Lebanese Hospitals Research Articles

Nurses’ Emotional Intelligence, Satisfaction in Lebanon: The Mediating Role of Job Stress

This study aims to examine the direct effect of nurses’ emotional intelligence (EI) on their job satisfaction, as well as the indirect effect through the mediating role of job stress (JS). The sample consisted of 365 nurses working in Lebanese hospitals during the COVID-19 period. The results revealed that EI elements (Self-awareness, self-management, social-awareness and relationship-management) had a significant positive effect on nurses’ job satisfaction. The existence of the negative mediation of job stress between the four EI skills and attitudes was found. The generalizability is limited to the Lebanese registered nurses in hospitals. Future research needs to incorporate other samples like the private nurses. A comparative study to provide further clarify the effect of EI and JS on the nurses at different levels is needed. This study extends research on organizational behavior to Eastern culture by examining the direct effect of EI on attitudes as well as the indirect effect through the mediating effect of JS which was not previously tackled. It suggests that the four skills of EI have a significant positive effect on nurses’ attitudes. It emphasizes the full mediation role of JS. The obtained results indicated that hospitals can increase job satisfaction bettering the employees’ EI.

Prevalence of Malnutrition in Hospitalized Patients in Lebanon Using Nutrition Risk Screening (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) Criteria and Its Association with Length of Stay.

(1) Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a healthcare priority. The aim of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM), and explore the association between malnutrition and the length of hospital stay (LOS) as a clinical outcome. (2) Methods: A representative cross-sectional sample of hospitalized patients was selected from a random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid-upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. (3) Results: A total of 343 adult patients were enrolled in this study. The prevalence of malnutrition risk according to NRS-2002 was 31.2%, and the prevalence of malnutrition according to the GLIM criteria was 35.6%. The most frequent malnutrition-associated criteria were weight loss and low food intake. Malnourished patients had a significantly longer LOS compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. (4) Conclusion and recommendations: the study documented the valid and practical use of GLIM for assessing the prevalence and magnitude of malnutrition in hospitalized patients in Lebanon, and highlighted the need for evidence-based interventions to address the underlying causes of malnutrition in Lebanese hospitals.

NURSES’ EMOTIONAL INTELLIGENCE, BEHAVIOR AND THE MEDIATING ROLE OF JOB STRESS IN LEBANON

The aim of this paper is to examine the influence of emotional intelligence, namely self-awareness, self-management, social awareness and management’s relationship on the nurse’s behavior within the Lebanese context. It specifically examines the indirect effect of the nurses’ EI and its sub skills on behavior, exit, voice, loyalty, neglect, through the mediating role of job stress. A total sample of subjects consisted of 365 registered nurses actively working in the Lebanese hospitals during the COVID 19 period. Mediation was tested using Baron and Kenny (1986)’s framework. The findings demonstrate that the EI elements (Self-awareness, self-management, social awareness and management’s relationship) had a significant positive effect on nurses’ behavior. Another finding revealed the negative effect of emotional intelligence with the subskills, namely SA, SM, SoA, and SK, on job stress. In particular, SM was the most important factor in decreasing stress. Moreover, SM had a greater negative influence on job stress than SA did, followed RR and the least one is the SoA. In addition, the results proved the existence of the negative partial mediation of job stress among the four skills of emotional intelligence and behavior. This result highlights the importance of skills like emotional intelligence to maintain the good behavior of the nurses.

