Observing nursing practice on placement in Romania

When nursing students Eve Buckley, Nicole Sparham and Shelby Small did their elective placements they opted for a trip to Romania. It proved to be an unforgettable experience.

When nursing students Eve Buckley, Nicole Sparham and Shelby Small did their elective placements they opted for a trip to Romania. It proved to be an unforgettable experience.

Disabled and orphaned adults with learning disabilities in Romania
Picture: Getty Images

We could have done our second-year placement anywhere providing we could justify its relevance to nursing practice and professional development. We decided to do our placement in Romania, working with children who have learning disabilities who were in ‘family-type homes’ and at an adult institution in Slatina – a town two hours’ drive west of the capital Bucharest.  


Amount Shelby Small raised to fund the trip

We thought it would be good opportunity to observe practice in another country, seeing how the culture influences this and observe innovations and challenges to practice which could broaden our understanding and skills. We made the arrangements ourselves to take advantage of an opportunity to explore an area of practice which we would have been unable to experience in a conventional placement. The university provided us with ideas and we were put in touch with a charity, the Life Foundation who work in Romania. 


Shelby Small

‘I had a friend with some land that we could use, discussed ideas with family and friends, and decided to hold a fun day. We had penalty shootout and wellington boot and sponge throwing competitions, plus a cake auction. I play in a steel band, so we held a steel pan workshop where people could pay to learn a tune. We had a Caribbean food stall and sold burgers and hot dogs.

'The adults with learning disabilities received no engagement as the staff were stretched and had little time'

Shelby Small

‘I wrote to all of the local activity parks, newspapers and radio stations. They provided me with tickets and prizes for a raffle. I aimed to raise £1,000 and managed to raise £2,500. I used the money to fund the trip and used the rest to pay four children’s school fees and bought their school supplies too. We also took clothes, toiletries, food and toys to the local adult institution,’ said Shelby Small.


There were many opportunities to give the children gifts and looking back we all feel that the gifts were tangible, essential and emotional. We took hand-held flashing sensory toys, nail polish, and toys for babies to chew and bubbles to blow. The children loved these. We also took clothing, baby milk, yogurts and fruit.

Perhaps our general engagement with the children and adults was the biggest gift of all. The staff in Romania did not seem to engage with the children or adults often, particularly those who were physically unable to move over to them to play. The adults with learning disabilities received no engagement as the staff – six members for 87 residents – were stretched and had little time. The engagement we provided was rewarding time for them and us.


The number of staff working with 87 residents in the home for adults with learning disabilities

Romanian translators accompanied us to each visit and we were made to feel welcome. We had to walk to each location, and we would take as many toys as we could to play with the children.

How did you find out about a child needing an operation and that you might be able to help?

‘Our translator, Marie, had told us previously about how hard the healthcare system in Romania was, as despite everyone being entitled to care, not everyone received it. She told us how nurses would leave patients without food and water, unless their families paid them extra to care for their loved ones.

Nicole Sparham

 ‘I found out about a boy who had Down’s syndrome, and needed cardiac surgery to correct a defect. He was two years old and had still not had the surgery he needed. There were doctors available to do the operation, but because the child’s support staff could not afford to give the doctor any extra money, the doctor would not do the surgery.

‘My time in Romania has made me appreciate that we in the UK are lucky to have the NHS’

Nicole Sparham

I decided to use all the extra funds to help in any way I could. I paid the doctor 300 Romanian leu (about £57), on the Thursday and he was booked in for surgery on the Sunday. Unfortunately, we had to leave and were not able to find out the outcome of the operation,’ said Ms Small.

What we learned

‘I learned how to manage my emotions in difficult and upsetting situations,’ said Ms Sparham.

'I had never experienced this before and it was difficult to cope, and manage. However, thanks to the support of others we addressed the issues after our visit to ensure that the time spent with the families was positive and beneficial for them.

‘My time in Romania has made me appreciate how lucky the UK is to have the NHS, and we need to ensure that we use services effectively to enhance and promote quality of life.’

Tips for your own trip

Go with people you know 

'I was lucky to go with two of my close friends,’ says Ms Sparham. ‘I don’t think I could have done it without them, we supported each other through talking, listening, reflecting and spending time together.

'We all had mixed emotions, and difficulties throughout the trip. This allowed our friendship to grow and we have shared some amazing experiences which helped us develop as people and as nurses.

Look beyond

‘It was the best feeling in the world giving my time to others and making their day. Look past the environment and circumstances so you are able to enjoy the company of the children and adults' says Ms Sparham


How has it changed your views?

‘The experience has opened my eyes to the challenges and differing approaches to practice in other countries. There were similarities in practice, for example the desire to have no institutions and provide support for people in the community instead,’ said Ms Buckley.

‘The main differences I observed included reduced resources and lower staff-to-patient ratios as well as a difference in cultural values and the resulting influence on everyday practice.’

Would you recommend it?

We would all recommend that every student goes on a similar visit if they get the chance. Although tough at times, it was one of the most rewarding things we have ever done.  It highlighted to us how far we have come in supporting individuals with a learning disability and made us realise how important it is to continue to educate others about individuals with learning disabilities.

Eve Buckley

‘I would advise travelling the country, see as much as you can, be open-minded about culture, speak to people and learn about their experiences and outlook on life,’ said Ms Buckley.

‘Just do it,’ added Ms Small. ‘This experience was a once in a lifetime trip and one I will never forget. I think everyone should have the opportunity to go on a trip like this just to highlight how thankful we should be to have the opportunity to bring happiness to those most in need.’

Eve Buckley is now a nurse on a children’s inpatient psychiatric ward at South London and Mausley NHS Foundation Trust, Nicole Sparham and Shelby Small are nurses on an adolescent forensic ward at Southern Health NHS Foundation Trust, Southampton. All three went on the placement while in their second year on the learning disability nursing degree course at the University of Hertfordshire. Ms Small received the Dean’s award for social responsibility to help with fundraising for the placement.

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