Myrna Doumit

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 womens 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 womans well being; the creation of informal support group is indispensable in helping these women cope with their conditions.

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 satisfiers than extrinsic factors.

Predictors of psychological distress in Lebanese hostages of war

A cross-sectional study addressed the experience of Lebanese hostages of war in Lebanon. It specifically assessed the prevalence of general distress and its relationship to captivity-related factors and selected psychosocial variables. Trained field researchers using standard measurements interviewed 118 Lebanese hostages released from Khiam prison, an Israeli detention center in Lebanon. Questionnaires administered included the GHQ-12 and the Harvard Trauma Questionnaire. Individuals were detained for 3.4 years on average, and 86% were tortured. Psychological distress was present in 42.1% of the sample compared to 27.8% among the control group. In the multivariate analysis, the significant predictors for distress were: years of education and increase in religiosity after release. In conclusion, even after 2 years of release, more than one-third of the Lebanese hostages released from Khiam prison were found to have psychological distress. Caregivers need to pay special attention to the mental health of hostages of war. The paper discusses the meaning and implications of the factors predicting resilience and vulnerability in this particular population.

Missed nursing care, level of staffing, and job satisfaction: Lebanon versus the United States.

Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a significant amount of care is being missed. This study is designed to determine if Lebanon is experiencing a similar phenomenon and what reasons are given for missing nursing care. Findings support that a substantial amount of nursing care is missed in Lebanon, although less than that in the United States (t = 11.53, P < .001), that nurses in Lebanon were less satisfied with being a nurse than are nurses in the United States, and there was no difference in the identification of staffing resources as a reason for missed care in the 2 countries.

Symptom Prevalence and Management of Cancer Patients in Lebanon

CONTEXT Cancer patients experience a great number of distressing physical and psychological symptoms. In Lebanon, there are no available data on symptom prevalence and symptom management in adults with cancer. OBJECTIVES The aim of this study was to determine the prevalence of symptoms and the effectiveness of treatment received as reported by patients. METHODS The study used a cross-sectional, descriptive survey design. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Memorial Symptom Assessment Scale were translated to Arabic and used; data were collected from adult Lebanese cancer patients at the American University of Beirut Medical Center. RESULTS A total of 200 cancer patients participated in the study; the majority were female with breast cancer and mean age was 54 years. The cognitive functioning domain of the EORTC QLQ-C30 scale was found to have the highest score and social functioning the lowest. The most prevalent symptom was lack of energy. Nausea and pain were the symptoms most treated. Males reported better quality of life (QoL), physical functioning, and role functioning than females; females reported more fatigue, pain, and appetite loss than males. Higher physical and psychological symptoms were correlated with lower health status, QoL, and functioning. CONCLUSION Although this sample reported a fair QoL and social functioning, many symptoms were highly prevalent and inadequately treated. Symptoms were found to negatively affect QoL and functioning. Based on these results, providing adequate symptom management and social support to Lebanese cancer patients is highly recommended.

Evaluating Palliative Care Needs in Middle Eastern Countries

BACKGROUND Cancer incidence in Middle Eastern countries, most categorized as low- and middle-income, is predicted to double in the next 10 years, greater than in any other part of the world. While progress has been made in cancer diagnosis/treatment, much remains to be done to improve palliative care for the majority of patients with cancer who present with advanced disease. OBJECTIVE To determine knowledge, beliefs, barriers, and resources regarding palliative care services in Middle Eastern countries and use findings to inform future educational and training activities. DESIGN Descriptive survey. SETTING/SUBJECTS Fifteen Middle Eastern countries; convenience sample of 776 nurses (44.3%), physicians (38.3%) and psychosocial, academic, and other health care professionals (17.4%) employed in varied settings. MEASUREMENTS Palliative care needs assessment. RESULTS Improved pain management services are key facilitators. Top barriers include lack of designated palliative care beds/services, community awareness, staff training, access to hospice services, and personnel/time. The nonexistence of functioning home-based and hospice services leaves families/providers unable to honor patient wishes. Respondents were least satisfied with discussions around advance directives and wish to learn more about palliative care focusing on communication techniques. Populations requiring special consideration comprise: patients with ethnic diversity, language barriers, and low literacy; pediatric and young adults; and the elderly. CONCLUSIONS The majority of Middle Eastern patients with cancer are treated in outlying regions; the community is pivotal and must be incorporated into future plans for developing palliative care services. Promoting palliative care education and certification for physicians and nurses is crucial; home-based and hospice services must be sustained.

