Feasibility and acceptability of advanced practice nursing in Lebanon: A convergent parallel mixed-methods study.
Most health professionals and service users in Lebanon support the introduction of advanced practice nursing roles, but significant barriers to implementation remain.
Where it sits
this study against the rest of the eloralintide corpusSummary and findings
This study assessed the feasibility and acceptability of introducing advanced practice nursing (APN) roles in Lebanon among health professionals and service users. A total of 87.7% of health professionals supported APN roles, and 97.1% of service users expressed willingness to receive follow-up care from an APN. The study identified barriers to implementation, including regulatory and educational challenges.
Abstract
<h4>Background</h4>Lebanon is facing a severe health system and workforce crisis, characterized by nurse emigration, service fragmentation, and a rising burden of chronic diseases. Advanced practice nursing may help strengthen access, continuity, and quality of care; however, these roles are not formally established in Lebanon.<h4>Objective</h4>To assess the feasibility and acceptability of introducing APN roles in Lebanon, identify perceived barriers and enabling conditions, and inform policy and implementation planning.<h4>Design</h4>Convergent parallel mixed-methods study informed by the participatory, evidence-based, patient-focused process for advanced practice nursing framework.<h4>Settings</h4>Hospitals and primary care centers in Lebanon.<h4>Participants</h4>Health professionals, adult service users, and key stakeholders involved in or affected by APN implementation.<h4>Methods</h4>Quantitative data were collected using structured questionnaires administered to health professionals and adult service users and analyzed descriptively using proportions with 95% confidence intervals (Cls) and exploratory subgroup comparisons. Qualitative data was generated through key informant interviews and focus groups with relevant stakeholders and analyzed thematically. Quantitative and qualitative findings were integrated during the interpretation stage using a side-by-side comparison of convergence, complementarity, and divergence.<h4>Results</h4>Most health professionals supported the introduction of advanced practice nursing roles (87.7%; 95% CI 81.4-92.1), and almost all anticipated benefits for chronic disease management and care coordination (99.3%; 95% CI 96.2-99.9). Most service users reported a willingness to receive follow-up from an advanced practice nurse (97.1%; 95% CI 89.9-99.2), and 92.6% (95% CI 83.9-96.8) anticipated improved access in underserved areas. Qualitative findings reinforced perceived benefits for prevention, continuity of care, and equity, while identifying major implementation barriers, including the absence of a clear legal and regulatory framework, unresolved scope-of-practice and reimbursement issues, limited public and professional awareness, insufficient educational pathways, and anticipated resistance from some physicians.<h4>Conclusions</h4>Stakeholders regarded advanced nursing practices in Lebanon as acceptable and potentially beneficial, particularly for chronic disease care and access in underserved areas. However, implementation may require regulatory clarification, investment in master-level education, interprofessional engagement, and context-sensitive policy planning.<h4>Social media abstract</h4>Stakeholders in Lebanon support advanced practice nursing, but legal, educational, and system barriers still limit implementation.
Background
This paper addresses the potential implementation of advanced practice nursing (APN) roles in Lebanon amidst a health system crisis characterized by nurse emigration and chronic disease burdens. Previous literature suggests that APN roles can enhance healthcare access and quality, but Lebanon lacks formal establishment of these roles. Understanding the feasibility and acceptability of APN is crucial for informing policy and implementation strategies.
Methods
The study employed a convergent parallel mixed-methods design, collecting quantitative data through structured questionnaires from health professionals and adult service users, analyzed descriptively. Qualitative data were gathered via key informant interviews and focus groups, analyzed thematically. The integration of findings occurred during interpretation, focusing on convergence and divergence.
Results
The primary finding indicates that 87.7% of health professionals support the introduction of APN roles (95% CI 81.4-92.1). Additionally, 99.3% of health professionals anticipated benefits for chronic disease management (95% CI 96.2-99.9), while 97.1% of service users expressed willingness to receive follow-up from an APN (95% CI 89.9-99.2).
Interpretation
The findings align with existing literature that supports the introduction of APN roles to improve healthcare delivery. While the statistical significance of the support for APN roles is notable, the clinical significance remains uncertain without evidence of actual implementation outcomes. Limitations such as potential biases in qualitative responses and the absence of a clear sample size may confound the conclusions.
Key findings
- 87.7% of health professionals supported the introduction of advanced practice nursing roles (95% CI 81.4-92.1)
- 99.3% anticipated benefits for chronic disease management and care coordination (95% CI 96.2-99.9)
- 97.1% of service users reported willingness to receive follow-up from an advanced practice nurse (95% CI 89.9-99.2)
- 92.6% anticipated improved access in underserved areas (95% CI 83.9-96.8)
Limitations
- Not reported in abstract.
- Potential biases in qualitative data collection.
- Findings based on perceptions, not actual implementation outcomes.