International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Minimum initial service package (MISP) for sexual and reproductive health for women in a displacement setting: a narrative review on the Syrian refugee crisis in Lebanon.

BACKGROUND: Women and girls are disproportionately affected in times of conflict and forced displacement, with disturbance in access to healthcare services leading to poor sexual and reproductive health outcomes. The minimal initial service package (MISP) was created to mitigate the consequences of conflict and prevent poor sexual and reproductive health (SRH) outcomes, especially among women and girls. The aim of this narrative review was to explore the SRH response for Syrian refugee women and girls in Lebanon, with a focus on MISP implementation. METHODOLOGY: A comprehensive literature search was conducted for peer-reviewed articles in 8 electronic databases and multiple grey literature sites for articles published from March 2011 to May 2019. The target population was Syrian refugee women in Lebanon displaced from Syria as a result of the conflict that erupted in March 2011. The selected articles addressed MISP, SRH needs and services, and barriers to service access. A narrative synthesis was conducted, guided by the six main objectives of the MISP. RESULTS: A total of 254 documents were retrieved, from which 12 peer-reviewed articles and 12 reports were included in the review. All identified articles were descriptive in nature and no studies evaluating MISP or other interventions or programs were found. The articles described the wide range of SRH services delivered in Lebanon to Syrian refugee women. However, access to and quality of these services remain a challenge. Multiple sources reported a lack of coordination, leading to fragmented service provision and duplication of effort. Studies reported a high level of sexual and gender-based violence, pregnancy complications and poor antenatal care compliance, and limited use of contraceptive methods. Very few studies reported on the prevalence of HIV and other STIs, reporting low levels of infection. Multiple barriers to healthcare access were identified, which included system-level, financial, informational and cultural factors, healthcare workers. CONCLUSION: This study highlights the main SRH services provided, their use and access by Syrian refugee women in Lebanon. Despite the multitude of services provided, the humanitarian response remains decentralized with limited coordination and multiple barriers that limit the utilization of these services. A clear gap remains, with limited evaluation of SRH services that are pertinent to achieve the MISP objectives and the ability to transition into comprehensive services. Improving the coordination of services through a lead agency can address many of the identified barriers and allow the transition into comprehensive services.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Factors Associated With the Resilience of Nurses During the COVID-19 Pandemic.

BACKGROUND: The delivery of health care during the COVID-19 outbreak imposed significant challenges on the global nursing workforce and placed them at a higher risk of occupational burnout and turnover. In Lebanon, the pandemic hit when nurses were already struggling with an economic collapse caused by government failures. Resilience may play a protective factor against adversity and enable effective adaption to the burden of the pandemic. AIMS: To determine the level of resilience in the nursing workforce and its relationship to burnout, intention to quit, and perceived COVID-19 risk. METHODS: A cross-sectional study was employed among all registered nurses affiliated with the Order of Nurses in Lebanon and working in patient care positions in hospitals. The online survey questionnaire incorporated the Connor-Davidson Resilience Scale and the Copenhagen Burnout Inventory. Quartile scores were used to differentiate levels of resilience and burnout. Multiple logistic regression identified variables significantly associated with resilience. RESULTS: Five-hundred and eleven nurses responded to the questionnaire. Nurses had a moderate level of resilience (M  = 72 ± 13.5). In multivariate analyses, being male (OR = 3.67; 95% CI [1.46, 9.22]; p = .006) and having a master's degree (OR = 4.082; 95% CI [1.49, 11.20]; p = .006) were independently associated with higher resilience. Resilience levels decreased with higher personal burnout (OR = 0.12; 95% CI [0.03, 0.435]; p = .001), work-related burnout (OR = 0.14; 95% CI [0.04, 0.46]; p = .001), and client-related burnout rates (OR = 0.09; 95% CI [0.03, 0.34]; p < .001). Nurses reporting the intention to quit their job had lower resilience scores (OR = 0.20; 95% CI [0.04, 0.88]; p = .033). LINKING EVIDENCE TO ACTION: Nursing stakeholders must introduce programs to regularly assess and enhance the resilience of nurses especially at time of crisis. Such programs would protect nurses from the perils of burnout and enhance their retention during times when they are most needed. Protecting nurses from burnout is an ethical imperative as well as an operational requirement.

