensions are approached in a dialogical perspective which complement each other, namely: professional autonomy for nursing and midwifery and, at the same time, better integration with the relational processes that configure the driving force of health care of the multidisciplinary team.

Furthermore, it is in this set of interactions that another principle of complexity is processed that may contribute to better understand the multifaceted perspective of the strategic directions for strengthening nursing and midwifery and, therefore, the very challenges of these professionals to meet the health and care demands of the people.

This principle is the unitas-multiplex, which asks to consider that the whole can be more or less than the sum of its parts(1515 Morin E. Ciência com consciência. 13. ed. Rio de Janeiro: Bertrand; 2010.). This is because the quality of the interactions matters more than their existence because, in a context unfavorable for the development of the parts, the negative interactions of the work process can limit, reduce, and disfavor the potential for transformation of the subject. The opposite can also be revealed by the same principle, that is: the quality of the interactions can enhance strengths of the work nature capable of favoring the nursing and midwifery professionals’ conditions to exercise their roles with excellence, as indicated by the WHO strategic directions.

This research presents as a limitation, in the epistemological order of apprehension of the investigated object, the incapacity of abstractions that can deepen the reality perceived by the professional nurses and midwives about the results presented. This way, other methodologies that address field research, for example, may deepen knowledge about the complex nature of strategic directions for strengthening nursing and midwifery.

On the other hand, the analysis of data from official WHO documents for the strengthening of human resources in nursing and midwifery from the complex perspective revealed the importance of an epistemological approach that allows contextualizing and interconnecting the multiple dimensions involved in the challenges for the strengthening of these professionals, who are permeated by cultural and power structures rooted in decision-making spaces. These realities result in the need for better connections between nursing and midwifery, decent working conditions, public policies, leadership, and global health.

Conclusion

The strategic directions for strengthening nursing and midwifery corroborate the perspective of complexity, while they value the multidimensionality inserted in the challenges for the professional practice of nurses and midwives.

In this logic, they reinforce the need for connections based on partnerships; the contextual implications for successfully implementing action-interaction strategies; and the interdisciplinary perspective, without, however, devaluing the need for professional autonomy.

  • *
    The publication of this article in the Thematic Series “Human Resources in Health and Nursing” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil.

References

  • 1
    Mendes IAC, Ventura CAA, Fumincelli L, Souza-Júnior VD, Godoy S. Nursing and Global Health: social determinants of health in the training of nurses. Rev Bras Enferm. 2018;71 Suppl 4:1700-5. doi: 10.1590/0034-7167-2017-0631
    » https://doi.org/10.1590/0034-7167-2017-0631
  • 2
    Preto VA, Batista JMF, Ventura CAA, Mendes IAC. Reflecting on nursing contributions to global health. Rev Gaúcha Enferm. 2015;36(Sp. Iss):267;70. doi: 10.1590/1983-1447.2015.esp.56643
    » https://doi.org/10.1590/1983-1447.2015.esp.56643
  • 3
    Sampaio JRC, Ventura M. The emergency of concept global health: perspectives for the fild of public health. Cad Ibero-Amer Dir Sanit. 2016;5(4):145-55. doi: 10.17566/ciads.v5i4.319
    » https://doi.org/10.17566/ciads.v5i4.319
  • 4
    Buss PM, Chamas C, Faid M, Morel C. Development, health, and international policy: the research and innovation dimension. Cad Saúde Pública. 2016;32(Sup.2):e00046815. doi: 10.1590/0103-311X00046815
    » https://doi.org/10.1590/0103-311X00046815
  • 5
    World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020. Geneva: WHO; 2016 [cited Apr 21, 2020]. Available from: https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
    » https://www.who.int/hrh/nursing_midwifery/global-strategy-midwifery-2016-2030/en/
  • 6
    Portela GZ, Fehn AC, Ungerer RLS, Poz MRD. Human resources for health: global crisis and international cooperation. Ciênc Saúde Coletiva. 2017;22(7):2237-46. doi: 10.1590/1413-81232017227.02702017
    » https://doi.org/10.1590/1413-81232017227.02702017
  • 7
    Frota MA, Wermelinger MCMW, Vieira LJES, Ximenes Neto FRG, Queiroz RSM, Amorim RF. Mapping nursing training in Brazil: challenges for actions in complex and globalized scenarios. Ciênc Saúde Coletiva. 2010;25(1):25-35. doi: 10.1590/1413-81232020251.27672019
    » https://doi.org/10.1590/1413-81232020251.27672019
  • 8
    Mendes IAC, Ventura CAA, Trevizan MA, Marchi-Alves LM, Souza-Júnior VD. Education, leadership and partnerships: nursing potenctial for Universal Health Coverage. Rev. Latino-Am. Enfermagem. 2016;24:e2673. doi: 10.1590/1518-8345.1092.2673
    » https://doi.org/10.1590/1518-8345.1092.2673
  • 9
    Almeida LMWS, Santos RM. The nursing work and the construction of a democratic society. Rev Bras Enferm. 2017;70(5):939-40. doi: 10.1590/0034-7167.2017700501
    » https://doi.org/10.1590/0034-7167.2017700501
  • 10
    Morin E. A cabeça bem-feita: repensar a reforma, reformar o pensamento. 18ª ed. Rio de Janeiro: Bertrand; 2010.
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    Mendes IAC, Trevizan MA, Mazzo A, Godoy S, Ventura CAA. Professional marketing and social visibility in nursing: a strategy to value human resources. Texto Contexto Enferm. 2011;20(4):788-95. doi: 10.1590/S0104-07072011000400019
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Publication Dates

  • Publication in this collection
    19 Oct 2020
  • Date of issue
    2020

History

  • Received
    21 Apr 2020
  • Accepted
    15 July 2020
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