Food safety knowledge attitude and practices of oncology nurses, in Lebanese hospitals

BackgroundCancer patients undergoing chemotherapy treatment, have a higher risk to foodborne infections as compared to other populations. Oncology nurses, having a direct significant contact with these patients, could be the first information source concerning food safety and play a pivotal role in reducing these risks. ObjectiveThis study aims to assess the level of knowledge regarding food safety among oncology nurses, as well as their attitudes and practices in private hospitals in Lebanon. MethodsA self-administered questionnaire was filled by Oncology nurses (n = 134) working in eighteen private hospitals in Lebanon located in Mount Lebanon (n = 11) and Beirut (n = 7). ResultsOverall, oncology nurses scored 76%, 95%, 86.9% and 83.4% on the knowledge, attitude, and practices questions, and overall composite knowledge, attitude, practices (KAP) score, respectively. Knowledge scores were higher among nurses holding a graduate degree (mean = 85; p < 0.05), and those who attended a training course (mean = 79; p < 0.05). Attitude scores of nurses who read brochures were higher (p < 0.001). Attending conferences on food safety showed statistically significant effect on better practice scores (p < 0.001). ConclusionAccordingly, the findings highlight the need to develop standardized food safety curriculum and training necessary to allow oncology nurses to contribute to the education of cancer patients and decrease their risk of foodborne infection.

The Experience of ER Nurses in Lebanese Hospitals, During the COVID-19 Outbreak: A Qualitative Study.

The increasing number of COVID-19 cases, as well as the overwhelming workload, constitutes a serious occupational health threat to Emergency Room (ER) nurses working on the frontlines. In Lebanon, where unstable socio-economic conditions reign, the Covid-19 outbreak was added to the plethora of daily challenges faced by healthcare workers. The study's objective is to explore how Lebanese ER nurses perceived their duty on the frontlines amid the Covid-19 pandemic. This study employed a descriptive exploratory qualitative design. 15 Lebanese ER nurses working directly with Covid-19 patients were recruited from 3 university hospitals in Beirut. Interviews were held for data collection until data saturation. Subsequent analysis was done via coding of the transcribed verbatim. The findings showed significant gaps related to preparedness, support, and governmental action. Similarly, the frontliners faced serious challenges that increased their stress levels both physically and mentally. Furthermore, some participants were subject to stigma and had to face irresponsible behaviors during triage. Participants emphasized the need to guarantee a safe environment at work, to provide Covid-19 patients with the needed care. ER nurses struggled during this pandemic while working on the frontlines. They described their experience as not satisfying, with high levels of stress, danger, and challenges.

Medical Waste Management in Lebanese Hospitals

Medical Waste Management in Lebanese Hospitals

Implementation of Health Information Systems to Improve Patient Identification.

Wellbeing can be ensured in society through quality healthcare, a minimum of medical errors, and the improved performance of healthcare professionals. To this end, health information systems have been implemented in hospitals, with this implementation representing progress in medicine and information technologies. As a result, life expectancy has significantly increased, standards in healthcare have been raised, and public health has improved. This progress is influenced by the process of managing healthcare organizations and information systems. While hospitals tend to adapt health information systems to reduce errors related to patient misidentification, the rise in the occurrence and recording of medical errors in Lebanon resulting from failures to correctly identify patients reveals that such measures remain insufficient due to unknown factors. This research aimed to investigate the effect of health information systems (HISs) and other factors related to work-related conditions on reductions in patient misidentification and related consequences. The empirical data were collected from 109 employees in Neioumazloum Hospital in Lebanon. The results revealed a correlation between HISs and components and the effects of other factors on patient identification. These other factors included workload, nurse fatigue, a culture of patient safety, and lack of implementation of patient identification policies. This paper provides evidence from a Lebanese hospital and paves the way for further studies aiming to explore the role of information technologies in adopting HISs for work performance and patient satisfaction. Improved care for patients can help achieve health equality, enhance healthcare delivery performance and patient safety, and decrease the numbers of medical errors.

Assessment of gender gap in surgical specialties among Lebanese medical personnel: the need for involvement of women in surgery.

