What made Lebanese emigrant nurses leave and what would bring them back? A cross-sectional survey.

BACKGROUND: The nursing workforce is critical for the provision of quality health-care and positive patient outcomes. There is a global trend of migration of nurses from under-developed to developed countries due to attractive job offers in the host countries. Lebanon presents such a case where nurses are migrating abroad, leading to shortages in the nursing workforce in their home country. OBJECTIVES: The aim of this study was to investigate reasons for the migration of Lebanese nurses, and incentives that would attract them back to their home country in order to enhance the nursing workforce in Lebanon. DESIGN: This study is a cross-sectional survey of emigrant Lebanese nurses. SETTINGS: Recipient countries where Lebanese nurses emigrated. PARTICIPANTS: 440 Emigrant Lebanese nurses were identified through the registration database of the Order of Nurses in Lebanon. The survey was sent to all of them via email; 153 responses were received. METHODS: Data were collected from November 2017 to March 2018. Analysis included univariate and bivariate tests to present descriptive statistics of the respondents, and to examine region of residence and gender in relation to their current job satisfaction, reasons for leaving Lebanon, intention to return to Lebanon, and aspects that would attract them back to their home country. Logistic regression analysis was used to determine the socio-demographic and work-related characteristics associated with the odds of returning to practice nursing in Lebanon. RESULTS: A total 136 completed responses were considered. Emigrant Lebanese nurses were highly educated, with more years of work experience, and older than nurses remaining in their home country. Top reasons for nurses to leave Lebanon included unsatisfactory salary or benefits, better work opportunities in other countries, and lack of professional development or career advancement. The majority of surveyed nurses (59%) expressed willingness to return to practice nursing in Lebanon. Aspects that would attract emigrant Lebanese nurses back to their home country include attractive salary or better benefits and opportunities for professional development, career advancement, or continuing education. Emigrant Lebanese nurses residing in the Gulf, staff nurses, and nurses with more years of work experience were more likely to return to practice nursing in Lebanon. CONCLUSION: Highly educated and experienced nurses are departing from Lebanon. This presents a challenge for the less experienced nurses remaining in the country, who could benefit from the mentorship and experience of their migrating peers. Creating an environment that could enhance the professional development of nurses in Lebanon, with financial incentives could retain the nursing workforce in the country.

Patients' knowledge and attitudes about myocardial infarction.

Delay in seeking emergency care contributes significantly to the mortality associated with myocardial infarction. The aims of this descriptive study were to determine Lebanese patients' knowledge, attitudes, and beliefs about heart disease following their hospitalization for acute myocardial infarction, the factors associated, and to investigate the education they receive about heart disease. The study targeted 50 participants diagnosed with myocardial infarction who were interviewed about their knowledge, attitudes, and perceived control related to heart disease in their home 1 month after being discharged from hospital using the Acute Coronary Syndrome Response Index and the Control Attitude Scale-Revised. The findings showed inadequate knowledge, with only 26% scoring over 70%. Moreover, only 16% reported having received education about heart disease. The participants reported confidence in recognizing symptoms and getting assistance during a myocardial infarction. However, their beliefs regarding the importance of prompt seeking of emergency care for myocardial infarction and control over their disease were inconsistent. Patient education and counseling about recognizing and responding adequately to symptoms of myocardial infarction must be improved in both acute and primary healthcare settings.

Role of the Lebanese family caregivers in cardiac self-care: a collective approach.

AIMS AND OBJECTIVES: The purpose of this study was to explore perceptions of cardiac self-care among Lebanese family caregivers of cardiac patients. The specific aims were to describe the cultural context of cardiac care-giving in Lebanon and to explore the roles of family caregivers in enhancing self-care practices in patients with cardiac diseases. BACKGROUND: The role of family caregivers in Lebanon, a country in the Middle East, is assumed to extend beyond care-giving to making decisions on behalf of the patient and assuming responsibility for patient care. To date, there has been no study done to empirically validate this impression. DESIGN: The design of the study is qualitative descriptive that used semi-structured individual interviews with family caregivers of Lebanese cardiac patients. METHOD: Thirteen family caregivers of cardiac patients were recruited from a referral medical centre in Lebanon. The participants were designated by their patients and interviewed in a place of their choice. RESULTS: One overarching and three themes emerged from data analysis describing roles of family care givers in cardiac self-care. The overarching theme was: Family caregivers of Lebanese cardiac patients were unfamiliar with the term, concept and meaning of Self-Care. The moral and emotional duty to care for the family member stemmed from obligation and responsibility towards patients (theme I). Interdependent care (theme II) between cardiac patients and their families emerged as a significant cultural role. Family members play multiple supportive roles in care-giving namely emotional, informational and instrumental role (theme III). CONCLUSION: In this study, family caregiver role is shown to be based in the sense of obligation and duty towards the sick family member who collectively provide different types of supportive care. RELEVANCE TO CLINICAL PRACTICE: Nurses have to give significant importance to the family caregiver role as an integral part of any culturally sensitive patient/family intervention.

