The Assessment of Lebanese Hospital Nurses’ Qualifications in The Fight Against COVID-19: Are They Well Prepared?

BackgroundOn December 31, 2019 China reported multiple cases of a novel coronavirus, This rapid and unexpected increase in cases caused a shortage of testing kits, personal protective equipment (PPE), medical treatments, ventilators, and other medical supplies. Therefore, nurses and physicians needed to feel safe, protected and confident while treating ill patients. It is the responsibility of the healthcare system's to wisely use the skills and available resources for an effective response and ensure the safety of the personnel. Our primary objective is to assess the preparedness of nurses against the coronavirus and then to evaluate the impact of the outbreak on the nurses and their attitude towards the pandemic. MethodsAn anonymous online survey was conducted among nurses across Lebanon. It consisted of 24 multiple-choice, closed-ended questions related to knowledge, attitude and practice. ResultsA total of 370 registered nurses completed the survey. Analysis showed that age had no effect on knowledge; males were more trained than females for triage, hand hygiene and working in isolation units, while females were more trained for handling PPE. Additionally, females attended national lectures more than males, while males received information from media and brochures. The training for PPE use and working in isolation unit was better conducted in university hospitals as compared to non-university ones. 50% of nurses in both hospital types did not attend any lectures. The nurses in all Lebanese districts had training about hand hygiene and working in isolation unit before the pandemic while they had the triage training mostly after the pandemic started. Analysis also showed that the nurse-to-patient ratio was higher for older nurses and in peripheral areas. For both genders, 66.3% had never undergone an N95 fit test. Lastly, almost half of the nurses thought about quitting their job. ConclusionThe study showed that there is some lack of nurses’ knowledge towards COVID-19. Variations were observed in nurses’ practice regarding age, gender, hospital type, district and nurses’ position. IntroductionOn December 31, 2019 China reported multiple cases of acute respiratory illnesses that were later found to be caused by a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. This virus is a member of the subfamily Coronavirinae and belongs to the same genus as coronaviruses that caused the severe acute respiratory syndrome (SARSCoV) reported in China in 2003, and Middle East respiratory syndrome (MERS-CoV) reported in Saudi Arabia in 2012 [2]. Unfortunately, the new coronavirus had spread very rapidly around the globe, so on March 11, 2020 the World Health Organization (WHO) declared SARS-CoV-2 a pandemic [3]. This rapid and unexpected increase in cases caused a shortage of testing kits, personal protective equipment (PPE), medical treatments, ventilators, and other medical supplies. In addition, the insufficiency was not only observed in material resources but in human resources as well, number of staff and preparedness of personnel [4]. Despite the elapse of more than a year after the declaration of the pandemic, there is still no curative treatment for SARS-CoV-2 and numbers continue to rise with nearly one million new cases in the last week of March 2021 and the emergence of new strains, more virulent, like the latest one in India [5-6]. According to Guest et al, the major steps in overcoming this pandemic are an effective lockdown, an increase in testing and most importantly an improvement of the healthcare system’s capacity to respond, which is the aim of this study [7]. In turn, ensuring the safety of health care workers (HCWs) should be a priority by vaccinating them, providing them with the appropriate PPEs, giving them the adequate training and updating their knowledge of the pandemic. Researchers in Taiwan found that the number of HCW decreased as the sense of security among them decreased; they felt unsafe treating coronavirus disease (COVID-19) patients, and avoided working in COVID-19 units [3]. Therefore, nurses and physicians needed to feel safe, protected and confident while treating ill patients; for this purpose, infectious disease specialists in Taiwan developed a “Traffic control bundling” map that ensures a passage for patients from triage to treatment zone where HCW are not exposed to the patient and those who are directly taking care of them are in full PPE. This map aims at preventing shortage in medical staff secondary to anxiety, thereby improving the workflow [3]. It is also very important for the workflow that the medical staff in a pandemic is not subject to any anxiety or stress. while it is difficult to determine the number of lives saved by epidemiological research, yet it is certain that good intervention and prevention strategies save millions of lives. It is our responsibility to