The Impact of the End-of-Life Nursing Education Consortium International Training Program on the Clinical Practice of Eastern European Nurses Working in Specialized Palliative Care Services A Romanian Case Study Nicoleta Mitrea, PhD, APRN, MSc ƒ Daniela Mos ¸ oiu, MD, PhD ƒ Camelia Ancut ¸ a, APRN, MSc ƒ Pam Malloy, RN, MN, FPCN ƒ Liliana Rogozea, 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. KEY WORDS barriers, changes, clinical practice, ELNEC, medical education, palliative care BACKGROUND In December 1989, after the fall of the communist regime, palliative care (PC) began to develop slowly and be recog- nized in Romania. In the early 1990s, with generous inter- national financial and technical support, charitable PC organizations were established to answer the urgent need to properly care for patients with incurable chronic dis- eases. Nongovernmental organizations implemented the necessary changes to make PC possible. They did so by reacting to and representing and advocating for a very large segment of the population whose needs were great, ini- tially human immunodeficiency virusYpositive patients. Sadly, more than 50% of Europe’s human immunodefi- ciency virusYpositive children/pediatric patients were born in Romania in 1988 to 1989. 1 As a result of this reality, sev- eral hospices in Cernavod", Bucharest, and Curtea de Argez were established in 1992. 2 It was the establishment of HOSPICE Casa Speran¢ei (HCS) service in Bras ¸ ov, in 1992, that marked the true Nicoleta Mitrea, PhD, APRN, MSc, is medical faculty, Transylvania University and HOSPICE Casa Sperant ¸ ei, Brasov, Romania. Daniela Mos ¸ oiu, MD, PhD, is medical faculty, Transylvania University; and HOSPICE Casa Sperant ¸ ei, Brasov, Romania. Camelia Ancut ¸a, APRN, MSc, HOSPICE Casa Sperantei, Brasov, Romania. Pam Malloy, RN, MN, FPCN, is ELNEC project director, American Asso- ciation of Colleges of Nursing, Washington, DC. Liliana Rogozea, MD, PhD, is medical faculty, Transylvania University, Brasov, Romania. Address correspondence to Daniela Mos ¸ oiu, MD, PhD, Sitei 17A, Brasov, Romania 500074 (daniela.mosoiu@hospice.ro). The authors have no conflicts of interest to disclose. Copyright B 2017 by The Hospice and Palliative Nurses Association. All rights reserved. DOI: 10.1097/NJH.0000000000000367 424 www.jhpn.com Volume 19 & Number 5 & October 2017 Feature Article