Determinants of nurse absenteeism and intent to leave: An international study.

AIM: To determine factors associated with nurses' intent to leave their positions and absenteeism. BACKGROUND: There is a recognized global shortage of nurses but limited data describing and determining factors associated with nurse absenteeism and intent to leave. METHODS: This study involved a secondary analysis of the results from direct-care registered nurses' responses to the MISSCARE Survey, with data from seven countries included. Multi-level modelling was used to determine nurse characteristics and working environment factors associated with nurse absenteeism and intent to leave. RESULTS: The level of absenteeism and intent to leave varied significantly across countries, with registered nurses in Lebanon reporting the highest intention to leave within 12 months (43%) and registered nurses in Iceland and Australia the highest level of absenteeism (74% and 73%, respectively). Factors associated with outcomes included perceived staffing adequacy of unit, job satisfaction, and age of the nurse. CONCLUSIONS: A significant difference between countries was identified in nurse absenteeism and intent to leave. Increased perception of unit staffing inadequacy, lower job satisfaction, less nurse experience, and younger age were significant contributors to nurse absenteeism and intent to leave. IMPLICATIONS FOR NURSING MANAGEMENT: These findings suggest that regardless of country and hospital, by ensuring that units are adequately staffed and increasing job satisfaction, younger, less experienced nurses can be retained and absenteeism reduced.

Facilitating and hindering factors for coping with the experience of having a child with cancer: A Lebanese perspective.

BACKGROUND: Families with a child with cancer face significant emotional and psychosocial stressors. The frequency of childhood cancer is increasing in Lebanon with more than 282 children diagnosed each year. This condition is reported to evoke a range of challenging emotions for parents, yet no studies have been conducted on the facilitating and hindering factors that affect Lebanese parents coping with a child with cancer. OBJECTIVES: The purpose of the study was to gain an in-depth understanding of factors facilitating and hindering coping methods of Lebanese parents with a child with cancer. METHODS: The study followed purposeful sampling and saturation principles in which 12 parents (mother or father) of a child were interviewed. Data were analyzed following the Utrecht School of phenomenology. RESULTS: Helpful and harmful experiences emerged through the coding process. The enabling factors were social/family support; talking about it; strong religious beliefs; and the communication style of health workers. On the other hand, the deterring factors were the waiting time and the hospital stay; changes in the couple's relationship; and sibling rivalry. CONCLUSION: These results could be used as the basis for additional research aimed at developing a structured approach to care that endorses the coping processes of Lebanese parents with a child with cancer. IMPLICATIONS FOR CLINICAL PRACTICE: Nursing and medical staff need to be conscious of parents' coping strategies and their impact on family dynamics and the relationship between the family and the health care team.

Nursing Research in Arab Countries: Current Status, Trends, Challenges, and Opportunities.

Introduction: Twenty-two Arab countries comprise the League of Arab States. While united in Arab identity, diversities among these countries exist at many levels. Conducting and publishing research in the Arabic speaking countries is an essential pillar for improving the status of the nursing profession. Purpose: The purpose of this study is to assess the current status, trends, challenges, and opportunities of nursing research in Arab countries. Methodology: An integrative review was conducted using (1) Index Medicus for the Eastern Mediterranean Regional Office Database Journals Directory (IMEMR), (2) the Iraqi Academic Scientific Journals Database (IASJD), (3) Ulrichsweb (UW), (4) The Geneva Foundation for Medical Education and Research/Middle Eastern Journals (GFMER), (5) the Nursing Journal Directory (NJD), (6) the Directory of Open Access Journals (DOAJ), and (7) Google Scholar. Journals and articles that met inclusion criteria were accessed, retrieved, reviewed, and subjected to content analysis by three authors, two of which were fluent in English, French, and Arabic languages. A third author fluent in all three languages confirmed the findings. Results: Nursing research in Arabic-speaking countries has evolved over the past decades but is still lacking compared to global nursing research. Moreover, it was found to be largely situated within academic institutions and linked to tenure and promotion requirements. Conclusion: Nursing journals in Arabic-speaking countries do not adequately represent that overall region and are limited in access.