Little is known about gender disparity in the surgery specialty in Lebanon. To assess the status of female surgeons and possible gender gaps in surgery specialty in Lebanon. The study was conducted in May 2021. Data were retrieved from the Lebanese Order of Physicians website, indicating the number of physicians in the different specialties, their gender, hospitals, and locations. The c2 test of homogeneity was used to establish whether the gender distribution was equal. Women only accounted for 21.84% (3,370) of physicians in Lebanon, with surgery having the lowest number of female physicians in (n = 65; 2.30%). Women accounted for 1.63% of all surgeons in Lebanese hospitals, there were more female plastic and reconstructive surgeons (n = 12; 7.14%), while neurosurgery, oncological surgery and vascular surgery had no females. There was no significant difference in gender between academic and non-academic institutions (χ2 = 2.164, P = 0.149), or between public and private hospitals (χ2 = 1.277, P = 0.234). The surgical specialty had the widest gender gap among all the medical fields in Lebanon. Therefore, the healthcare systems, including public and private hospitals, have a long and difficult road in narrowing the gender gap. Different strategies to incorporate women into surgery should be explored to assure equitable opportunities for all physicians, based on competency rather than gender.

Epidemiology of Community-Acquired Respiratory Tract Infections in Patients Admitted at the Emergency Departments

Objectives: Community-acquired respiratory infections (CARTIs) are responsible for serious morbidities worldwide. Identifying the aetiology can decrease the use of unnecessary antimicrobial therapy. In this study, we intend to determine the pathogenic agents responsible for respiratory infections in patients presenting to the emergency department of several Lebanese hospitals. Methods: A total of 100 patients presenting to the emergency departments of four Lebanese hospitals and identified as having CARTIs between September 2017 and September 2018 were recruited. Specimens of upper and lower respiratory tract samples were collected. Pathogens were detected by a multiplex polymerase chain reaction respiratory panel. Results: Of 100 specimens, 84 contained at least one pathogen. Many patients were detected with ≥2 pathogens. The total number of pathogens from these 84 patients was 163. Of these pathogens, 36 (22%) were human rhinovirus, 28 (17%) were Streptococcus pneumoniae, 16 (10%) were metapneumovirus, 16 (10%) were influenza A virus, and other pathogens were detected with lower percentages. As expected, the highest occurrence of pathogens was observed between December and March. Respiratory syncytial virus accounted for 2% of the cases and only correlated to paediatric patients. Conclusion: CARTI epidemiology is important and understudied in Lebanon. This study offers the first Lebanese data about CARTI pathogens. Viruses were the most common aetiologies of CARTIs. Thus, a different approach must be used for the empirical management of CARTI. Rapid testing might be useful in identifying patients who need antibiotic therapy.

Impact, obstacles and boundaries of patient partnership: A qualitative interventional study in Lebanon.

The patient as partner approach is a modern ‎model of patient engagement that integrates the patients' knowledge and skills into managing their own health. This study aims to evaluate the benefits and barriers of patient partnership in a healthcare setting. It is a qualitative and interventional study that implemented a patient and family partnership committee (PFPC) at a Lebanese hospital during the COVID-19 pandemic. A purposeful guided approach was used for sampling, and data was collected by structured questionnaire ‎interviews. Seven PFPC team dynamics building blocks were generated: transparency, support, motivation, comfortable communication, mutual understanding, equity in positions and empowerment to participate. Both the patient partners (94%) and healthcare professionals (90%) were satisfied with the PFPC experience. The majority of the healthcare professionals (HP) reported a noticeable change in the quality improvement process (QIP) (89%) and approved to standardize the PFPC (93%). The patient partnership benefits were clear, and the PFPC was perceived positively by both patient partners (PP) and HP. PP experienced distress relief (37%), gained ideas (41%) and felt that their opinion was heard (27%) after PFPC participation. PP reported benefits to hospitalized patients, including respect and care (63%) and patient satisfaction (20%). The main challenges for PFPC implementation were time availability and conflicts. Lessons from patient partnership can be utilized to improve the patient care policies in the Lebanese healthcare system. Moreover, developing countries can benefit from the patient partnership approach in their healthcare settings.

