Nursing was my passport

By Huda Abu-Saad Huijer | 11/02/2018

Her advice to nurse researchers? Believe in what you do and persevere.

Nursing was my passport
She saw children suffer from post-surgery pain, felt they shouldn’t suffer unnecessarily, and set out to do something about it. Thus began her global career in academic research.

When I decided on a career in nursing, I had no idea where that decision would take me, nor the challenges I would encounter. My family also didn’t know what this choice entailed and worried about the difficulties I would face. I loved my nursing education at the American University of Beirut (AUB) in Lebanon and the variety of clinical experiences it offered. I was called the social butterfly of my class because of the activities and trips I organized for nursing students and faculty members.

Shortly after graduating and gaining hospital nursing experience, I was invited to teach at AUB School of Nursing and was appointed clinical instructor. This was truly a turning point for me because I discovered my love for teaching and for mentoring and coaching students who, at that time, were just a few years younger than me.

Less than three years later, I was offered a scholarship to pursue my master’s degree in the United States. I applied to and was accepted at various universities, but I selected the University of Florida in Gainesville. Besides wanting a good program, I wanted a place where I could enjoy nice weather, similar to my own country. I had to get used to alligators sunning themselves on the shores of campus lakes and the “gator man” who fed them while students watched. Those experiences were unforgettable, and I remember and talk about them to this very day.

Civil war changes career path
I never really planned my career; I grabbed it as it came. When I finished my master’s and was preparing to go back to Lebanon, civil war broke out in my country, and I could not return. So, I applied to and was accepted by the University of Florida to start my PhD studies. I was fortunate to have support of excellent faculty and friends, and my dissertation, “Nursing: A World View,” was published as a book by Mosby.

While pursuing my PhD, I met my future husband, a student from the Netherlands who was getting his PhD in engineering, and our lives took a different turn! After graduating, we stayed in the United States and sought employment. I landed at the University of California San Francisco (UCSF), and my husband obtained a position at Hewlett-Packard in Palo Alto. During our time in California, our two children were born.

Focus on pain
As a tenure-track assistant professor at UCSF, I taught pediatric clinical courses at Stanford University Hospital. That experience sparked my interest in clinical research. While clinically supervising nursing students on pediatric units, I observed the suffering of school-age children after surgery and reluctance of nurses and physicians in those days to manage their pain. I believed that children should not suffer unnecessarily. My observations of ineffective pain management led to my groundbreaking and seminal study on pain in children, published in the journal Pain. Thus began my research career.

Because I believed that pain management should be a priority in all healthcare settings, I expanded my research to include other age groups and disease conditions, eventually venturing into untouched areas of research on pain in neonates and cognitively impaired children. Looking back, I am delighted to say a lot has been accomplished since my first study on the subject of pain.

My career in academic nursing research since then has been truly global. I have had the privilege of working in various countries and collaborating with experts from a variety of disciplines: nursing, medicine, public health, psychology, sociology, anthropology, biostatistics, epidemiology, ethics, health services, and health policy. These interdisciplinary collaborations enriched my scope of knowledge and contributed to the quality of my teaching, research, and administration. Although the majority of my academic positions have been in administration, research has remained a primary focus of my career.

Mentoring expands research focus
My study of pain in children continued to be the focal point of my research when we moved from the United States to the Netherlands, where I was initially associate professor at the University of Limburg and, later, professor and chairperson at the University of Maastricht. My interest in pain in children was passed along to my students. Mentoring and supervising students as they prepare PhD dissertations have been among the most rewarding aspects of my academic career. I’ve learned much from them.

One of my first PhD students examined factors influencing nurse decision-making in assessing and relieving pain in children. In a follow-up randomized, double-blind, placebo-controlled study, we studied the effect of paracetamol, fentanyl, and systematic assessments on children’s pain following adenotonsillectomy. In collaboration with colleagues in Sydney, Australia, another student of mine studied management of venipuncture pain with music distraction, placebo, and EMLA cream. We found EMLA cream superior to music and placebo in relieving pain in young children. Another student compared patient-controlled analgesia to continuous infusion and found no significant difference between using both approaches in relieving pain as opposed to using continuous infusion only.

As my interest in the subject of pain in children expanded to focus on pain in neonates and cognitively impaired children, PhD dissertations from two other students of mine led to development of international guidelines on pain management. One of these dissertations resulted from a study on chronic pain in children with cancer, conducted during my sabbatical in Paris. The other dissertation reported on a study of assessing and managing headache pain in children. Based on its success, a follow-up funded randomized controlled trial (RCT) study tested the effectiveness of a self-management training program for elementary schoolchildren.

