Palliative Care Masterclass for Nurses in Central-Eastern Europe: An International Collaboration.

Given the increased need for palliative care services globally, the education of nurses has become paramount. In response, a group of nurses from Romania and the United States developed diverse nursing educational programs to meet the palliative care educational needs of nurses in Central-Eastern European countries. The purpose of this article is to describe a palliative nursing masterclass that was offered virtually to 59 participants, primarily nurses but also other health care professionals, from 11 Central-Eastern European countries.

Development of collaborative family nurse practitioner education using physician preceptors: A focused critical ethnographic study.

BACKGROUND: Global oppressive power structures in healthcare systems and between professions hinder care delivery. The family nurse practitioner is a new role in Israel. Through an innovative international collaborative education partnership, 19 Israeli nurses were trained as family nurse practitioners. Israeli physician preceptors integrated them into a national health maintenance organization despite national and organizational resistance. OBJECTIVES: Explore Israeli physicians' experiences while providing clinical mentorship to family nurse practitioners and develop strategies for the implementation of the new community role. DESIGN: Qualitative focused critical ethnographic approach. PARTICIPANTS: Eleven Israeli physician preceptors were recruited from a larger pool of 50. METHODS: Physicians were interviewed via recorded phone calls and asked open-ended questions about precepting family nurse practitioners. Observations of the program were included from the year prior to the interviews. Data were analyzed using Carspecken's five steps for critical ethnographic approach. RESULTS: Three categories for transforming the current status were identified: role clarification, logistics, and collaborative education. Exemplar cases described collaborative practice regarding measurable outcomes. Learning happened through "shadowing" and "coaching" techniques. Findings led to the Collaborative Team Development Illustration which mirrors current recommendations from the World Health Organization and Institute of Medicine. CONCLUSIONS: The Collaborative Team Development Illustration offers a structured strategy for advocacy and transformation in other oppressive health systems considering introducing nurse practitioners. This paper provides evidence that physician participants believed partnerships with nurse practitioners could improve patient care delivery. We hope this research will contribute to changing power relations in healthcare and improve outcomes. This may offer hope for integration of family nurse practitioners in countries that currently do not support advanced practice nursing roles.

Evaluation of the optimal positioning of subcutaneous butterfly when administering injectable opioids in cancer patients.

BACKGROUND AND AIMS: The increasing number of cancer patients, together with the development of new palliative care services in Romania, warrants the evaluation of nursing strategies meant to improve the level of comfort of patients who are suffering from advanced cancer. The main objective of the study was to evaluate the optimal positioning of the subcutaneous (sc) butterfly, in accordance with its resistance in the insertion tissue, the local complications that may occur, and the evaluation of the time of resistance at the insertion site (puncture) with the daily frequency of injectable opioid administration. METHODS: A prospective experimental pilot study was designed and conducted between January and May 2011. Patients admitted to the Hospice Casa Sperantei (Brasov, Romania) with moderate or severe cancer pain, who were receiving subcutaneously opioids, over the age of 18, with normal body index ranging from 18.5 - 22.0, were assigned randomly to one of two groups, after signing the informed consent. In group one, the butterfly was positioned with the needle bevel up - this was considered to be the control group as this modality of inserting the needle is considered standard practice; in group two the butterfly was positioned with the needle bevel down - experimental group. The drugs used for pain relief were sc tramadol for moderate pain and sc morphine for severe pain. RESULTS: Our research supported the hypothesis that the occurrence of local complications coincides with the decrease of sc butterfly resistance in time at the place of insertion, and the sc butterfly has a higher rate of resistance in time at the insertion site if the frequency of injectable opioids administration is lower (twice per day). CONCLUSION: The positioning of the butterflies with the bevel down (experimental group) is associated with a longer resistance in time at the site of insertion, and causes fewer local complications compared to the sc butterflies positioned with the bevel up (control group).

Postoperative pain: acupuncture versus percutaneous electrical nerve stimulation.

The purpose of this study was to examine the effect of traditional acupuncture compared with acupuncture with percutaneous electrical nerve stimulation (PENS) on postoperative surgical pain relief in gynecologic oncology patients. Twenty postoperative gynecologic oncology patients were randomly assigned into the two groups, and the intervention was initiated within 24 hours after surgery. The patients in each group received four treatments in the subsequent 48 hours, with 12 hours between each treatment. Either traditional acupuncture needles or acupuncture needles with a pulsed electric current were applied to stimulate the area of points Sp6 and Sp8 near the saphenous nerve. Pain measurement instruments included a visual analog scale and the McGill Pain Questionnaire. Although the PENS treatment group demonstrated a consistent decrease in pain with each treatment application compared with the traditional acupuncture group, after 48 hours both groups experienced equivalent pain relief.

Evolution of an international collaboration: a unique experience across borders.

An international collaboration to support and mentor palliative care nurses was developed between two educational institutions in the New England region of the United States and the Hospice Casa Sperantei in Brasov, Romania. Through teleconferences, onsite visits, research, and shared publications, the collaboration continues to be a dynamic experience for the partners and students. The seven-year relationship has affected the Romanian nursing team by providing professional education and support, as well as validation of clinical practice.

Enhancing end-of-life care with dignity: characterizing hospice nursing in Romania.

AIMS: The purpose of this research was to characterize the nursing actions practiced by Romanian nurses affiliated with Hospices of Hope that promote dignified dying and explore needs to promote a more dignified death. METHODS: A survey method used the International Classification for Nursing Practice dignified dying survey. A convenience sample of 43 hospice nurses responded. Descriptive statistics, t-tests and content analysis were used to analyze the data. RESULTS: Characteristics that promoted dignified dying included the use of a formal, iterative process of assessment, interventions that supported pain and symptom management, and spiritual comfort at the end of life. Participants described family-centered hospice care that integrated Christian orthodox tradition that transformed patients as death approached. CONCLUSION: Dignity for terminally ill Romanian will be enhanced as the nurses implement these interventions. Awareness of cultural and spiritual differences concerning end of life will facilitate dialogue among nurse scientists.