Interdiciplinary Programme On Chronic Care and End of Life Care


University College Arteveldehogeschool – Gent, Belgium
This is the third year that I have accompanied UConn nursing students to this two week, intensive program. The USA is one of eight countries participating with Estonia, The Netherlands, Norway, Lithuania, Portugal, Belgium and the Czech Republic.
As in the past, these students were also responsible participants and wonderful ambassadors for the USA. Their blogs have been shared with the other faculty members. Their comments regarding the “elementary level” of some of the presentations have been noted and will be considered as we plan for the 2014 conference. Students vary in their depth of knowledge thus, it is a challenge to meet the needs of everyone.
Kathryn Stewart Hegedus, Associate Professor, Emerita

Laura Bishop
The experience in Belgium is one that will stay with me for the rest of my life. When I first applied to the program I was unaware of how intensive and demanding the course would be. The very concentrated curriculum required every student who was part of IPCEC to be completely and totally committed to learning about caring for the chronically ill/end of life patient.
The part of the program that will stay with me forever is every moment that all the students spent together outside of class. I learned more about other cultures/countries by having casual conversations with students, then by the formal lectures from the instructors. Every day I was excited to get to know the international students better. The most surprising aspect of the experience was how welcoming the Belgium students were. They were genuinely caring, helpful and resourceful whenever someone had a question or needed help simply getting around the city of Ghent.
My interest in the program was sparked by the information we received about euthanasia. In the United States euthanasia is not legally practiced. Physician assisted suicide is the only ending of life option. Learning about the options suffering patients have in end of life decisions in Belgium opened my eyes to the potential future possibilities patients could have in the United States. The main problem I see in the U.S. society is stubbornness. It seems to me that most Americans are stubborn or unwilling to learn about a practice that is not seen as socially acceptable. My society needs to open their eyes and learn about options they might not personally agree with. I myself do not personally agree with euthanasia, but, what gives me the right to discredit a practice I know so little about? Keeping the IPCEC program running will help to educate other countries’ health care professionals become more understanding of another culture/country’s practices. To see through the eyes of another and accept them for who they are and what they practice is when we can call ourselves truly educated future health care professionals.

Stephanie Kish
I am glad I had the opportunity to study abroad at Arteveldehogeschool in Ghent, Belgium, and Deistelheide in Dworp, Belgium. Before coming to Belgium I had never left the United States before; the farthest I’d ever travelled was Florida. The 8+ hour flight did not intimidate me (I’d been in 8+ hour car rides before, and I love flying), it was navigating through airports and foreign public transportation that made me most nervous. But as there were seven of us, we were able to figure it out. The best part of the experience by far was getting to met and become friends with students from Belgium, The Netherlands, Norway, Portugal, Estonia, Greece, Lithuania, and Czech Republic. Everyone was so friendly. I remember a few days into the trip was my birthday. That combined with being far from home for the first time made me very homesick for family and friends. However, my group and our international friends quickly made me feel comfortable and at home by singing happy birthday several times throughout the day and in a couple of languages, along with receiving a Belgian éclair and learning about the three kisses tradition.
It made me realize (and carry with me throughout the trip) that even though you are not surrounded by the familiarities and comforts of home, you can still have great experiences and memories as long as you have good people with you, which we did.
One thing I thought was interesting was that sometimes if someone I was talking to knew I was American, they would often feel self-conscious about their English or their accent, while on the other hand I was self-conscious because English is the only language I can speak (fluently, anyway). Meanwhile, the people we met could speak three to four languages.
Throughout IPCEC, I not only learned about healthcare in other countries, but gained a better grasp on health care in the United States, and a more developed opinion on healthcare systems in general. Yes, America has many issues in affordability of healthcare and health insurance, but we are on the right track with certain things such as stressing patient autonomy, the importance of patient education, and trying to eradicate paternalism. We also had a lecture/debate on euthanasia; it was interesting to learn about this sensitive topic in a country where it is legal.
In Deistelheide we participated in various alternative therapy workshops, including art therapy, music therapy, aromatherapy, and basal stimulation. Usually skeptical of alternative therapy techniques, I now understand how and why they are used and found them therapeutic myself during the workshops.
Overall, I am glad I went on this two-week study abroad trip to Belgium. If I wanted to make this blog longer, I could go on about the Belgian beer; chocolate shops; extreme dehydration; the fact that we experienced every type of Belgian weather; doing everything wrong on Belgian trains; that I checked “visit a castle” off of my bucket list; my love of Speculoos; kip as my first word in Dutch (it means chicken); and that I would love to continue exploring Europe during my life as well as other continents.

