Spring 2009 Vol. VII, No. 3
February 19, 2009: Welcome to AUB’s
new Rafic Hariri School
Despite everything they stand for, new building inaugurations aren’t usually raucous, exciting, or inspiring. But during the mid-day event inaugurating the new Rafic Hariri School of Nursing (SoN), AUB Trustee MP Saad Hariri invoked the memory of his father before a rowdy crowd of AUB students who seemed keen to rush the stage, with only several rows of distinguished guests (and effective security) holding them back. Between loud cheers, Trustee Hariri reminded the audience that his father, former prime minister and AUB trustee Rafic B. Hariri, considered AUB “an integral element” in Lebanon’s unique education-based formula for success. It was to honor the memory of his father, who—in the words of his son—“nursed” Lebanon during some particularly difficult periods, that MP Hariri made a $10 million gift to AUB to name and support its School of Nursing.
For some who had spent many years in Dale Home, which had housed the SoN since 1926, the celebration was bittersweet. Professor Myrna Doumit (BSN ’88, MPH ’96) says that she is worried that she and her colleagues will lose the unique “family culture” they have enjoyed in Dale Home in their more spacious quarters in the Hariri School. Professor Mary Arevian (BSN ’69) says that she will also miss the very strong connection that she felt in Dale Home with the school’s founders—Mary Bliss Dale and Jane Elizabeth van Zandt—hard workers who “devoted their entire lives to the education of many generations of young people in the Middle East.” (Mary Bliss Dale was the eldest daughter of the Reverend Daniel Bliss, who founded the Syrian Protestant College in 1866 and served as its president until 1902. In addition to being superintendent of the hospital for many years, Dale worked closely with Jane Elizabeth van Zandt to establish AUB’s nursing school. Van Zandt was director of the school from the time it was established in 1905 until 1932.)
But instead of digging into the archives and revisiting some of the illustrious history that dates back to 1905, we are focusing instead—as are the nursing students and faculty members themselves—on some of the more recent changes. The SoN moved into a new home this spring; the MSN program that was introduced only five years ago is thriving, and student and faculty member research is improving health care throughout the region. (For more on SoN history, revisit the winter 2005 MainGate.)
From Dale Home to Hariri SoN
Although many will miss Dale Home, the new building, conveniently located next door to the AUB Medical Center and across the street from the Saab Medical Library, has something for everyone including a state-of-the-art skills and simulation lab. “That’s the jewel in the crown,” agrees Dr. Huda Abu-Saad Huijer (BSN ’71), director of the School of Nursing. She goes on to explain that the new building also includes technologically-equipped classrooms, a computer lab for the exclusive use of nursing students, an auditorium, a reference room for graduate students, and a research center, and, she said, “We will be able to use the intranet to communicate with students and faculty as well as do electronic posting on LCD screens instead of bulletin boards.”
Professor Hala Darwish (BS ’97), who learned advanced nursing skills in simulation labs as a graduate student in the United States, explains that “learning to perform simple yet invasive nursing procedures such as injections and catheter insertions is anxiety provoking for both patients and students. When nurses practice on patients, they don’t usually have the luxury of repeating an unsuccessful procedure because of concerns for patient comfort. However, when the skill is perfected in the lab, the nursing student’s self confidence in his/her own dexterity and knowledge is increased, which means less student anxiety, fewer errors, and less discomfort for patients.” A simulation lab offers a wide range of learning opportunities for students that begins with simple nursing procedures and gradually becomes a place where complex critical thinking is developed and practiced.
The introduction of technology in the classroom also allows nursing instructors to create, modify, simplify, or complicate clinical situations based on the student nurse’s response and behavior. The ability to record students’ performances is also an invaluable teaching tool. Huijer says that this type of interaction in the classroom and laboratories will transform the educational experience of AUB nursing students.
SoN Students Today
Of the 184 nursing students at AUB in spring 2009, almost one-third are enrolled in the MSN program, which has grown dramatically since it admitted its first students in fall 2004. There are five times as many students enrolled in the MSN program now as there were that first year. There has been an equally spectacular increase in the number of MSN students from the region: from just 3 percent in 2006-07 to 23 percent in 2008-09. Not surprisingly, Huijer reports, “We have been very pleased with the response to the MSN program.”