Nurses\u2019 eating habits in Lebanon during the economic and health crises: a cross-sectional study

BackgroundNurses face multiple stressors that can influence their lifestyle, thus affecting their health status. Scarce are the scientific data on the nutritional status of nurses, especially during health crises. The aim of this study was to assess the impact of the COVID-19 pandemic on the eating habits of hospital nurses in the context of an exceptional economic situation in Lebanon.MethodsA cross-sectional study was conducted using a web-based questionnaire, targeting a non-random sampling of frontline nurses using the snowball technique. Descriptive and bivariate analyses were carried out. The population of the study included all registered nurses working in the Lebanese hospitals. A total of 533 nurses completed the questionnaire; 500 surveys were selected after excluding the ones presenting conditions that may affect their eating behavior.ResultsThe majority of the respondents were women (78.6%) with a mean age of 33 years [18-60] [SD,7.44 years]. Most of them (57.6%) had a crowding index ≥1. The consumption of different food groups decreased during these crises. There was a significant correlation between stress and deterioration of healthy food consumption, which provides beneficial nutrients and minimizes potentially harmful elements, especially for meat (OR 2.388, CI 1.463 to 3.898, P < 0.001). The decrease in monthly income showed a real impact on the consumption of healthy food such as meat (OR 2.181, CI 1.504 to 3.161, P < 001), fruits (OR 1.930, CI 1.289 to 2.888, P = 0.001), and milk and dairy products (OR 1.544, CI 1.039 to 2.295, P = 0.031).ConclusionsThe pandemic and in particular the economic crisis has changed the consumption of healthy food among hospital nurses in Lebanon. Similar research and support may be extended to include other frontline health care workers.

Two Adults with Rhinosinusitis Fungal Infection Post COVID-19 in A Lebanese Hospital: Case Report

Coronavirus disease 2019 (COVID-19) is a newly-emerging viral illness, affecting primarily the respiratory tract, that has been linked to the occurrence of severe opportunistic fungal and bacterial infections. The incidence of fungal infection increases in patients infected with COVID-19 due to the use of corticosteroids and the accompanying uncontrolled hyperglycemia. We report two cases of acute invasive fungal rhinosinusitis (AIFR): Mucormycosis and Aspergillosis (cases 1 and 2 respectively), diagnosed radiologically and histopathologically. Both cases were treated by a combination of medical treatment and surgical debridement. The first patient improved and was discharged home, while there was a delay in the operation for the second patient who passed away. It is important to raise efforts to adjust hyperglycemia and limit the excessive systematic use of steroids during COVID pandemic to reduce fungal infections.

Use of social media in healthcare

Our study describes the potential use of social media by hospitals in general and focuses on its actual use by Lebanese and American hospitals. We carried out an investigation concerning both countries’ hospitals in order to determine each their level of involvement, and its public’s level of engagement. This study also compares the way people react on each post, depending on the social network platform, the nature of each post, and the category of topics discussed. The results of this investigation unveiled a great disparity between these two countries concerning the frequency and the number of posts.

Variability, shift‐specific workloads and rationed care predictors of work satisfaction among Registered nurses providing acute care: A longitudinal study

AimsThe aim of this study was to explore nurses’ shift‐work satisfaction variability across time and its shift‐specific predictors: perceived workload, patient‐to‐nurse ratio and rationing of nursing care.DesignLongitudinal study of 90 Registered nurses (N = 1,303 responses) in a Lebanese hospital over 91 days of data collection.MethodsIntraclass correlation coefficients (ICCs) were computed to determine shift‐work satisfaction variability between individual nurses and working‐unit clusters. Generalized linear mixed models were used to explore the workloads and rationed care predictors of nurses’ shift‐work satisfaction separately for day and night shifts.ResultsVariability in shift‐work satisfaction was noted between individual nurses in day (ICC = 0.43) and night shifts (ICC = 0.37), but not between medical/surgical units. Nurses satisfied with their shift‐specific work were less probably to ration necessary nursing care (OR = 0.68; 95% CI = 0.60–0.77) in day shifts and to perceive high workload demands in both, day (OR = 0.29; 95% CI = 0.23–0.37) and night (OR = 0.29; 95% CI = 0.18–0.47) shifts. Monitoring and lowering workload demands while observing rationing of care is necessary to improve nurses’ shift‐work satisfaction.

