Moral and Professional Values of Nurses in Lebanon.

BACKGROUND: Moral and professional values vary among cultures. The purpose of this study was to explore the moral and professional values of registered nurses at a university medical center in a Middle Eastern country and determine the relationship among formal ethics education, background variables (age, gender, nursing degree, regular daily prayer), and nurses' professional and moral values. METHOD: A cross-sectional survey method with 123 nurses was used. Data on background variables, moral and professional values, and confidence in ethical decision-making were assessed. RESULTS: Professional values were significantly higher among older nurses and nurses with master's degrees compared with younger nurses and nurses with bachelor's degrees. Daily prayer was related to higher mean scores for moral values. Nurses were confident in their ethical decision-making; however, formal education in ethics did not influence professional or moral values. CONCLUSION: Although formal education in ethics did not influence the professional or moral values of nurses in Lebanon, this finding does not negate the need for future studies to investigate the content and duration of ethics education that is likely to affect professional or moral values. [J Contin Educ Nurs. 2021;52(9):429-437.].

Implementing NIDCAP training in a low-middle-income country: Comparing nurses and physicians' attitudes.

BACKGROUND: The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides developmentally supportive environment for preterm infants and their families. Few studies evaluated staff perceptions about NIDCAP implementation and its effect on infant and parents and working conditions. AIMS: To assess the perception and experience of NICU staff during the NIDCAP implementation. STUDY DESIGN: Cross-sectional anonymous online survey. SUBJECTS: 57 NICU staff (29 nurses and 28 doctors) who were present at least one year prior to and during the implementation of NIDCAP training in a tertiary care center. OUTCOME MEASURES: A standard questionnaire addressing attitude, perceived behavioral control, subjective norm, intention, behavior and NIDCAP impact related to NICU conditions was used after initiating developmental care activities and NIDCAP training in the unit from June 2014 to May 2018. RESULTS: Forty-six doctors and nurses filled the questionnaire; they scored ≥3 out of 5 on all the questionnaire items. Nurses scored significantly higher than doctors (mean 4.00 ± 036) versus (3.57 ± 0.30) (p < 0.001) on the overall NIDCAP score. Specifically, nurses scores were significantly higher for attitude (p < 0.001), perceived behavioral control (p = 0.029); subjective norm (p = 0.011), intention (p = 0.024) and behavior (p < 0.001) questions. CONCLUSION: The implementation of NIDCAP in a low-middle income country was perceived as a positive experience for both nurses and doctors: It was thought to have improved infant care and wellbeing as well as the staff relationship with parents, however working conditions remained a challenge. More studies are needed to address areas of improvement for implementation.

Achieving a Zero Central Line-Associated Bloodstream Infection Rate in 4 Critical Care Units in Lebanon.

Every health care facility aims to achieve and maintain a zero central line-associated bloodstream infection (CLABSI) rate. Infections can be costly for institutions of any size and are often not covered by health insurance. The interventions put in place in this quality improvement project were implemented in 4 phases: (1) develop a new standard of care for central lines and give nurses full responsibility for the care and handling of these lines (including blood sampling); (2) revise policy and provide educational sessions to support nurses; (3) document compliance with the new policy; and (4) document CLABSI rates. The project took place during a 15-month period between January 1, 2016 and March 30, 2017, in 4 critical care units in a university medical center in Lebanon. The results revealed a reduction in CLABSI rates from a maximum rate of more than 17 per 1000 catheter days to zero per 1000 catheter days, which was sustained for 10 months. Nurse compliance with the new policy after 3 months ranged from 95% to 99%.

Predictors of Pressure Injuries in a Critical Care Unit in Lebanon: Prevalence, Characteristics, and Associated Factors.