Coping with the experience of having a child with cancer: A Lebanese perspective

T of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) among health care workers (HCWs) and patients has been documented with mortality rate approximating 36%. We propose ‘Advanced-Infection Control Measures’ (A-IC) used in conjunction with ‘Basic-Infection Control Measures’ (B-IC) which help to reduce pathogen transmission. B-IC include standard and transmission based precautions. A-IC are initiatives implemented within our center to enhance effectiveness of B-IC. Our objective is to study effectiveness of combining B-IC and A-IC to prevent transmission of MERS-CoV to HCWs. A retrospective observational study was undertaken. A-IC measures include; administrative support with daily rounds, infection control risk assessment, timely screening, isolation, and specimen analysis, collaboration, epidemic-plan, stock-piling, implementation of contingency plan, full PPE use for advanced airway management, real-time electronic isolation flagging system, IC team on-call, pre-transfer MERS-CoV testing and education. Total of 874 real-time PCR MERS-CoV tests were performed from July 1st, 2013 to January 31st, 2015. 694 non-HCWs were tested; of these 16 were MERS-CoV positive and community-acquired. 69% of the confirmed MERS-CoV positive cases were male, with an average age of 56 years (range: 19-84 years). Of the total tested for MERS-CoV, 180 were HCWs with zero positivity. In conclusion, adhering to a combination of B-IC and A-IC reduces the risk of MERS-CoV transmission to HCWs.P nurses require comprehensive skills related to growth and development to support communication with pediatric clients of all stages of development. Pediatrics is a specialized area of nursing. Nurses and student nurses are required to recognize, understand, and apply knowledge of growth and developmental stages to have successful communication with children in healthcare settings. Nurses encounter pediatric clients in various settings in healthcare. These range from educational settings to acute and chronic care settings. Communication with children is dependent on the child’s level of growth and development. A skilled healthcare provider who communicates effectively with children does so by recognizing stages of growth and development. Humor development, which mirrors cognitive development, is not readily used in the education of student nurses or pediatric nurses. Educating nurses and student nurses on humor development could enhance the understanding and comprehension of cognitive growth and development.Background: Current asthma care can be inconsistent due to providers’ variable approaches to asthma diagnosis and management guidelines. This variability is often a result of time and cost constraints. An approach to overcome these constraints and to increase adherence to guidelines is the SMA. The SMA is a medical appointment carried out with a group of consenting patients and their caregivers by a provider and other health professionals. SMAs are typically designed as 90-minute medical appointments in which 4 to 9 patients and their parents are seen in a group setting. This type of appointment allows both the provider and the patient to bridge a gap between individual appointments, which frequently lack the time needed for detailed education.I which is defined by QSEN as: Using information and technology to communicate, manage knowledge, mitigate error, and support decision making; is one of the core competencies for nursing set forth by the Institute of Medicine (IOM) and The Quality and Safety Education for Nurses (QSEN) faculty. One of the QSEN core skills linked to informatics is documenting and planning patient care in the electronic medical record (EMR), a skill that can be confusing to a beginning nursing student. Nursing students can also become easily confused when learning assessment skills in the classroom, but accurate assessment skills must be achieved in order to complete accurate documentation. When assessing a patient, distinquishing what the assessment findings are and what should be documented in the electronic EMR to clearly communicate the findings are special skills that are vital to the nursing role, communication among care team members and patient safety. Linking these two skills in a real-life, fun and innovative way in the classroom can make for better overall understanding of each skill and its importance to safe patient care.C is a leading cause of death worldwide and accounts for 7.6 million deaths annually. In the Middle East, an increase in cancer mortality of approximately 181% is expected during the next 15 years. We explored the barriers to colorectal cancer (CRC) screening in primary care settings in Oman. The participants were nurses (57.7%) and physicians (42.3%) with an average age of 32.5 years and clinical experience of 9.5 years. The majority (64.8%) of the participants reported that they rarely ordered, referred to, educated about, or recommended CRC screening for eligible patients. The factors perceived by nurses and physicians to have the most influence on their CRC screening practices were regular availability of patients who need CRC screening, continuing professional education about cancer prevention, availability of cancer specialists, and health facility policy about cancer screening. The only patient-related barrier to CRC screening rated as “major” by the majority of participants (63.7%) was patients’ lack of awareness about CRC tests. Significant differences existed between nurses’ and physicians’ rating of patient-related barriers, such as fear of finding out about a cancer diagnosis (P≥0.05), belief that screening is not effective (P≥0.05), embarrassment or anxiety about screening tests (P≥0.03), and culture (P≥0.0). The reported major system barriers to CRC screening were lack of hospital policy or protocols, shortage of trained healthcare providers, availability of screening services, and waiting time for screening appointments. These findings indicate a need to increase patient awareness and interventions to enhance healthcare providers’ practices. Nurse educators, researchers, and nurse administrators have major roles to play in cancer prevention.