“I think the MSN program was top notch,” says Sherry El Sadr (MSN ’06). El Sadr moved to Lebanon with her husband and children in 2003 so they could spend time with her husband’s family and to give her children a chance to experience life in Lebanon. Now back in Detroit, Michigan where she is a nurse educator at Karmanos Cancer Center, El Sadr says, “I am as prepared as other colleagues to do research, care for patients, and teach . . . I loved every minute I spent in that program and that school.”
The MSN program provides once in a lifetime opportunities to do research and have experiences such as a residency at Johns Hopkins University’s School of Nursing—a program that the Hariri Foundation funded for nine students in 2007-08. Lina Younan (MSN ’07), who is now the director of nursing at Labib Medical Center in Saida, describes her residency there as “the most enriching, joyful, and unforgettable learning experience that I have ever had.”
It was while she was at Johns Hopkins that Rebecca El-Asmar (MSN ’09) finalized her MSN research topic. “The patients I met there,” she remembers, “were so informed about their disease, its treatment, the side effects of treatment, etc . . . . I thought about our cancer patients [at AUBMC] and how many of them don’t even know they have cancer, and even those who do know they have cancer know so much less about it.” She did a literature search and determined that there had been “only preliminary qualitative studies that concluded that patients in Lebanon would also like to be informed of their diagnosis and involved in their treatment, but no specific studies on patient education and patients’ learning needs.”
El-Asmar surveyed 30 female breast cancer patients at AUBMC and discovered that 28 of the 30 reported that they would have benefited from having written material at home and that they were interested in learning more about the treatment for breast cancer and its effects. This prompted El-Asmar to create a reader-friendly booklet for breast cancer patients that she plans to present to AUBMC’s Nursing Services Department soon. She hopes that it might some day be included in the Medical Center’s ongoing educational outreach programs.
Angela Massouh (MSN ’08) also gathered information while she was at Johns Hopkins for her MSN research concerning the establishment of a heart failure clinic in Lebanon. “I was able to follow heart failure patients across the whole continuum of care from the acute inpatient setting to stable outpatient clinics to the chronic rehabilitation care.” She observed that patients in the United States have much easier access to health care services “compared to our Lebanese patient population.” Massouh explains that because of the inadequate number of long term or rehabilitation facilities in Lebanon, many Lebanese heart failure patients “are constantly readmitted with exacerbations and spend relatively long periods of time in our Coronary Care Unit.”
Massouh, who is a registered nurse at AUBMC’s Coronary Care Unit notes that many studies have demonstrated that patients receive the best care when they are treated by a “holistic, multidisciplinary team.” She points out that in addition to reducing heart failure morbidity and mortality, this approach is also less expensive. The heart failure clinic that Massouh proposed would be a nurse-facilitated/coordinated clinic that would be directed by a medical doctor and staffed by an Advanced Practice Nurse (APN) who would direct patient care management and a cardiologist specialized in heart failure. The multidisciplinary team would also include a dietician and a physical therapist.
One of the other advantages that the Hariri School offers its nursing students are the close programmatic and institutional ties it enjoys with the AUB Medical Center. Rima Saad (MSN ’09), who juggled a full-time job at AUBMC with the demands of the MSN program, reports that the program “caused my thinking process to become more structured, comprehensive, and proactive.” She is especially grateful for the opportunity she had to do a residency at the St. Jude Children’s Research Hospital in Memphis, Tennessee, where she picked up some ideas she is trying to implement at the Children’s Cancer Center of Lebanon, where she has worked since 2003.
Faculty members as well as MSN students conduct research at AUBMC. Huijer herself has done extensive work related especially to pain assessment and management and palliative care in adults and children. She is currently conducting a national study on the quality of care provided to cancer patients in Lebanon. Professor Samar Noureddine’s (BSN ’83) current research focuses on beliefs and behaviors related to cardiac illness among the Lebanese population. “I am particularly interested in the factors that influence the decision of heart attack victims to seek emergency care when they experience symptoms,” she says. She has discovered some intriguing differences between patients in Lebanon and the United States. It turns out that patients in Lebanon wait longer than patients in the United States before seeking medical care (a median of 4.5 hours versus 2.5-3 hours). She also reports that although the difference is not statistically significant, women—in Lebanon and the United States—tend to wait longer than men before going to the hospital.
