Dyadic lived experiences of ventricular assist device in a crisis torn country

Funding Acknowledgements

Type of funding sources: None.

Dyadic lived experiences of ventricular assist device in a crisis torn country

Background

 Patients with Heart Failure benefit from advanced treatment modalities like the Left Ventricular Assist Device [VAD]. Literature has addressed the complexity of the VAD experience in terms of lifestyle changes and adaptive processes affecting dyads, patients and their caregivers 1,2. In Lebanon, a knowledge gap on the experiences of dyads after VAD implantation is identified. Dyads in Lebanon are challenged by the country’s political and economic instability. It is thus imperative to explore VAD dyadic lived experiences in a country with limited resources and aggravated crises. 

Purpose

 This study aims to explore the lived experiences of VAD dyads and gain insight on how they adapt to their new life with the VAD.

Methods

 Following a qualitative phenomenological design, we interviewed 5 patients [3:2, Male: Female] along with their identified caregivers [1:4, Male: Female]. Transcription was completed verbatim in Arabic. Back translation to English was completed independently by the researchers. Colaizzi’s descriptive phenomenological method guided the thematic analysis.

Results

 4 out of 5 dyads reported a complementary care approach where both members of the dyad counterpart each other in caring for the VAD patient. One dyad had a caregiver oriented approach. Two themes emerged capturing determinants that impact adaptation to a life with a VAD. 

Theme I

Challenges to the VAD experience, personal and contextual. Patients perceived body image alterations as a barrier for intimacy. Spousal caregiver role was problematic. With patients’ heightened sensitivity, spouses dwelled on the need for vigilance with every act. Initially, the presence of the VAD was coupled with dyadic anticipated concern on adaptation and caregiving. Patients complained about the weight of the VAD. Contextual challenges centered around the economic crisis resulting in supply cutoffs and inflated prices for daily VAD care supplies. Along with the medical bills’ steep rise, dyads had to endure electrical supply shortage. 

Theme II

Facilitators to the VAD experience, personal and cultural. Dyads considered the need for VAD placement to be determined by God’s will. Faith assisted them to cope and accept their lifestyle changes. Mental wellbeing promoted high spirits and positively impacted their recovery. In line with the collectivistic culture, support from the family and social circle elevated morale. One of the patients who was unmarried described the lack of responsibilities as a facilitator for acceptance of the VAD. 

Conclusion

This is one of the first studies to address the paucity of knowledge on how dyads experience their new life following VAD implantation. The unstable living conditions add to the complexity of the VAD experience. The identified challenges and facilitators inform healthcare professionals on means to support VAD patient caregiver dyads.

Work environment-related factors and nurses' health outcomes: a cross-sectional study in Lebanese hospitals

Background

Worldwide, studies show a relationship between nurses’ health and some work environment factors; however, data on nurses’ health and self-perceived workload and nursing task allocation are lacking, particularly for Lebanese nurses. We assessed the relationship of several work environment factors: overall workload and specific temporal, physical, mental, effort, frustration, and performance demands (NASA Task Load Index), staffing resources and adequacy and leadership (Practice Environment Scale of Nursing Work Index), teamwork climate (Safety Attitudes Questionnaire), and nursing task allocation (Basel Extent of Rationing of Nursing Care)) with self-reported musculoskeletal, cardiovascular, skin, and mental health diseases (Work Ability Index) and emotional exhaustion (Maslach Burnout Inventory) among Lebanese nurses.

Methods

A cross-sectional self-report survey was distributed to all 289 registered nurses (RNs) in the medical, surgical, and pediatric units in two Lebanese university-affiliated hospitals; 170 RNs had complete data. Adjusted multivariable logistic regression models were used to estimate the association between work environment factors and health outcomes.

Results

The most prevalent outcomes were musculoskeletal disease (69%), emotional exhaustion (59%), and mental health problems (56%); 70% of RNs had ≥2 and 35.29% had ≥4 co-occurring health problems. Musculoskeletal disease was associated with higher overall (OR = 1.36 (95%CI = 1.03, 1.80)), temporal (OR = 1.30 (95%CI = 1.09, 1.55)), and physical demands (OR = 1.20 (95%CI = 1.03, 1.49)), higher task allocation to RNs (OR = 1.11 (95%CI = 1.01, 1.23)) and lower teamwork climate (OR = 0.60 (95%CI = 0.36, 0.98). Higher odds of mental/emotional problems were associated with higher overall, temporal, frustration, and effort demands, and lower teamwork climate, performance satisfaction, and resources adequacy (increased odds ranging from 18 to 88%). Work environment indicators were associated with higher co-occurrence of health problems.

Conclusions

Results show elevated health burden and co-morbidity among Lebanese RNs and highlight the value of comprehensive approaches that can simultaneously improve several work environment factors (namely self-perceived workload, teamwork,, resources, and nursing task allocation) to reduce this burden.

Perspectives of Registered Nurses on refugee healthcare in Lebanon and Jordan (PROfILE): A multi-site cross-sectional study protocol

AIM

This is a study protocol to investigate nurses' perspectives on refugee health care in two countries. The aims are to: (a) explore self-reported work environment factors, including work stressors, self-rated leadership, staffing and resources adequacy, and teamwork among Jordanian and Lebanese nurses caring for refugees; (b) investigate the relationship between nurse related outcomes (physical health; emotional exhaustion) and their psychosocial work environment; and (c) assess the association between nurses' perceived work environment factors and implicit rationing of care and quality of patient care.

BACKGROUND

Globally, the care of refugees is achieving increased attention. Over 6.3 million people are internally displaced and 4.8 million recorded Syrian expatriates are residing in and receiving healthcare services in the neighbouring host countries.