Cancer patients support

In Lebanon cancer is one of the leading causes of death. Few years back it was not unusual for the Lebanese families and oncologists to avoid using the word cancer and to avoid telling patients that they have cancer [1]. However, trends are changing nowadays and patients are becoming more assertive and they are requesting to be told the truth [2]. Quality of life and psychological well being of the cancer patient have become essential outcome care criteria. This knowledge has caused higher alertness regarding psychological needs and interventions as a crucial approach to cancer therapy. As a consequence, psychosocial group interventions have started to develop. The ‘Faire Face’ (let’s face it) was founded in 1995 as a voluntary community cancer support group. ‘Faire Face’ launched the first in-hospital cancer support group in Lebanon in 2003.The group is formed of 20 female volunteers between the ages 40 and 70 years. Their experiences with cancer vary from being breast cancer survivors, family members of cancer patients or health-care workers. The volunteers received training in the area of psychology and communication for a limited period of time. In addition, they have continuous practice meetings with psychotherapists. The faire face group uses the traditional method of individual face-to-face meeting with patient and family members. The meeting usually takes place in the patient’s room or in the ‘Faire Face’ office in the hospital, which contains a laptop, journals and reading materials for patients and family members to use. Every day two or three volunteers meet with patients after consulting with the nurse in-charge on the unit. It is worth noting that oncologists play the role of facilitators in this process. The meeting time with patient varies between 30min and 1 h. At the end of each meeting, the volunteer documents the patient’s current status and the recommendations for future meetings. These notes are kept in a locked cabinet in the ‘Faire Face’ office. Patients are given room to verbalize their feelings, worries and concerns. The volunteer offers a listening non-judgmental ear; provides emotional and spiritual support and supplies patients with reading materials. ‘Faire Face’ group also assists patients in putting them in contact with other health-care providers; provides prosthesis for patients who are unable to afford their own; and raises funds for patients who cannot afford the cost of treatment. Volunteers also provide patients’ families a psychological support. Patients are also informed that they can contact the Faire Face organization through a hotline. The ‘Faire Face’ volunteers reported that at the beginning patients and family members were reluctant in sharing their feelings with them. But later volunteers discerned an enormous change in attitude. Patients and family members became more cooperative, eager to talk and shared their deep feelings, worries and concerns that are translated in a better coping and compliance and acceptance of the disease. The volunteers’ encounter with cancer patients and their families was a transforming and revealing experience for them. They all talked about their psychological and spiritual gains. Though cancer support group is still practiced in one hospital in Lebanon, the outcomes have been satisfactory. Such initiatives are helpful in alleviating the patient’s and family members’ cancerrelated stress. Similar approaches need to be disseminated across the different regions of Lebanon and replicated with other chronic diseases.

“My Greatest Fear Is Becoming a Robot”: The Paradox of Transitioning to Nursing Practice in Lebanon

We investigated the challenges final-year nursing students (FYNSs) and first-year registered nurses (FYRNs) face as they transition to nursing practice in Lebanon. Our purpose was to understand the challenges of transition from the perspective of FYNS and FYRNs. We conducted focus group discussions with FYNSs and FYRNs recruited from four leading universities. Thematic analysis identified an unexpected paradox that has implications for quality of nursing care and retention of graduates. While humanoids are marketed to communicate empathically with patients, FYNSs in Lebanon struggle to resist becoming robots.

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.