The relationship between work-related musculoskeletal disorders, chronic occupational fatigue, and work organization: A multi-hospital cross-sectional study.

AIMS: To identify the prevalence of work-related musculoskeletal disorders, levels of chronic occupational fatigue, and how they vary with individual and work organization factors. DESIGN: A multi-hospital cross-sectional survey. METHODS: Nurses from 39 hospitals completed self-reported questionnaires from June to September 2015. Descriptive statistics were used to summarize hospitals and nurses' characteristics, fatigue levels and prevalence, and type of musculoskeletal disorders. Linear and logistic regression analyses were used to identify correlational factors. RESULTS: The results revealed that 71.3% of participants reported a work-related musculoskeletal disorder in the previous 12 months, mainly back pain. The reported musculoskeletal disorders were significantly correlated with years of experience, nurse to patient ratios, and chronic occupational fatigue. Higher chronic occupational fatigue levels were associated with education, age, years of experience, nurse to patient ratio, and model of care. CONCLUSION: Preventive work organization strategies are needed to ensure healthier occupational environment for nurses.

The first Arabic version of the Actual Scope of Nursing Practice Scale: Psychometric evaluation.

AIM: We examined the validity and reliability of nursing activity levels of complexity in the first Arabic version of the Actual Scope of Nursing Practice Questionnaire. BACKGROUND: Nurse executives need valid and reliable data on the scope and complexity of nursing practice to make decisions about cost-effective and safe deployment of the nursing workforce. We translated the English version of the Actual Scope of Nursing Practice Questionnaire into Arabic for use in Lebanon and the eastern Mediterranean region. METHODS: Data were collected from a national sample of bedside nurses in Lebanon in which 3,157 questionnaires were returned for analysis. We used multidimensional scaling, hierarchical cluster analysis, and confirmatory factor analysis to examine the Arabic Actual Scope of Nursing Practice Questionnaire levels of nursing complexity. RESULTS: Multidimensional scaling analysis and hierarchical cluster analysis confirmed the unidimensionality of the Arabic Actual Scope of Nursing Practice Questionnaire. Confirmatory factor analysis produced essentially the same fit statistics for the unidimensional model and three-dimensional models of item complexity. CONCLUSION: The Arabic Actual Scope of Nursing Practice Questionnaire is a valid and reliable unidimensional measure of nursing complexity. IMPLICATION FOR NURSING MANAGEMENT: Nurse executives and hospital managers in Lebanon and the eastern Mediterranean region can use total and mean Arabic Actual Scope of Nursing Practice Questionnaire scores as aids when making decisions about nursing workforce deployment.

The making of nursing practice law in Lebanon: a policy analysis case study.

BACKGROUND: Evidence-informed decisions can strengthen health systems, improve health, and reduce health inequities. Despite the Beijing, Montreux, and Bamako calls for action, literature shows that research evidence is underemployed in policymaking, especially in the East Mediterranean region (EMR). Selecting the draft nursing practice law as a case study, this policy analysis exercise aims at generating in-depth insights on the public policymaking process, identifying the factors that influence policymaking and assessing to what extent evidence is used in this process. METHODS: This study utilized a qualitative research design using a case study approach and was conducted in two phases: data collection and analysis, and validation. In the first phase, data was collected through key informant interviews that covered 17 stakeholders. In the second phase, a panel discussion was organized to validate the findings, identify any gaps, and gain insights and feedback of the panelists. Thematic analysis was conducted and guided by the Walt & Gilson's "Policy Triangle Framework" as themes were categorized into content, actors, process, and context. RESULTS: Findings shed light on the complex nature of health policymaking and the unstructured approach of decision making. This study uncovered the barriers that hindered the progress of the draft nursing law and the main barriers against the use of evidence in policymaking. Findings also uncovered the risk involved in the use of international recommendations without the involvement of stakeholders and without accounting for contextual factors and implementation barriers. Findings were interpreted within the context of the Lebanese political environment and the power play between stakeholders, taking into account equity considerations. CONCLUSIONS: This policy analysis exercise presents findings that are helpful for policymakers and all other stakeholders and can feed into revising the draft nursing law to reach an effective alternative that is feasible in Lebanon. Our findings are relevant in local and regional context as policymakers and other stakeholders can benefit from this experience when drafting laws and at the global context, as international organizations can consider this case study when developing global guidance and recommendations.