Deciding to Seek Emergency Care for Acute Myocardial Infarction.

The purpose of this qualitative descriptive study was to explore how patients who experience acute myocardial infarction (AMI) decide to seek emergency care. Fifty patients with AMI were interviewed at two hospitals in Lebanon. The perspective of 22 witnesses of the attack was also sought about the cardiac event. The themes that transpired from the data were as follows: making sense of the symptoms, waiting to see what happens, deciding to come to the hospital, and the family influenced the decision to seek care. The witnesses of the cardiac event, mostly family members, supported the decision to seek emergency care. Deciding to seek emergency care for AMI is complex. Nurses must solicit their patients' perception of the cardiac event to provide them with tailored education and counseling about heart attack symptoms and how to respond to them in case they recur. Family members must be included in the education process.

A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

BACKGROUND: Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. METHODS: This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. RESULTS: A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried, with less years of work experience and were not working towards a higher degree. Analysis reveals a directly proportional relationship between nurses' reported job satisfaction and their intent to stay. CONCLUSION: This study reveals poor retention of nurses in rural and underserved areas in Lebanon, especially in the hospital sector. The status quo is disquieting as it reflects an unstable and dissatisfied nursing workforce. Developing targeted retention strategies for younger nurses and those working in hospitals as well as the offering of professional development opportunities and devising an incentive scheme targeting rural nurses is pivotal to enhance nurses' job satisfaction and retention in rural settings.

Intention to stay of nurses in current posts in difficult-to-staff areas of Yemen, Jordan, Lebanon and Qatar: a cross-sectional study.

BACKGROUND: The nursing workforce shortages in difficult-to-staff areas have implications not only for quality of care but also for population health outcomes. An understanding of attrition and of retention is important to inform policies on the nursing workforce. OBJECTIVES: This paper draws on questionnaire survey data from nurses working in difficult-to-staff areas in four countries in the Eastern Mediterranean Region (Yemen, Jordan, Lebanon and Qatar). It aims to identify the specific and common factors associated with nurses' intention to stay in their current post for the coming 1-3 years in three countries with an internally trained nursing workforce and in a fourth where the workforce is externally recruited. METHODS: Nurses working in 'difficult to staff' areas in Yemen, Jordan, Lebanon and Qatar were surveyed. A conceptual model composed of 6 dimensions based on that of the World Health Organization was constructed with 'intent to stay' (Career Decisions) as the main outcome. Regression models were constructed for each of the dimensions in the conceptual model with 'intent to stay' as the dependent variable for each of the study countries. Subsequently, a collective model that combined Lebanon, Jordan and Yemen was constructed to identify common factors that are associated with intent to stay. RESULTS: Factors associated with intent to stay differed for study countries. Marriage was positively associated with intent to stay in Lebanon and Jordan whereas years of experience were positively significant for Lebanon and Yemen. Shorter commuting time was significantly associated with intent to stay in Jordan whereas a preference for village life was significant for Lebanon. Job satisfaction was significantly associated with intent to stay in all study countries. Nurses in Lebanon, Jordan and Qatar who indicated that they would choose nursing if they had the opportunity to choose a career all over again were significantly more likely to intend to stay in their current post. CONCLUSIONS: Studies of nurses working in these areas can help national policymakers and local nursing directors better manage the sparse nursing workforce in these localities and to provide them with appropriate incentives and support to encourage them to stay.

Readmission rates and emergency department visits after coronary artery bypass graft surgery and related factors.

INTRODUCTION: Coronary artery bypass graft (CABG) surgery is associated with complications like wound infection, arrhythmias, heart failure, and pulmonary complications, leading to hospital readmissions. This study aim was to determine rates of readmissions and emergency department (ED) visits in CABG surgery patients within 30 days post-discharge. Reasons for and frequency of readmissions, and associated factors were examined. METHODS: Retrospective review of medical records of patients operated on in 2010 at a tertiary medical center was done. Adult (18+ years) CABG surgery patients were included while those who underwent CABG with valve surgery or had mental disorders were excluded. RESULTS: Of the 110 patients studied, 9.1% were readmitted and 13.6% visited the ED within one month of discharge. The most frequent reasons for readmission were pleural effusion and dyspnea, and for ED visits, dyspnea and wound infection. Readmitted patients had fewer grafts performed than those who were not. Patients who visited the ED had higher incidence of bundle branch block and a trend towards higher body mass index than those who did not visit. CONCLUSION: Patients must be closely followed up following CABG surgery for respiratory complications and educated about how to care for the surgical wound. Prospective studies with larger samples are recommended.