Lauren Papa
Reflection on Belgium Experience
For me traveling to Belgium was much more than just an educational experience. What I found most valuable about this experience was not the time spent in the classroom but the time spent getting to know students from different cultures. It was eye opening to see not just how different we all were, but also how alike. I found it very valuable to put myself in a position where I knew nothing about the culture, and be simply immersed in a world so unlike my own. Meeting, working, and socializing with a diverse group of students gave me a new perspective on the world and myself.
Going into this experience I have to admit I knew little to nothing about what it meant to be a nurse in other countries. I very naively thought that a “nurse was a nurse,” no matter where you are but what I learned was that the role of the nurse is a little bit different everywhere you go. This was eye opening to me and it really gave me a much better appreciation for nursing as a global profession. I also gained a global perspective on end of life care. As our population ages it is important to be familiar with all the different choices one can make at the end of life. It was particularly interesting to learn about euthanasia and the impact it has had in both Belgium and the Netherlands. This choice, virtually unavailable to those in the United States, has brought closure to many peoples in a very peaceful and meaningful way. I feel that by having had this experience, and having learned from other professionals, that I am better prepared to be a culturally competent provider here at home.
One of my favorite experiences in Belgium was the opportunity to participate in site visits. I was able to see first hand nursing care in a few different contexts. The site that had a meaningful impact on me was a breast cancer rehabilitation facility. Its inception was from the idea that there is a transition phase between the end of treatment and the return to a normal routine. At this facility women are invited to participate in a treatment regimen that focus on strengthening the body, mind, and spirit all the while taking place in a historic royal villa on the waters edge. This experience had an impact on me because I wish there were places like this available to my Aunt when she was transitioning from being “sick” to being “Cured”. Overall I was impressed by the sheer amount of facilities dedicated to taking care of the whole individual separate from the disease process. In addition my mind was opened up to all the different options for quality end of life care available in different countries.
It is impossible to have an experience like this and not compare it to what I know to be true at home, and through doing this I was able to see the importance of education. Every healthcare provider should be educated about intercontinental and intercultural differences so as to better understand the care we provide in our own countries. I feel that there is nothing more limiting than a lack of knowledge and understanding of what is out there. This experience continues to impact my nursing education as well as my clinical practice. As a nurse I am more culturally competent, and more open to a variety of end of life choices. As an individual I am stronger having left my comfort zone to have an amazing experience. But most importantly as a student I have made connections and friendships that will last a lifetime.

Brittany Rubenstein
My experience in Belgium is one that I will remember for the rest of my life. This trip did have its ups and downs, but the positive aspects will be the ones I will cherish forever. I had never been to Europe before, but after attending this conference I will most definitely return to this beautiful land.
The classroom content itself was rather basic, but the knowledge from outside the classroom was unforgettable. In my opinion I learned more from than other students, than the faculty itself. I feel like the content of the class can improve and become more challenging. The most useful topic was the discussion on Euthanasia. The topic of Euthanasia is rarely talked about in the United States, which is why this lecture was so valuable to me. I think it is in the conferences best interest if they elaborated more on this topic. For me, Euthanasia was one reason why I wanted to attend this conference. I have had family members who have suffered from terminal illnesses and in my opinion the end-of-life care in the United States is lacking. I wanted to attend this multicultural conference to see how the United States can improve on their end-of-life care.
It was a great experience to attend the day visits at the various healthcare institutions in Belgium. This really made the conference worthwhile for me because we were able to physically see how the healthcare system operated in this country. One of my visits was to an adult day care center, which was absolutely amazing. This facility was somewhere I would want my family members to attend if they were terminally ill. I personally wish that the United States could have something similar to this program.
Overall this conference was a great opportunity. I left this conference with friends from various countries and an opinion with how my homeland can improve on their end-of-life care.

Brenna Czudak
This year I was a participant in the Uconn Study Abroad to Belgium. I have never been on a plane, let alone left the country, and thus every moment was a new and amazing experience for me.
Being in a foreign country was humbling, because it’s so very easy to forget how much of the world is out there when you’ve never really left the small state you grew up in. I learned words quickly (kip is the word for chicken in Dutch!) and learned about local traditions and landmarks. The fact that I was walking streets that had been in existence for hundreds, even thousands of years, reminded me of how young our country really is. One particular morning, a friend and I left the hostel early and bought breakfast from a small boulangerie on the way to class, and as I was watching the steam come off the freshly made croissant from a bakery that had been in existence since the 16th century, it hit me how very blessed I was to be a part of this world that had such an remarkable story to tell.
This feeling was compounded by the opportunity I had to interact with students from so many other countries, learning about our differences but most notably, our similarities. Students were welcoming, and always willing to share. It was amazing to see my own country through their eyes—and healthcare on a global level, for the first time. Cultural night was one of the best nights of the trip. Each country created a presentation about their country’s culture, with food, posters, pictures, clothing, and dance. One of the best and uniting moments was when we were all dancing the Lithuanian dance. On multiple occasions throughout the trip (even at the bar!) someone would play this song and EVERYONE would get up and dance. It became a part of us, part of our shared experience, reminding us we are never far from each other and the incredible friends we had made.
There was so much I learned that I wish to bring into my practice as a nurse in the United States. I’ve been an aide in long term care for years, but had never really looked at death, open and exposed, the way we did during lectures and discussions during class. So much of what was taught and explored was about the holistic care of these dying patients, and it was refreshing and educational to focus on the spirit after being enmeshed in the medical model of care for so long. I loved the workshops we participated it—my choices were basal stimulation, massage, reiki and art therapy. The panel discussion on euthanasia was also an incredible experience. I know that I grew in knowledge and practice, and this experience will highly benefit by care as a future nurse.
To have an opportunity to participate in a program like this is a blessing. The intercultural and interdisciplinary education and experience is invaluable. I have returned home with new knowledge, stories to last a lifetime, and friends, from across the globe. I will never forget this experience, and its hand in shaping who I will become, both as a nurse and an individual.