wisely use the skills and available resources for an effective response. For this reason, the WHO published a checklist to help hospitals assess their preparedness in order to ensure a rapid response to the outbreak [8]. This study aims to assess how well the Lebanese nurses are prepared for this new pandemic. Our primary objective is to assess the preparedness of nurses against the SARS-CoV-2 outbreak based on the level of knowledge, training and practice. The secondary objective is to evaluate the impact of the outbreak on the nurses and their attitude towards the pandemic. Materials and methodsStudy design and data collection procedureThis is a descriptive, observational cross-sectional study, for which the approval of the Institutional Review Boards of the Lebanese American University was obtained in May 2020 IRB #: LAU.SOM.RS2.11/ May/2020. It was based on an anonymous self-administered online survey. The questionnaire was created using Google Forms, saved as a link, and reviewed by the Lebanese Order of Nurses who distributed it via email to all registered nurses. Data collection took place between July 2020 and February 2021 (The Beirut Blast that occurred on the 4th of August 2020, caused a halt in data collection for approximately two months.) Only answers of currently practicing nurses, whether in the private or public sector, working in any of the Lebanese governorates, were included. Nurses who were not registered, did not hold a license to practice, or were not currently practicing were excluded from the study. Sample sizeThe sample size was calculated using Epi Info 7 StatCalc functions for a population survey. Given that the number of registered nurses in 2020 was 16927 and, with an expected confidence level of 95% along with a margin of error of 5%, the minimum sample size required to obtain statistically significant results was determined to be 370 nurses. Survey developmentThe questionnaire was designed after reviewing multiple studies discussing COVID-19 preparedness among HCW, as well as preparedness for other epidemics and pandemics. It was initially written in English then translated to Arabic by a translator and cross-checked with the team of the study. It was then back-translated to ensure accuracy to English. Both the English and Arabic versions were piloted by two nurses, one day apart, to make sure they were equally understood. This way we were able to check for the comprehension of the questionnaire in both languages and agreement (reliability of the questionnaire) in their answers before conducting the study. The questionnaire was composed of 24 multiple choice questions that mainly look into the sociodemographic characteristics of the nurses, their training and educational backgrounds. This allowed us to assess nurses’ knowledge, the load they were dealing with and to analyze their practice. In addition, there were few questions that look into nurses’ attitude towards this crisis. To note that the survey was sent in both languages, Arabic and English, and the answers provided were collected on an online sheet. Data management and statistical analysisStatistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) for Windows, Version 23.0. Means and standard deviations were reported for continuous variables. Categorical variables were assessed and described as frequency and percentage. Bivariate analysis was performed using Chi square test and Fisher test to examine associations between knowledge, practice and attitude and the different sociodemographic variables (gender, age, experience, job position, years of experience, type of hospital and hospital location). A p-value of <0.05 was considered statistically significant. ResultsGeneral CharacteristicsA total of 370 nurses responded to the questionnaire; however, only 359 were currently practicing and thus included in the study. Among them, 155 were male (41.8%) and 215 were female (58.2%).Respondents’ ages ranged from 21 to 63 with a mean age of 32 years. Additionally, 223 (62.1%) worked in private hospitals, 89 (24.8%) worked in public hospitals and 47 (13.1%) worked in both sectors simultaneously. When considering the type of hospital, 204 (56.8 %) participants were practicing in university hospitals while the rest were working in non-university hospitals. Moreover, when considering the geographical distribution, the majority 167 (46.5 %) of nurses were practicing in the capital Beirut, and the rest were distributed across the North, South, Bekaa and Mount Lebanon.After reviewing the numbers and the descriptions of the sample obtained, we tried to observe the correlation between the above-mentioned demographics and other characteristics such as experience, job position…with the knowledge, practice and attitude of the nurses towards the pandemic; result of our observations is described in the following section. Nurses’ KnowledgeTo assess nurses’ knowledge, the questionnaire included questions regarding training (triage of COVID-19 patients, use of