The making of nursing practice Law in Lebanon: a policy analysis case study

Abstract

BackgroundEvidence-informed decisions can strengthen health systems, improve health, and reduce health inequities. Despite the Beijing, Montreux, and Bamako calls for action, literature shows that research evidence is underemployed in policymaking, especially in the East Mediterranean region (EMR). Selecting the draft nursing practice law as a case study, this policy analysis exercise aims at generating in-depth insights on the public policymaking process, identifying the factors that influence policymaking and assessing to what extent evidence is used in this process.MethodsThis study utilized a qualitative research design using a case study approach and was conducted in two phases: data collection and analysis, and validation. In the first phase, data was collected through key informant interviews that covered 17 stakeholders. In the second phase, a panel discussion was organized to validate the findings, identify any gaps, and gain insights and feedback of the panelists. Thematic analysis was conducted and guided by the Walt & Gilson’s “Policy Triangle Framework” as themes were categorized into content, actors, process, and context.ResultsFindings shed light on the complex nature of health policymaking and the unstructured approach of decision making. This study uncovered the barriers that hindered the progress of the draft nursing law and the main barriers against the use of evidence in policymaking. Findings also uncovered the risk involved in the use of international recommendations without the involvement of stakeholders and without accounting for contextual factors and implementation barriers. Findings were interpreted within the context of the Lebanese political environment and the power play between stakeholders, taking into account equity considerations.ConclusionsThis policy analysis exercise presents findings that are helpful for policymakers and all other stakeholders and can feed into revising the draft nursing law to reach an effective alternative that is feasible in Lebanon. Our findings are relevant in local and regional context as policymakers and other stakeholders can benefit from this experience when drafting laws and at the global context, as international organizations can consider this case study when developing global guidance and recommendations.

The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state

“…Lebanon welcomed more than 1.2 million Syrian refugees registered with UNHCR from 2012 till the end of 2015 ( Figure 1 ), 5 , 6 and many more are present but without registration. 7 As the Lebanese Government has not permitted the establishment of formal camps, displaced Syrians remain dispersed all over the country in over 1,700 localities 8 all over the six districts, where Bekaa (Arsal) and North (Akkar), which include the most vulnerable, poor, and undeserved communities, 9 host the largest numbers (373,124) followed by Beirut (314,731). 10 In spite of its contemporary history of military and political conflicts as well as pressures on its infrastructure, Lebanon kept its borders open till October 2014, 7 , 11 , 12 after which it adopted a policy paper to limit and decrease the Syrian refugee population on the Lebanese land, secure Lebanese and Syrian people’s safety, and ease the burden placed on Lebanese people and economy.…”

The translation and cultural adaptation validity of the Actual Scope of Practice Questionnaire

“…The findings of Phase I of the study clearly indicated that the A-ASCOP was not suitable for use following the initial translation. Of the 26 items, seven items [3,5,6,7,8,13,17] confused the participants and did not preserve the meaning of the original ASCOP questionnaire. Although properly translated, five of the remaining items [2,4,9,10,15] needed to be rephrased ( Figure 1).…”

“…Lebanese nurse leaders have responded to the omissions and ambiguities in Decree 1655 by drafting an updated practice act with three categories of nurse delineated by level of preparation: nurse specialist (Master of Science in Nursing), nurse (Bachelor of Science in Nursing), and nurse assistant (Baccalaureate Technique Certificate). The draft updated decree lists nursing activities corresponding with the three levels of preparation (6). Neither the updated practice act, nor the draft qualification and specific scopes of nursing practice have been approved due to the political situation in the country.…”

The Impact of the Syrian Refugee Crisis on Nurses and the Healthcare System in Lebanon: A Qualitative Exploratory Study

“…Even before the Syrian crisis, there was a remarkable shortage in nursing, especially in the underserved areas of Lebanon. Pre‐crisis, the ratio of nurses (including midwives) was 1.8 per 1,000 population, the eighth lowest nursing density in the eastern Mediterranean region (El‐Jardali et al., ). In response, the Lebanese MoPH in coordination with the Order of Nurses in Lebanon (ONL) made concerted efforts to increase the number of nurses working in health organizations across Lebanon (Ammar et al., ).…”