Effectiveness of an Educational Workshop on Palliative Care Knowledge in Lebanese Nurses.

Background: Lebanon is one of the world's smallest countries, with an area of 10,452 square kilometers. Life expectancy in Lebanon presently stands at about 76.6 years for men and 79.3 years for women. It is well known that with long life comes chronic disease, serious illness, and increased resource utilization. With a rapidly aging population and ever-increasing life expectancy, an increase in illnesses that affect the elderly is expected to follow, including non-communicable diseases and cancer. Nurses are the largest workforce in Lebanon and are thus in a prominent position to influence the quality of palliative care (PC) delivery throughout the course of illness. Purpose: The purpose of this study was to evaluate the impact of an educational workshop on PC knowledge, attitude, and skills for practicing nurses at a Lebanese university medical center. Design: A mixed-method approach comprising a quasi-experimental and a qualitative process evaluation was followed to assess the nurses' knowledge, attitude, and skills about PC before and after the workshop and to evaluate the process itself. A convenience sample of 45 registered nurses working at the university medical center from multiple clinical units participated in the workshop that took place over one day in a referral medical center in Beirut. Inferential statistical analysis was used. Results: Data were analyzed using SPSS 25 for Windows. The paired t test showed a significant increase between the pre-and post-test scores t (39) = 11.07, p < 0.001 with a 95% confidence interval for the mean difference of (17.58-25.45). Thirty-eight participants (90.5%) did not pass the pre-test exam whereas only 12 participants (30.0%) did not pass the post-test exam. Recommendations: It is highly recommended to follow up with the participants of this workshop to determine the immediate and long-term outcomes of this educational workshop as well as offer workshops for a wider population of nurses in Lebanon and the region.

Spirituality among parents of children with cancer in a Middle Eastern country.

PURPOSE: Family caregivers of children with cancer face emotional, psychological, and spiritual challenges coping with their child's illness. For ensuring comprehensive multidisciplinary pediatric care, there is a need to understand and define what spirituality means for them in relation to their child's illness. The purpose of this study is to understand the meaning of spirituality for parents of cancer patients in Lebanon. METHODS: This qualitative study followed the Heideggerian interpretive phenomenological method. Through purposeful sampling, 11 parents (mother or father) of children with cancer receiving treatment at a tertiary care center in Beirut, Lebanon were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998). RESULTS: A constitutive pattern and overarching theme, "spirituality is a two-level relationship. It is a relation with God and with people. It is the act of receiving and giving back" and five major themes emerged from the data. These were "Being there for me; " "Connectedness with other parents is a blessing and a torment; " "The power of knowing; " "Communication with Unknown" and "Spirituality is not religiosity". CONCLUSION: Lebanese parents of children with cancer defined the elements of their own spirituality. Relational aspects dominated and communication was an important factor. IMPLICATIONS FOR PRACTICE: This is the first study in the Middle East to address the meaning of spirituality in this population, and would pave the way for a customized palliative care program and integrative approach to patient care.

Focus Groups Investigating Mental Health Attitudes and Beliefs of Parents and Teachers in South Lebanon: Are They Culturally Determined?

