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barriers, changes, clinical practice, ELNEC, medical education, palliative care



  1. Mitrea, Nicoleta PhD, APRN, MSc
  2. Mosoiu, Daniela MD, PhD
  3. Ancuta, Camelia APRN, MSc
  4. Malloy, Pam RN, MN, FPCN
  5. Rogozea, Liliana MD, PhD


Palliative care nurses in Romania have a long history of collaborating with the End-of-Life Nursing Education Consortium (ELNEC) project, a national education initiative administered by the American Association of Colleges of Nursing (AACN) in Washington, DC, and the City of Hope National Medical Center in Duarte, California. Between January 2013 and October 2014, 1360 Romanian nurses participated in ELNEC palliative care training courses; 306 of these nurses attended both the introductory and advanced ELNEC courses. The aims of this study were to identify the changes implemented by the participant nurses in their clinical practice, after attending ELNEC palliative care introductory and advanced courses, and to compare the participant nurses' palliative care knowledge precourse versus postcourse. The data were collected from 6 focus groups at 3 to 6 months postcourse, in 6 different locations in Romania. Five themes were identified, with related subthemes including new perspectives of care, the importance of communication skills, the role of interprofessional teams in the healthcare system, addressing the needs of the patient and family, and informed decision-making by the patient and family. This study showed that the ELNEC introductory and advanced courses lead to changes in the participant nurses' clinical practice and aided nurses in identifying barriers in the Romanian public healthcare system that need to be addressed to improve palliative care.