Building Palliative Cancer Care Nursing Capabilities
or the past seven years, Nicoleta Mitrea, project coordinator at Hospice Casa Speranţei in Brasov, Romania, has been passionate about her mission to have palliative care for cancer and other terminal illnesses recognized as a nursing specialty not only in Romania, but throughout Central and Eastern Europe (CEE).
The need for palliative care throughout CEE is significant, given the high rate of cancer in the region. Many countries lack primary cancer prevention education and secondary prevention measures are introduced late, leading to a cancer mortality rate that is considerably higher than the rest of Europe: 1.6 times higher for men and 1.4 times higher for women*.
To help reduce the disparities and promote health equity within CEE for populations disproportionately affected by cancer, the Bristol Myers Squibb Foundation has established three nursing practice Centers of Excellence in Cancer Care, including Hospice Casa Speranţei’s Nursing Practice Center of Excellence in Palliative Care.
Palliative care involves specialized care for patients with serious terminal illnesses, such as cancer, providing relief from the symptoms and stresses of the disease and improving quality of life for patients and their families. “We are in a profession that touches not only a patient’s physical side, but their soul – their being – as well,” says Nicoleta, who has been a nurse for 24 years. “Specialized nursing skills that provide physical, psychological, social and spiritual care for terminally ill patients and their families are essential.”
When Hospice Casa Speranţei was founded in 1992, there were no palliative care services available in Romania. Today, services meet seven percent of the country’s need for palliative care. In Brasov, however, where Hospice Casa Speranţei is located, services cover more than 50 percent of the need.
Foundation grants support development of professional and leadership capacities in palliative care for nurses and allied healthcare professionals in Romania and CEE and empower patients with life-threatening illnesses and their families through information and education. They have also called attention to palliative care as a nursing specialty. Hospice Casa Speranţei has already earned recognition for excellence in palliative care training and for palliative care advocacy at the national and international levels.
Programs supported by earlier Foundation grants set the stage for Hospice Casa Speranţei’s success by increasing access to quality palliative care training for entry-level and experienced nurses. More than 6,000 nurses from Albania, Armenia, Greece, Hungary, Moldova, Romania, Russia and Serbia have received training; an additional 64 nurse leaders participated in a leadership skills program and now train other nurses in their home countries.
Although Hospice Casa Speranţei has raised the profile of palliative care nursing in Romania, national policy has not yet recognized it as a nursing specialty. Nicoleta, recently named coordinator of the Scientific Committee of the 14th Romanian Nursing Conference and the 4th International Conference of the Romanian Order for Registered Nurses, will continue working toward that goal.
“It takes time, no matter what you are advocating for,” she says. “I have been doing whatever is possible and taking every opportunity to move toward this target. I’m confident this change will happen soon.”
*Quinn MJ, d’Onofrio A, Moller B, et al. Cancer mortality trends in the EU and acceding countries up to 2015. Ann Oncol 2003;14:1148-52.