INTRODUCTION: The wars that Lebanon had endured led to a devastating number of deaths, injuries, and displacements. Such tragedies have detrimentally affected its civilians psychologically. PURPOSE: To identify knowledge, attitudes, and practices of teachers and parents concerning child/adolescent mental health. METHOD: Using purposeful sampling, five focus groups were conducted with teachers and parents of students from elementary, middle, and secondary levels in two private hub schools in South Lebanon. RESULTS: A total of 27 teachers and 18 parents participated separately in focus groups. Three themes emerged: (a) Mental health care is a priority for overall health, (b) Mental illness is a cultural taboo, and (c) There is a need for better education and cultural understanding about mental health. DISCUSSION: This is the first study in Lebanon directly targeted at parents' and teachers' mental health concerns. Such findings will add to transcultural nursing knowledge about the importance of mental health care.

The lived experience of Lebanese oncology patients receiving palliative care.

The purpose of this study was to uncover the lived experience of Lebanese oncology patients receiving palliative care. The study design was based on the Utrecht School of Phenomenology based on the Dutch school of phenomenology. This study followed purposeful sampling in which ten participants, six women, and four men, with a mean age of 54.4 years were selected. In-depth semi-structured interviews along with observation field notes were used as the source for data collection. Data were analyzed using the hermeneutic phenomenological approach based on the Utrecht School of Phenomenology. The participants highlighted their distress from being dependent; their dislike for pity; their worry for the family and the worry about the family's worry; their reliance on God and divinity; their dislike of the hospital stay; their need to be productive; their fear of pain; and their need to communicate. Specific nursing actions related to the themes would include exploring patients' ideas, beliefs, and experiences regarding pain, and improved communication among patient, family, and the health care providers.

The lived experience of parents of children admitted to the pediatric intensive care unit in Lebanon.

BACKGROUND: Family caregivers have a significant responsibility in the care of their child in the Pediatric Intensive Care Unit (PICU). Parents staying with their child in the PICU have particular needs that should be acknowledged and responded to by clinicians. Several studies have been conducted in the USA and Europe to try to understand the experience of family caregivers of children admitted to the Pediatric Intensive Care Unit. There are no such studies in Lebanon or the Middle East where the culture and support systems differ from other countries. OBJECTIVE: To understand the lived experience of Lebanese parents of children admitted to the PICU in a tertiary hospital in Beirut. DESIGN: Phenomenological study. METHODS: The study followed purposeful sampling in which 10 parents (mother or father) of children admitted to PICU were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironside (1998). RESULTS: A constitutive pattern "Journey into the unknown" which constitutes an overarching theme and four major themes with subthemes emerged from the data. These were: We are human beings with dignity "; "looking for a healthier environment"; Dependence on God and "The need to be in the loop" reveal the parents' journey into the unknown. CONCLUSION: This qualitative study adds to the knowledge that would help health care workers understand the experience of Lebanese parents with a child in PICU and to highlight the significance of this experience to them. The findings could be used to inform the development of a PICU parental satisfaction instrument for the sample group.

Living with breast cancer, a Lebanese experience.

AIM: The purpose of this qualitative phenomenological study is to provide in-depth understanding of the experience of Lebanese women living with breast cancer. BACKGROUND: Breast cancer is the most frequently diagnosed cancer in women worldwide. In Lebanon, a country of 4 million people, breast cancer is as well the most widespread type of cancer among Lebanese women. The meaning of cancer diagnosis, the meaning of childbearing and femininity all have cultural bases in Lebanon. The international literature lacks information on how Lebanese women live with breast cancer when compared with women of other cultures. METHOD: The study followed purposeful sampling and saturation principles in which 10 participants with a mean age of 51.3 years were chosen based on their actual knowledge of the phenomenon, and their readiness to share that knowledge. Data were collected between December 2007 and May 2008. All interviews were audio-taped and transcribed verbatim. Data were analyzed based on the Utrecht School of Phenomenology. FINDINGS: Four major core themes describing the participants' lived experience emerged from the interviews: Living with losses; living with guilt feeling; living with fears and uncertainty; Living with the need to know and to share that knowledge. CONCLUSION: The experience of Lebanese women with breast cancer revealed distinctive themes not reported by other women from other cultures. The results of this study challenge health care providers and educators to be aware of the difficulties that Lebanese women are facing when they are living with breast cancer.