PURPOSE: The purpose of this study was to identify factors associated with pressure injury in a medical-surgical intensive care unit (MSICU). DESIGN: Retrospective review of medical records. SUBJECTS AND SETTING: We reviewed the medical records of 145 patients who developed a new pressure injury in the MSICU of a 420-bed university medical center in Lebanon. METHODS: Medical records of all patients cared for in the MSICU from December 2014 to June 2017 were reviewed by a research assistant using a standardized form. We extracted potential risk factors for pressure injury including sex, age, weight upon admission, weight at discharge, length of MSICU stay, episodes of hypotension, administration of inotropes/vasopressors, admitting diagnosis, comorbid conditions, and cumulative scores on the Braden Scale for Pressure Sore Risk. The outcome variable was development of any new pressure injury during their stay in our intensive care unit. RESULTS: Forty-nine patents (33.7%) developed a new pressure injury. Bivariate analysis found statistically significant associations between pressure injury occurrences and administration of vasopressors (odds ratio [OR] = 0.42; 95% confidence interval = 0.29-0.87; P = .02), the administration of dopamine (OR = 0.20; 95% confidence interval = 0.04-0.94; P = .04), and hospital-acquired pressure injury. Among the continuous variables, analysis revealed significant relationships between weight at discharge (t = 2.31, P = .02), MSICU length of stay (t = 5.30; P = .000), cumulative Braden Scale score (t = 3.06; P = .002), hypotension (t =-2.74; P = .007), and development a new pressure injury. Multivariate analysis indicated that length of stay (ß= -.110; P = .002), administration of vasopressors (ß=-.266; P = .029), and total hours of hypotension (ß=-.53; P = .041) were significant predictors of pressure injury. CONCLUSIONS: Vasopressor use, hypotension, and length of stay were associated with an increased likelihood of pressure injury in adults managed in an MSICU. None of these factors is specifically evaluated during completion of the Braden Scale for Pressure Sore Risk. Based on these findings we recommend development of a pressure injury scale specific to critically ill adults.

Preterm infants exhibited less pain during a heel stick when they were played the same music their mothers listened to during pregnancy.

AIM: Playing music during painful procedures has shown inconsistent benefits for preterm infants. This study observed preterm infants during a heel stick procedure to assess whether listening to the music their mothers listened to during pregnancy had any impact on their pain and physiological and behavioural parameters. METHODS: We randomly exposed 42 preterm infants, with a mean gestational age of 31.8 ± 2.79 weeks, to the music their mothers listened to during pregnancy, recorded lullabies and no music, before, during and after a heel stick. Pain responses were measured using the Neonatal Pain, Agitation and Sedation Scale (N-PASS), and physiological and behavioural responses were recorded by a nurse blinded to the intervention. RESULTS: N-PASS pain scores were lowest during mothers' music, with a mean of 1.40 (±1.28), compared to 2.33 (±1.64) for no music and 1.62 (±2.27) for the lullabies [F(3/121) = 4.86, p = 0.009]. Physiological parameters were not significantly different between the conditions. During the mothers' music, infants spent more time in a quiet alert state, with a significant decrease in their respiratory rates. CONCLUSION: The music mothers listened to during pregnancy was more beneficial for preterm infants, as it decreased pain and improved behavioural states during a heel stick.

The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study.

BACKGROUND: Pressure Ulcers (PUs) are associated with high mortality, morbidity, and health care costs. In addition to being costly, PrUs cause pain, suffering, infection, a lower quality of life, extended hospital stay and even death. Although several nursing interventions have been advocated in the literature, there is a paucity of research on what constitutes the most effective nursing intervention. OBJECTIVES: To determine the efficacy of multidisciplinary intervention and to assess which component of the intervention was most predictive of decreasing the prevalence of Hospital acquired pressure ulcers (HAPU) in a tertiary setting in Lebanon. DESIGN: An evaluation prospective research design was utilized with data before and after the intervention. The sample consisted of 468 patients admitted to the hospital from January 2012 to April 2013. RESULTS: The prevalence of HAPU was significantly reduced from 6.63% in 2012 to 2.47. Sensitivity of the Braden scale in predicting a HAPU was 92.30% and specificity was 60.04%. A logistic multiple regression equation found that two factors significantly predicted the development of a HAPU; skin care and Braden scores. CONCLUSION: The multidisciplinary approach was effective in decreasing the prevalence of HAPUs. Skin care management which was a significant predictor of PUs should alert nurses to the cost effectiveness of this intervention. Lower Braden scores also were predictive of HAPUs.