Learning Objective #1: Identify three barriers to quality maternity care in the Dominican Republic

Learning Objective #2: Describe three contributors to motivation for behavioral change among auxiliary nurses to improve quality of care

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This presentation reports upon one aspect of an international nursing and nurse- midwifery education, research, and health profession interchange project (Proyecto ADAMES) currently underway in one hospital in the Dominican Republic (DR). The project serves as a working example of Newman's theoretical concept of health as expanding consciousness, applied to a group of auxiliary maternity nurses who attend 95% of the vaginal deliveries in the public hospital. The education component evolved from an evaluation (by invitation by the nursing leadership in the Dominican Republic) from a US team of nurse-midwives in 2002. The outcome of this initial evaluation resulted in a mutually agreed upon plan for a series of educational conferences, conducted by nurse-midwifery faculty and labor and delivery nurses in the United States, designed for nurse auxiliaries. Additionally a professional interchange allows US based health providers a preliminary volunteer experience in international health and Spanish language immersion. The research component of the project conducted from June 2004 to March 2005 uses a team based method of inquiry by a Dominican and North American team to listen to auxiliary nurses narrate their understanding of the quality of care in their setting, how they envision change, and their own agency in bringing it about. The auxiliary nurses have identified systematic patterns in maternity care; the process of working side by side with nurses outside the DR has led to a diminished sense of resignation about maternal mortality. Reproductive health and human rights discourse has come alive for these auxiliary nurses as they witness the global concern for maternal-child health and experience the caring presence of other nurses in their transformation.