Using "best-fit" interventions to improve the nursing intershift handoff process at a medical center in Lebanon.

BACKGROUND: Nursing intershift handoff involves communicating essential patient information between the outgoing and the oncoming nurses during shift changes. A subsequent review of reported patient safety incidents at Labib Medical Center (LMC), Saida, Lebanon, showed that medication errors, delay in treatment, wrong treatment, duplication of laboratory tests, and near-miss events were caused by patient information omissions during intershift handoffs. In response, LMC initiated a quality improvement project using a multifaceted intervention to improve the quality of nursing intershift handoffs. METHODS: The barriers to effective intershift handoff identified in the literature that best fit the current context of intershift handoffs at LMC showed that the following three issues needed to be addressed: (1) the absence of a standardized intershift communication tool, (2) inadequate training of RNs on intershift handoff communication, and (3) the interruptions during the shift reports. Accordingly, a three-faceted intervention was constructed, entailing (1) introduction of a standardized intershift handoff tool, (2) training RNs about effective handoff communication, and (3) decreasing interruptions. RESULTS: The mean number of omissions per handoff across the three units decreased from 4.96 to 2.29 (t = 6.29, p = .000), as did the mean number of interruptions per intershift report--from 2.17 to 1.26 (t = 2.7, p = .008). RNs' knowledge of the criteria to be communicated suggested a greater appreciation of their own role in patient safety. CONCLUSION: The intershift handoff communication process can be improved using evidence-based strategies that target internal barriers where the shift report occurs. Regular monitoring and follow-up are essential to maintain the improvement.

An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers.

Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.

Multidimensional Rasch Analysis of the Arabic Occupational Fatigue Exhaustion Recovery Subscales.

BACKGROUND AND PURPOSE: Investigation of the psychometric properties of the Arabic version of the Occupational Fatigue Exhaustion Recovery (A-OFER) subscales. METHODS: Partial credit model (PCM) analyses of 2037 Lebanese nurses' responses to the chronic fatigue (CF), acute fatigue (AF), and intershift recovery (IR) subscales. RESULTS: The data were a better fit to the three-dimensional Rasch PCM; difference, χ2 = 2199.3, df = 5, p = .01; unidimensional Akaike information criterion (AIC) = 107355; multidimensional AIC = 105166. Rating categories were disordered and there was item dependence among negatively-keyed items. All items were free of subgroup bias. Inter-subscale correlations were contrary to expectations. CONCLUSION: The CF subscale has sufficient reliability for screening nurses in Lebanon and the Eastern Mediterranean region for low to moderate levels of occupational fatigue. The construct validity of the A-OFER requires further investigation.

The translation and cultural adaptation validity of the Actual Scope of Practice Questionnaire.

BACKGROUND: Information on the scope of nursing practice is urgently needed in the Eastern Mediterranean region to help policy makers and directors of nursing develop informed workforce plans. AIMS: This study aimed to validate the Arabic translation and cultural adaptation of the Actual Scope of Practice Questionnaire (A-ASCOP). METHODS: The process of translation and cultural validation adhered to WHO guidelines. The process involved forward translation, review by an expert panel, back-translation, pre-testing and cognitive interviewing. RESULTS: The clarity, meaningfulness and relevance of the first Arabic version of the A-ASCOP has been validated. CONCLUSION: Subject to psychometric analysis, the A-ASCOP is suitable for use in Lebanon and countries of the Middle Eastern region.

Multidimensional Analysis of the Arabic Version of the Actual Scope of Nursing Practice Scale.

BACKGROUND AND PURPOSE: Data were analyzed from a national convenience sample of 3,000 bedside nurses in Lebanon to evaluate the psychometric characteristics of the first Arabic version of the Actual Scope of Nursing Practice (A-ASCOP) questionnaire. METHODS: The method used in this study was application of the partial credit model using the multidimensional random coefficients multinomial logit model. RESULTS: A-ASCOP subscales (r = .81-.94) and levels of item complexity (r = .95-.98) were highly correlated. CONCLUSIONS: As a 26-item scale, the A-ASCOP has high internal consistency (Cronbach's α = 0.93). The A-ASCOP subscales have acceptable multidimensional reliability Expected A-Posteriori/Plausible Value ratio (EAP/PV > .80) and are suitable for descriptive surveys. The three A-ASCOP levels of item complexity were not valid for this sample. We report norms for unidimensional Rasch and 0-100 transformed measures by category of participant.