DESIGN

This is a cross-sectional, comparative study using a survey design.

METHOD

The study setting involves both private and public hospitals and primary healthcare centres that provide care to refugees on regular basis in Lebanon and Jordan. The estimated sample size includes 3,000 Registered Nurses from Lebanon and 2,500 nurses and midwives from Jordan.

DISCUSSION

Workplace factors affecting quality of nursing care and psychosocial status of nurses caring for refugees will be identified. Potential findings will help leaders design interventions to support nurses who are serving refugees for safer care and better patient outcomes. Findings will assist in more efficient resource allocation and management.

IMPACT

New knowledge on the impact of providing health care for refugees will be generated based on the structure of nursing care (e.g., work environment), on the nursing process (e.g., implicit rationing of care), and nurse outcomes (health) in two hosting communities. Moreover, factors enabling resilience in patients, providers, and systems will be identified and be of potential use in addressing the growing global problem of caring for displaced persons.

Anaphylaxis management: a survey of school and day care nurses in Lebanon

OBJECTIVE

Children are at a high risk of developing allergic reactions. Since they spend lots of time at the school or day care, the odds of having an allergic event in this setting is high, hence placing the onus of properly managing their event on nurses. In Lebanon, little is known whether a standardised policy for managing allergic and anaphylactic reaction exists, leaving children unsafe and the school personnel liable. Thus, the aim of this study is to describe the current practices in the management of severe allergies and anaphylaxis by Lebanese nurses working in schools and day cares and to explore the perceived need for a protocol to manage anaphylaxis reaction.

METHODS

A cross-sectional survey with nurses working at schools and day cares in Lebanon was conducted.

RESULTS

A total of 59 school and day care nurses participated. Eighteen of the school and day care nurses reported having a written policy describing the management steps. Only 12 had witnessed an anaphylactic event. Of those, 10 reported administering an antihistamine medication orally instead of epinephrine intramuscular. Most respondents (56) believed that a standardised guideline for the management of anaphylaxis was essential, and 9 indicated being hesitant to give the epinephrine intramuscular even in the presence of a policy. Finally, 55 stated the need for training nurses in identifying and managing anaphylaxis as a must.

CONCLUSION

Currently, the management of anaphylaxis reaction in schools and day cares is suboptimal. Hence, there is a need for a standardised nursing guideline and training for nurses in these settings.

A national cross-sectional study on nurses' intent to leave and job satisfaction in Lebanon: implications for policy and practice

Background

Lebanon is perceived to be suffering from excessive nurse migration, low job satisfaction, poor retention and high turnover. Little is known about the magnitude of nurse migration and predictors of intent to leave. The objective of this study is to determine the extent of nurses' intent to leave and examine the impact of job satisfaction on intent to leave. Intent to leave was explored to differentiate between nurses who intend to leave their current hospital and those intending to leave the country.

Methods

A cross-sectional design was used to survey nurses currently practicing in Lebanese hospitals. A total of 1,793 nurses employed in 69 hospitals were surveyed. Questions included those relating to demographic characteristics, intent to leave, and the McCloskey Mueller Satisfaction Scale. Univariate descriptive statistics were conducted on sample's demographic characteristics including gender, age, marital status and educational level. Bivariate associations between intent to leave and demographic characteristics were tested using Pearson Chi-square. Differences in satisfaction scores between nurses with and without intent to leave were tested using t-test and ANOVA f-test. A multinomial logistic regression model was created to predict intent to leave the hospital and intent to leave the country.

Results

An alarming 67.5% reported intent to leave within the next 1 to 3 years, many of whom disclosed intent to leave the country (36.7%). Within nurses who reported an intent to leave the hospital but stay in Lebanon, 22.1% plan to move to a different health organization in Lebanon, 29.4% plan to leave the profession and 48.5% had other plans. Nurses reported being least satisfied with extrinsic rewards. A common predictor of intent to leave the hospital and the country was dissatisfaction with extrinsic rewards. Other predictors of intent to leave (country or hospital) included age, gender, marital status, degree type, and dissatisfaction with scheduling, interaction opportunities, and control and responsibility.

Conclusion

Study findings demonstrate linkages between job satisfaction, intent to leave, and migration in a country suffering from a nursing shortage. Findings can be used by health care managers and policy makers in managing job satisfaction, intent to leave and nurse migration.

Weight control measures among university students in a developing country: a cultural association or a risk behavior

OBJECTIVE

The purpose of the study was to determine the prevalence of university students, in Lebanon, trying to lose weight and assess the relation of trying to lose weight with demographic, scholastic and health behavioral factors.

METHODS

The study was cross-sectional conducted in the academic year 2000-2001. A proportionate random sample of 2,013 students was selected among five public and private universities in Beirut. Participants completed a self-administered anonymous questionnaire that included questions on trying to lose weight, demographic, scholastic, and health behavioral factors including smoking, alcohol, and seat belt use. Bivariate and stepwise logistic regression analyses were performed to examine the association between trying to lose weight and the above-mentioned characteristics.

RESULTS

The overall prevalence of students trying to lose weight was 30%, with 71% of them being under weight or normal weight. Use of medications and inducement of vomiting constituted 12% and 11%, respectively. Stepwise logistic regression analysis showed that the variables significantly associated with trying to lose weight were socio-economical factors rather than risky behaviors. Students who were at increased odds of performing such methods were females OR = (2.08, 95% CI = 1.6-2.5), employed (OR = 1.36, 95% CI = 1.01-1.8), and registered in a private university (OR = 1.69, 95% CI = 1.25-2.0). The major of students was also a significant predictor.

CONCLUSION

In Lebanon, weight reduction could be re-enforced by socio-economical factors and not necessarily be an adolescent risk behavior.