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Spotlight on Simmons

'Nursing is a Universal Language'

Simmons College nursing faculty recently took several nursing students to Romania for a week to observe the work of hospice centers in Bucharest, Brasov, and surrounding communities. The trip was the second project of the New England Alliance for Hospices of Hope, co-founded by Simmons in 2003. Julie Vosit-Steller, clinical assistant professor of nursing, Allison B. Morse, an adjunct faculty member, and two graduate nursing students attended.

The New England Alliance is affiliated with the U.S. office of Hospices of Hope in Nyack, N.Y., which introduced free hospice and palliative care services to Romania in 1992. The pioneer organization is changing the culture of end-of-life care in this post-communist country and in Eastern Europe. Vosit-Steller shares her experiences of this trip below:


Allison B. Morse Simmons nursing faculty member

Recently, our team of nurse practitioners and students from Simmons went to Romania to work with a multidisciplinary Hospices of Hope team. It was an inspiring and humbling experience for all of us.

Romanians suffering from life-threatening or terminal illnesses, such as advanced cancer or AIDS, and chronically ill children are particularly vulnerable to poorly funded services. People diagnosed with a terminal illness are likely to be sent home from the hospital to die without any clinical support or adequate pain relief.

Nursing professionals from our two countries worked together to expand current hospices practice that would incorporate an approach to end-of-life care, including spiritual assessment, research, tailored clinical needs, and complementary therapies that are culturally sensitive.

This multi-disciplinary approach, known as palliative care, works to improve quality of care for the terminally ill and their families through increased provision of and access to services for patients, and training for the professionals who care for them.
This concept is fairly new and not accessible to most of the Romanian population, where deaths from cancer and other terminal illnesses number approximately 41,000 annually. The vision of Hospices of Hope-Romania is that all terminally ill patients in Romania and surrounding countries are able to live and die with dignity as respected and valued members of society.


Bucharest Hospital

Comparing Health Care Systems
As practicing nurse practitioners in Boston, one of the most progressive medical cities in the world, the apparent lack of preventative care provided by Romania's public health infrastructure was surprising to us.

In Bucharest, we had the opportunity to tour the chronic care hospital and visit a new outpatient clinic/referral center. The hospitals are not used in the same fashion as American facilities, because there is no public health infrastructure to support preventive health care. Therefore, patients utilize the hospital when they have no family to care for them, or they have no other choice.

These patients have no expectations of the medical system; most do not anticipate receiving treatment for terminal illnesses. In addition, the governmental allocation of health care resources for Romanian people is strict and difficult to navigate. Until this year, Hospices of Hope oncologists were unable to prescribe narcotics to their patients in pain, because the House of Insurance would not grant them contracts. These occurrences left us comparing the differences between our medical practices and realizing our own country's abundant resources.


Roma family

Visiting the Patients
In Brasov, we spent several days at Hospice Casa Sperantei, a very sophisticated inpatient hospice and respite center for both adults and children. We also spent a day in the community, paired individually with a hospice nurse. We visited the homes of a wide variety of patients: pediatric, cancer patients, and members of the Roma community (local gypsy communities).

The Romanian nurses reach myriad communities in the geographic area, traveling rugged and challenging terrain to reach their patients. Although they have minimal support and supplies, these nurses function at a sophisticated level, relying on critical thinking and creativity. In one such visit, a pediatric nurse and I drove to the foot of a mountain in a Roma community, and then hiked up about a quarter mile to visit with a young girl who had cystic fibrosis. The nurse monitored her medications that the grandmother managed, and performed chest physical therapy.

Nursing is a universal language, in which comfort is offered to suffering patients. While holding the hand of an ailing Romanian patient, my American colleague listened and understood as the woman told her story tearfully. They were able to connect in a therapeutic manner across cultural and linguistic barriers.


Romanian Village

Reflections
Although we anticipated examining the end-of-life practices of Romanian women, our observations led us to a much deeper respect and interest in that culture's meaning of life and death. For example, we learned that the family does much of the work that our American funeral homes provide, including bathing and preparing a deceased patient for viewing. The practice of honoring one's life is done at home, in the community, rather than at an outside facility. Sharing of these intimate details allowed us to consider how Americans honor our dead family members and compare our cultural and religious rituals.

Upon return to the U.S., we spent time reflecting on the intensity of the clinical presentations of some of the patients, and the conditions in which our Romanian nursing colleagues navigate. It had been challenging to deal with the vivid images of cancerous wounds and crowded living conditions of Roma families. Fortunately, however, the gift of being skilled clinicians assisted each of us in translating our new knowledge into substantial support for our Romanian colleagues. We are actively working to determine the most beneficial use of our collective resources.