The Spread of Plasmidic AmpC in a General Lebanese Hospital Over Nine Consecutive Years and the Relationship With Restricted Isolation Protocols.

Background: The dreaded bacterial infection by extended-spectrum β-lactamases (ESBL)-producers has always troubled the medical field whether on the public, scientific, or clinical levels. One of the lesser known β-lactamases, which is capable of hydrolyzing broad and extended-spectrum cephalosporins—i.e., cephamycins plus oxyimino-β-lactams—are the AmpC β-lactamases. This group, which has also been termed occasionally—and incorrectly—as ESBL Class C, confers resistance to β-lactamase inhibitors. The prevalence of plasmidic AmpC (pAmpC) strains is possibly still a matter of debate considering the unevenly matched data between phenotypically-detected and molecularly-detected pAmpC.Aim: In the absence of any study in Lebanon addressing the AmpC, our intention was to determine the numbers and percentages of AmpC Enterobacteriaceae isolates, notably plasmid-mediated ones, across different wards at the Centre Hospitalier du Nord (CHN), Lebanon, and highlight the importance of infection control protocols.Materials and Methods: Carriage and infection with pAmpC Enterobacteriaceae were retrospectively investigated between 2011 and 2015 and prospectively between 2016 and 2019 at the Centre Hospitalier du Nord Hospital, North Lebanon. The rise or decline in the numbers of such strains, in concordance with the allegedly intensive isolation of the patients, were analyzed.Results: Intensive care unit (ICU) data shows an initial rise in infection isolates from 2012 to 2014 and in the carriage isolates from 2012 to 2013 with later notable overall decrease in the both isolates' numbers with the application of the isolation protocols at CHN from 2014 onwards. Floors 2, 3, and 4 seemed to house the bulk of the isolates as well.Conclusion: Preventive measures, such as on-going surveillance of the hospital wards by specialized healthcare personnel and strict implementation of infection control practices, should be a top priority in any medical center in order to isolate such strains and try to put a limit for the development and the dissemination of any possible multidrug resistant strains.

Implementation of e-health innovative technologies in North Lebanon hospitals.

E-health is considered the single most important revolution in health care since the advent of modern medicine. It is an emerging field of medical informatics, used in the organization and delivery of health services and information. It is expected to improve various aspects of health care. To achieve universal health coverage in Lebanon, and to explore e-health implementation in Northern Lebanese hospitals and factors influencing the adoption of recent specialized technology in e-health. We adopted an exploratory research method based on a semi-structured questionnaire. The main 14 hospitals in Northern Lebanon were chosen for face-to-face interviews to assess and measure behaviour and knowledge regarding e-health and its implementation. Data were analysed using SPSS software, followed by SWOT analysis. The hospitals surveyed had partly implemented and continuously tried to apply some e-health technologies, but there were no real medical records for patients. Various challenges were faced for full e-health technology implementation in Lebanon: primarily cost, followed by some personnel resistance, lack of legislation and common standards, and the necessity for continual training. The majority of hospitals are conscious of the importance of e-health technology and the urgent need to implement these new methods. After the legislative rules are issued, the financial aspects remain the major handicap to full implementation. A major role must be played by the academic institutions to provide appropriate education on e-health in their programmes for future graduates.