During the same period, I supervised several dissertations based on funded pain studies that addressed pain assessment and pharmacological pain management practices of nurses, benefit analysis of at-home pain diaries by chronic cancer patients, and pain in elderly people with severe dementia, among others. These were in addition to supervising a number of dissertation authors on the nurse’s role in managing conditions such as sleep problems, heart failure, migraine, fatigue, chronic obstructive pulmonary disease, rheumatoid arthritis, psychiatric conditions, stroke, and pressure ulcers.

In the late 1990s and early 2000s, while continuing to serve as a professor and director at the University of Maastricht, I also served as a visiting professor at the University of Manchester and the University of Surrey in England. During this period, my research interest expanded to include palliative care across the life span. Funded studies on end-of-life care have resulted in publications addressing the care of terminally ill patients. Topics included needs of family caregivers, defining a “good death,” normative expectations around death and dying, euthanasia and physician-assisted suicide in the Dutch homecare sector, and role of the district nurse.

Return to Lebanon
In 2003, I returned to my home country of Lebanon, where I have served as a professor of nursing science and dean of the Rafic Hariri School of Nursing at the American University of Beirut. Here, I have conducted the first funded national study on palliative care in Lebanon, an assessment that involved 15 hospitals, 1,873 nurses, and 1,884 physicians. This was followed by two funded studies about palliative care in Lebanon— one related to adults with cancer, the other to children with cancer.

At present, two studies are being completed on chronic pain in adults and palliative care in older adults. In addition to my own research, I have supervised PhD dissertations related to palliative care of Lebanese oncology patients, end-of-life care for Muslims and Christians in Lebanon, family caregivers of cancer patients, perspectives of bereaved parents in a palliative care program in Lebanon, and knowledge of Lebanese nurses regarding pain management, among others.

My research has had a major impact on healthcare delivery in Europe and Lebanon. My studies on pain relief and palliative care have shaped policy and developed the field in the Netherlands and, more recently, in Lebanon and the region. A mandate on pain relief and palliative care that I wrote while in Lebanon has led to major changes in the field and a national healthcare policy that recognizes palliative care as a healthcare field. The mandate focuses on five areas of palliative care: education, practice, research, public policy, and opioid accessibility.

I currently serve as vice president of the National Committee on Pain Relief and Palliative Care, appointed by the Minister of Health. In addition to chairing its subcommittee on research, I play a key role in focusing attention on development of this field in my country. I have also served as president of the Lebanese Society for the Study of Pain, a chapter of the International Association for the Study of Pain. In both capacities, I have contributed to declarations that recognize pain relief and palliative care as human rights. Recently, I was invited to serve as a commissioner on the Lancet Commission on Global Access to Palliative Care and Pain Relief.

Ultimate nursing research recognition
My professional and life journey was not planned. It fell into place with incredible and prestigious positions in various countries across the globe. Nursing has been an excellent choice for me, and it was truly my passport to the academic world. My advice to aspiring nurse researchers? If you believe in what you do, persevere, and excel, you will surely reap rewards.

It was a great honor to be nominated for and inducted into the International Nurse Researcher Hall of Fame. I look back with fond memories to the nomination process and the exhilarating experience of being selected for this prestigious award. My professional life journey has been academic nursing, and, in my opinion, being inducted into the International Nurse Researcher Hall of Fame is the ultimate recognition by colleagues and fellow researchers. I encourage all nurse researchers to work toward achieving this goal in their careers. RNL

Huda Abu-Saad Huijer, PhD, RN, FEANS, FAAN, a professor of nursing and dean of the Rafic Hariri School of Nursing at the American University of Beirut, was inducted into the International Nurse Researcher Hall of Fame in 2016. That same year, she was appointed an honorary member of the International Association for the Study of Pain. In 2017, she received the Princess Muna Regional Award for Excellence in Nursing in recognition of her dedication and leadership in nursing at the regional level and for her significant contributions to healthcare across borders.

Editor’s note: The International Nurse Researcher Hall of Fame award, first presented in 2010 by Sigma Theta Tau International Honor Society of Nursing (Sigma), honors nurse researchers who have achieved significant and sustained national and/or international recognition for their work and whose research has influenced the profession and the people it serves. The induction ceremony during the 30th International Nursing Research Congress, 25-29 July 2019, in Calgary, Alberta, Canada, will mark the 10th presentation of the award. Nominations are now open, and the nominating deadline is 11 December 2018. All active Sigma members worldwide are eligible. Current members of the Sigma board of directors, Sigma staff, Sigma consultants and contracted staff, and members of the judging committee are not eligible. Click here for more information.

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