Professor Laila Farhood (BSN ’71) has studied Post-Traumatic Stress Disorder (PTSD) particularly in south Lebanon. Working with co-investigator Dr. Hani Dimassi, Farhood led a team of investigators who gathered data from a random selection of 975 people living in eight villages to assess levels of PTSD and depression in south Lebanon before and after the July 2006 war. Farhood is also organizing group sessions (cognitive behavioral therapy or CBT) for participants who scored above the cut-off score on the PTSD and depression scales to test “CBT effectiveness through randomized group sessions in a sample of citizens from three villages screened for PTSD and depression.” Farhood explains that one of the goals of her research is to “provide professionals with evidence-based interventions for traumatized civilians in a post-conflict region.”
Although she is proud of the MSN program and of the strong focus on research at the nursing school, Huijer says, “The BSN program remains our core business.” She notes with enormous appreciation that $3 million of the Hariri gift will be used to provide scholarships for nursing students. “Being able to offer financial assistance to young men and women who are interested in pursuing careers in nursing is absolutely essential,” she says. She reports that she and her colleagues have launched a major effort to encourage more young men and women to consider careers in nursing—and to prepare for those careers by attending AUB.
Huijer points out that AUB nursing graduates are heavily recruited and work in a wide variety and an increasing number of positions—in hospitals, of course, but also in ministries of health, at schools and universities, with insurance and pharmaceutical companies, and for NGOs and community-based organizations. To ensure that AUB graduates are prepared to select from the full range of choices available to nurses today, the Hariri School of Nursing is exploring some exciting new academic programs including a collaborative PhD program with Johns Hopkins University School of Nursing and a joint master’s of science in nursing/master’s in business administration (MSN/MBA) program with AUB’s Suliman S. Olayan School of Business.
Student residents at Johns Hopkins
Rafika Zaatari (MSN ’07), who has been working at AUBMC since she earned her BSN degree in 2003, is a clinical educator at the Clinical and Professional Development Center, which is the first ANCC (American Nurses Credentialing Center) accredited continuing education center in the Middle East and only the second outside the United States. She says that she was pleased to discover during the summer she spent at Johns Hopkins that nursing at AUBMC was on par with one of the best US nursing programs.
Nour Alayan (MSN ’08), who spent the summer of 2007 at Johns Hopkins, says she was struck by the “different health care culture and management approach” in the United States and comments that nursing is more appreciated in the United States than it is in Lebanon.
Today’s MSN students
Nisreen Sidani (MSN ’06) describes her residency at the Lebanese Ministry of Public Health and her involvement with its breast cancer campaign as a “golden opportunity for me to follow up a social marketing campaign from A to Z.”
Nada Nassar (MSN ’07), who worked as a nurse manager in oncology while enrolled in the MSN program, did her residency and her MSN project—an assessment of nursing management team competencies at AUBMC—with Gladys Mouro, assistant hospital director for nursing services at AUBMC.
As a case manager at AUBMC, Mohammad Hasan Fakih (MSN ’06) regularly refers patients to home care agencies, which is an area he researched as an MSN student. Despite the fact that his needs assessment “rendered positive outcomes,” he says that hospitals in Lebanon are reluctant to set up home care departments because public health care insurance (NSSF) won’t pay for nursing home care services and private health care insurance companies charge clients high premiums for nursing home care.
For some master’s students, the opportunity to do research has sparked an interest that is leading them to pursue a PhD in nursing. Sarah Abboud (MSN ’07), a research assistant at the Hariri School of Nursing, is planning to build on the work she has already done with HIV/AIDS patients in Lebanon to “focus especially on community health for underserved persons with HIV/AIDS.”
Current faculty research
Professor Mary Arevian (BSN ’69), who spent spring 2009 as director of the Division of Nursing at the Mohammad AlMana College of Health Sciences in Khoubar, Saudi Arabia, has published several studies related to cancer and heart disease in women.
Professor Myrna Doumit (BSN ’88, MPH ’96) recently conducted the first study of the “lived experience of Lebanese women with breast cancer” and discovered that they were particularly concerned with knowing the truth about their condition and expressed a strong interest in participating in a cancer patient support group.
As a member of a research team including Dr. Fadi Jardali and Gladys Mouro, Professor Nuhad Dumit (BSN ’80) is tackling one of the biggest problems facing nursing directors in Lebanon: how to hold on to good nurses. The results of a study that the team conducted of 76 hospitals in 2007-08 revealed that the primary “retention challenges” are related to unsatisfactory salary, inconvenient shifts, long working hours, and the availability of more attractive opportunities within or outside the country.