A retrospective study of antibiotic resistance patterns of bacterial pathogens isolated from patients in two Lebanese hospitals for two consecutive years (2018 and 2019)

A retrospective study of antibiotic resistance patterns of bacterial pathogens isolated from patients in two Lebanese hospitals for two consecutive years (2018 and 2019)

Evaluation of hypertension treatment in acute ischemic stroke

BackgroundTreating hypertension (HTN) in acute ischemic stroke (AIS) is controversial, since both extremely high and low blood pressures (BP) are associated with poor outcomes. ObjectiveThis study was designed to describe and assess the frequency and the factors affecting BP overtreatment in AIS. Methods and materialThis was a retrospective observational study conducted at Lebanese hospitals. BP readings at baseline and after treatment with antihypertensive drugs were recorded. Overtreatment was defined as baseline BP below 220/120 mmHg and an antihypertensive drug was prescribed. ResultsA total of 141 patients were enrolled with a mean age of 76.89 years and 43.3% were males. Overtreatment rate was 62.6%, and was significantly more common in patients with a previous history of HTN and hyperlipidemia. In addition, overtreatment was significantly more common in patients treated with antihypertensive drugs, had high modified Rankin Scale score (>2) at baseline, and had high systolic BP at baseline (p < 0.05). Results of multivariate analysis revealed that the highest risk of overtreatment was significantly shown in patients who had HTN (OR = 4.589, p = 0.017), and who had high systolic BP at baseline (OR = 1.061, p = 0.001). ConclusionBP management in AIS was generally not consistent with the guidelines. This supports the need for further research to investigate the effects of BP overtreatment on patient outcomes.

Relationship of perceived supervisor support, self-efficacy and turnover intention, the mediating role of burnout

PurposeThe purpose of this paper is to study the effect of two positive organizational factors: the perceived supervisor support (PSS) and the self-efficacy (SE) on nurses' burnout (BO), which concurrently affect the turnover intention (TI) and the mediating role of BO in this relationship.Design/methodology/approachA cross-sectional survey-based study of a sample of 552 Lebanese registered nurses from 19 Lebanese hospitals was conducted.FindingsThe authors’ findings confirm that PSS and SE both reduce the level of BO and the turnover intention significantly. The higher the perceived supervisors' support and the nurses' SE, the less they experience BO. BO has partially mediated the relationship of the PSS and SE on TI. This study reveals that supervisors' support is well perceived by Lebanese nurses, whose s is relatively high, while their levels of BO are considered moderate. However, BO levels vary proportionally with demographic variables, namely age, work experience, gender, marital status and education.Originality/valueThis study provides new evidence on the relationship between PSS, SE and BO and turnover intention of Lebanese nurses. It is unique in studying the role of nurses' SE with regard to BO and TI and improving the quality of nurses' work life. It shows the significance of the supervisors' role in supporting the psychological state of nurses. The context of the study, Lebanon, is also novel as it differs from advanced economies institutionally, culturally and in legal frameworks that govern the employee–supervisor relationships.

Healthcare and Terrorism: The Lebanese Experience.

Due to the common instability caused by political and security issues, Lebanese hospitals have experienced acts of terrorism multiple times. The most recent Beirut Explosion even forced several hospitals to cease operations for the first time in decades-but studies show the preparedness levels for such attacks in similar countries are low. The aim of this study is to explore the experience of Lebanese hospitals with terrorist attacks. This qualitative study used semi-structured interviews with various stakeholders to assess their experience with terrorist bombings. Data was analyzed using the thematic analysis method. The researchers found that Lebanese hospitals vary greatly in their structures and procedures. Those differences are a function of 3 contextual factors: location, culture, and accreditation status. Hospitals found near 'dangerous zones' were more likely to be aware and to have better response to such events. A severe lack of communication, unity of command, and collaboration between stakeholders has made the process fragmented. The researchers recommend a larger role for the Ministry of Public Health (MOPH) in this process, and the creation of a platform where Lebanese organizations can share their experiences to improve preparedness and resilience of the Lebanese healthcare system in the face of terrorism.