Casey Martin
When I went to Belgium I had no idea what to expect. I knew we were going to learn about palliative care but that was my only expectation. We were all pleasantly surprised not only by Belgium itself but by the people who were also at the conference. Each country brought very different perspectives not only about end of life care but about nursing in general. I learned more than I ever imagined I would during this conference. Surprisingly, I learned more from the other students than I did in our classes. They provided more information about their culture and healthcare system than any class ever could. It was eye opening to hear about how healthcare systems operate in other countries; and comparing other countries to the United States really made me appreciate our healthcare system.
My favorite part of this program was the demonstration of complementary therapies that are widely used in Europe especially at the end of life. Some of the complementary therapies we discussed were aromatherapy, pet therapy, massage, light therapy, feet reflexology, music therapy, and reiki. Before this experience I had barely heard about the majority of these therapies let alone how to perform them. Practicing these on classmates and getting to experience each therapy made all of us realize how useful and calming each of the therapies can be for individual patients. It really made me think of how I can incorporate some of these therapies into my patients care to make them more comfortable.
Overall, Belgium was a wonderful learning experience that I highly suggest to other students with an interest in end of life care and complementary therapies.

Courtney Beyers
Seven students from the University of Connecticut School of Nursing were invited to participate in the European Union 2013 IPCEC Study Abroad experience: International Programme on Chronic and End-of-Life Care.

We departed from the US on January 18 and began our study abroad experience in Ghent, Belgium. Initially, we discussed elementary concepts such as pain management as we became acquainted with our various cultural representations and broke our language barriers. Nearly a dozen counties and languages were represented at this conference/study abroad, however, it was conducted in English.

Early in the first week, we had a “cultural night” when we celebrated the various counties attending the experience. This was a wonderful opportunity to get to know everyone participating as they presented food and dances representative of their home countries. We had many opportunities to chat, learn each other’s names, and become more comfortable with each other.

We continued to attend lecture throughout the week, but also had the opportunity for two site visits. My first site visit was a home for the elderly in Ghent. A local student took us there and provided a tour. It was very interesting to see the continuity of care at the facility and “aging in place” from independent living, to assisted living, to 24 hour nursing care and care at the end of life. Everyone was extremely welcoming on behalf of the staff and the residents were very happy to greet us as well. I would definitely be comfortable living there later in life.

My second site visit was a palliative care unit in Brugges. The definition of “palliative” is different than the American connotation. In Belgium, a palliative care unit is equivalent to an inpatient hospice unit in America. This was at first confusing and surprising to me, because I was not expecting it. Instead, I was expecting something along the lines of a patient-centered medical home to provide palliative care or “symptom management” for chronic patients. I am so used to caring for patients with Sickle Cell Disease, so my personal experiences had motivated this mindset.

The palliative care unit nurses were extremely calm and welcoming. It was obvious they were passionate about their work, to care for people at the end of life. An interesting discussion that was motivated by our site visit was “truth telling” at the end of life. Do you tell someone that they are dying? Do you not tell someone that they are dying? Is this necessary? Is this an injustice, or is it justice?

It’s all debatable.

Our group chose to work on a representation of the palliative care unit for our group work for the remainder of the conference. After the first week, the entire conference migrated to Dworp for complementary and alternative therapy training. The location was very fitting for this study because it was set in a quiet, more rural area.

During week two, we were offered several hands-on workshops such as: reiki, music therapy, art therapy, massage, etc. I think we were very fortunate to have the opportunity to get comfortable with reiki, since it has caught on in the West and will only become more popular.

As I reflect back upon this experience, I feel that the workshops, lectures, and site visits have advanced my clinical competence. Already, I have been able to employ what I have learned into clinical practice. A very nauseous cancer patient undergoing chemotherapy was not responding well to Zofran… and so I took her away to a beach through the means of guided imagery and the help of a T.V. station at the hospital called the “Relaxation Station.” I feel I had the confident to facilitate deep breathing guided imagery, and in the end, she did not vomit! In fact, she reported that her nausea resolved. This was definitely a very useful adjuvant to her Zofran.

I am still in touch with friends I made during this conference. It is amazing how many experiences we have shared! We grew so close together throughout the two weeks. I will always treasure this experience.