Productivity and Empowerment of Nurses During Conflict: A Secondary Phenomenological Analysis of The PEACE Study Data

Abstract

Since 2019, Lebanon has experienced a convergence of crises, including political unrest, economic collapse, the COVID-19 pandemic, the Beirut Port explosion, and, most recently, the 2024 war. These overlapping shocks have severely strained the healthcare system, leading to shortages of supplies, unsafe working conditions, and significant workforce attrition, with nearly 30% of registered nurses leaving the country. Nurses who remained have faced increasing financial hardship, emotional distress, and heightened professional demands, all of which intensified during the current war as hospitals became overwhelmed and staff were exposed to direct security threats and displacement. The Productivity, Empowerment, and Care Experiences (PEACE) study was launched to examine how nurses and nurse managers navigated these compounded conditions during the 2024 war in one large tertiary academic institution in Lebanon. The study focused on Nurses’ empowerment and productivity and how they are perceived in times of uncertainty and conflict as key phenomena. Empowerment is conceptualized as both structural, referring to institutional support, and personal, reflecting emotional resilience and internal coping capacity. Productivity is understood as nurses’ perceived ability to remain functional, focused, and effective in delivering care under sustained stress and uncertainty.

This project used secondary qualitative data from the PEACE study to explore nurses’ experiences of empowerment and productivity amid conflict and to identify resilience strategies in crisis settings.

A descriptive phenomenological analysis was applied to the PEACE study data: semi-structured interviews were conducted with thirteen nurses and nurse managers at a tertiary hospital in Beirut. Coding was performed using Quirkos software, with bracketing and intuiting steps to ensure rigor.

This secondary analysis revealed five interrelated themes reflecting the lived experiences of nurses and nurse managers at the institution during wartime: (1) reshaping of nursing practice and care experiences amid mass-casualty demands and ongoing threat, (2) the stabilizing role of structural empowerment, (3) the emergence of personal and collective empowerment, (4) the strain on productivity caused by psychological and physical burdens, (5) the use of coping mechanisms as essential catalysts for sustaining care. Despite working in unsafe and high-stress environments, participants demonstrated professional commitment, adaptability, and a deep sense of duty that sustained their productivity.

The lived experiences of nurses and nurse managers revealed both empowerment and vulnerabilities amid crises that impacted their productivity. The findings reinforce the urgent need to support nursing staff during conflict, to mitigate the fallout of the healthcare system.