Coping with breast cancer: a phenomenological study.

BACKGROUND: Breast cancer is the most common malignancy affecting women worldwide. In Lebanon, a country of 4 million people, breast cancer is also the most prevalent type of cancer among Lebanese women. OBJECTIVE: The purpose of this study was to gain a more in-depth understanding of the coping strategies espoused by Lebanese women with breast cancer. METHODS: The study followed purposeful sampling and saturation principles in which 10 female participants diagnosed as having breast cancer were interviewed. Data were analyzed following a hermeneutical process as described by Diekelmann and Ironside (Encyclopedia of Nursing Research. 1998:50-68). RESULTS: Seven main themes and 1 constitutive pattern emerged from the study describing the Lebanese women's coping strategies with breast cancer. The negative stigma of cancer in the Lebanese culture, the role of women in the Lebanese families, and the embedded role of religion in Lebanese society are bases of the differences in the coping strategies of Lebanese women with breast cancer as compared to women with breast cancer from other cultures. CONCLUSION: These findings cannot be directly generalized, but they could act as a basis for further research on which to base a development of a framework for an approach to care that promotes coping processes in Lebanese women living with breast cancer. IMPLICATIONS FOR PRACTICE: Nursing and medical staff need to have a better understanding of the individual coping strategies of each woman and its impact on the woman's well being; the creation of informal support group is indispensable in helping these women cope with their conditions.

The lived experience of Lebanese family caregivers of cancer patients.

The purpose of this study was to explore, through in-depth semistructured interviews, the lived experience of Lebanese family caregivers of cancer patients and acquire a better knowledge of the meaning and interpretation of their experience. The study design was based on the Utrecht School of Phenomenology. This study followed purposeful sampling, in which 9 participants with a mean age of 51 years were selected. Data were analyzed using the hermeneutic phenomenological approach based on the Utrecht School of Phenomenology. Eight core themes describing the participants' lived experience emerged from the interviews: living with fears and uncertainty, loss of happiness, feeling of added responsibility, living in a state of emergency, sharing the pain, living the dilemma of truth telling, disturbed by being pitied, and reliance on God. The results of this study challenge nurses to be conscious of the nature and difficulties that family caregivers are encountering.

Personal characteristics and job satisfaction among nurses in Lebanon.

OBJECTIVE: This study investigates the level of satisfaction of Lebanese nurses in their job and the influence of their personal characteristics. BACKGROUND: Given the current difficulties experienced by Lebanese hospitals in recruiting and retaining a sufficient number of nurses, the need to understand the reasons of nurses' dissatisfaction became urgent. Moreover, satisfaction at work is essentially a personal experience also affected by cultural factors. Therefore, it was necessary to study the links between personal characteristics and nurses' dissatisfaction. METHODS: The study included 421 registered nurses. A modified version of Measure of Job Satisfaction, developed by Taynor and Wade, was used to assess the effect of the personal characteristics, namely educational level, age, years of work experience, position, and marital and parental status, on 5 dimensions of satisfaction: personal satisfaction, workload, professional support, pay and prospect, and training. RESULTS: The findings suggest that personal characteristics have important influences on nurses' job perceptions. University graduate nurses reported more dissatisfaction with the quality of supervision and with respect and treatment they receive from their superiors. Nurses younger than 30 years and the technically trained were more dissatisfied with the available opportunities to attend continuing education courses. Results of staff nurses and unmarried nurses showed trends of more dissatisfaction than the married and nurses of higher positions. Moreover, the whole sample perceived that nursing provided a high level of personal satisfaction, but nurses were most dissatisfied with salary and lack of prospects for promotion. CONCLUSION: The results indicate the importance of personal characteristics on nurses' retention. Furthermore, intrinsic factors related to the nature and experience of nursing are more job satisfying than extrinsic factors.