Rafic Hariri School of Nursing: Quick Facts
2003: Introduction of Master of Science in Nursing (MSN) program.
October 13, 2007: The Commission on Collegiate Nursing Education in the United States grants both the BSN and MSN programs unconditional accreditation for a five-year term, which is the longest term that it grants.
Also in 2007: The American Association of Colleges of Nursing, the governing body of CCNE, invites the School of Nursing to become a full member of the association.
October 20, 2008: AUB announces $10 million pledge from AUB Trustee MP Saad Hariri to renovate, equip, and name the new building; to endow the directorship of the school; to approve scholarships for nursing students; and to endow a faculty chair in nursing.
February 19, 2009: The Rafic Hariri School of Nursing is inaugurated.
AUBMC Nurse and MSN Student: A Day in the Life
Raja Issa, 24, SoN master’s student and full-time employee at AUBMC, recognized that nursing was not considered an appropriate profession for a man in Lebanon. Despite his family’s reservations, he entered the BSN program in 2004 and graduated with a specialization in pediatric nursing. He is currently enrolled in the MSN program and working at AUBMC’s Rescue Unit. “My family is now supportive of me,” he says, adding, “AUB prepares you to be autonomous—a leader—at a very high level of nursing. I am very proud to be a nurse.”
The Rescue Unit provides nurses to departments on an as-needed basis, which means that Raja works all over the hospital. As the only resident nurse (RN) qualified to work in both pediatric and adult health, he is a busy man. Every day brings new challenges for Raja—he may arrive at work and find that the Children’s Cancer Center is understaffed that day, or have to rush to the Emergency Room to help deal with a crisis there. MainGate accompanied him around AUBMC to see what a working nursing student does on a typical day.
Raja’s day starts early, heading straight to the Medical Surgical Unit, where he is briefed by the night staff on patients’ conditions and anything that has happened during their shift.
Morning rounds: Raja wakes up patients, assesses their conditions, and brings them their medications. He may also help them eat breakfast, use the toilet, and wash. He doesn’t mind this part of the job, he says, explaining that he tries to treat every patient “as if they are a member of my family.” Each nurse is responsible for four or five patients.
After he finishes his work at the Medical Surgical Unit, he heads over to the new Children’s Cancer Center where he is able to put his specialties—pediatric and oncology nursing—into practice. “At the Cancer Center nurses really get involved with patients and their families because they’re long term and need lots of care. I always make sure I explain to children what is happening or try and make a game of it. Every nurse has their own personal approach to patients.” Rima Saad, a senior nurse on the ward, agrees. “Because we deal with children we have to be creative; otherwise they get bored easily.” The center is equipped with an attractive playroom, but if the children are too sick to leave their beds, Raja and the other nurses spend time with them in their private rooms. There they help to keep them entertained, administer any medication and pain relief, and offer the children and their parents information about living with cancer.
After leaving the Cancer Center, Raja stops by the nursing school to meet with a couple of his professors to discuss his project on “the association between rationing nursing care and patient outcomes” for his Advanced Nursing Research Course, before heading to lunch. Raja and his fellow nursing students Jehan, Layel, Rachel, and Samer in the Medical Surgery Unit agreed that while it can be difficult juggling their studies and their duties as nurses, AUMBC makes sure their schedules are flexible so they have time for their classes. Many of the nurses on the master’s course also work full-time, so coordination between the hospital and the course administrators is vital.
After lunch, Raja walks over to the Emergency Room for his final shift of the day. “You get to meet a diverse group of people in the ER and there’s always something different happening,” he says. He recalls one time in particular when he had to administer CPR to a cardiac arrest patient who was still in the ambulance, while a fellow nursing student on the ward, Lamia Eid, noted that they had to stay in the ER for two days dealing with casualties during the July 2006 war. On this particular day, Raja helps to tend to a 14 year old boy who has broken his arm playing football and treats a woman who was brought in by ambulance suffering from a severe asthma attack.
Raja’s shift finishes at 3 pm, leaving him an hour before his Managing Quality in Teams class at the Hariri School. “It’s very busy doing a master’s degree while being a full-time nurse and does not leave much time for a social life,” he says, “but I try to live the life of an AUB student too."