Implementation of Obstetric Nursing Residency Programs in Brazil Using the Consolidated Framework for Implementation Research

Abstract

Implementing evidence-based training for nurses is crucial for improving maternal health, especially in low- and middle-income countries. In Brazil, the Obstetric Nursing Residency Program of Pernambuco (ONRPP) was established to promote humanized childbirth care by developing the nursing workforce. This study used the Consolidated Framework for Implementation Research (CFIR) to analyze key factors affecting the program’s implementation. We conducted a qualitative, multiple-case study at two reference hospitals in Pernambuco. Data were collected through document analysis, semi-structured interviews with managers and preceptors, and a focus group with residents. We performed a directed content analysis based on the five domains and 39 constructs of the CFIR. Data were coded and synthesized using MAXQDA to assess the valence and strength of each construct. Our findings revealed several facilitators, including the strong scientific basis of the training, high resident engagement, and a flexible program structure. However, we also identified significant barriers: lack of infrastructure and funding, weak inter-institutional communication, resistance from some clinical staff, and limited opportunities for feedback. Although residents reported increased autonomy and alignment with evidence-based practices, their role remained ambiguous for some staff. The ONRPP is a promising model for strengthening obstetric nursing and humanized care in Brazil. However, its long-term success requires strategic investment in leadership, communication, and organizational learning. This study contributes to the use of implementation frameworks like CFIR in nursing education and highlights their importance for guiding future scale-up strategies.