1. Project Summary: Cumulative stressors in Lebanon lead to the physical and mental exhaustion of nurses, negatively affecting quality of care and patient outcomes. It is crucial to promote healthy lifestyle practices in nurses to ensure wellness and increase work sustainability. This project has two short term objectives that will be conducted over 12 months: 1) To design a Wellness Program targeting nurses 2) To pilot the Wellness Program on a group of nurses at the AUB medical center (AUBMC) and test their knowledge, attitude and intention to practice wellness using a pre-posttest approach. Student(s) in the Masters program will conduct a narrative review of literature to identify evidence on programs improving wellness among nurses, and consequently design training modules. The modules will be delivered to a group of nurses; pretest and posttest will be conducted to assess knowledge, attitude and intention to practice the behaviors. Ultimately, we will use the findings from this project to test the impact of this program on wellness and sustainability. 2. Introduction: For the past three years, nurses in Lebanon have been facing a multitude of challenges over and above the COVID-19 pandemic that led to a mass exodus of nurses, and placed the remaining nurses at high risk for poor physical and mental health outcomes. As a result, Lebanon is experiencing a nursing workforce sustainability crisis. Hence, the urgent need for interventions to sustain and retain Lebanese nurses. We are proposing a project to design an intervention addressing health promotion for nurses. By the end of this project, we will develop a Wellness Program tailored for practicing nurses, pilot the Program on a group of nurses and test their knowledge, attitude and intention to adopt the various healthy habits promoted by the program. This will be the first Wellness Program for nurses in Lebanon and the region and one-step towards sustaining nurses in Lebanon. 3. Problem Statement: The nursing profession has been suffering from severe sustainability crisis throughout. Prior to the pandemic, a survey at the American University of Beirut Medical Center showed that 36% of nurses experienced symptoms of major depression and almost 53% reported burnout (Talih, Ajaltouni, Farhood, 2018). Over the past 3 years, there has been a cascade of crises including the August 4th (2020) blast, political instability, and an economic collapse, over and above the COVID-19 crisis (World Bank, 2021) that led to physical and mental exhaustion, ending with a mass exodus of nurses (Dadouch & Durgham N., 2021). This situation has a detrimental impact on the sustainability of nurses remaining in the profession, and eventually on the quality of care they deliver Promoting the health of nurses will help them endure challenging work conditions; the latter will help improve patient care and secure healthcare sector sustainability in Lebanon. 4. Background: Based on the recent Nurses’ Health Study in Lebanon, currently only about 6,000 nurses are practicing in Lebanon (Unpublished data, AUB & Order of Nurses), serving a population of 4 million Lebanese, and an additional 2 million Syrian and other refugees; or a ratio of 1 nurse per 1,000 people. Thus, nurses endure the responsibility of caring for large numbers of high-acuity patients in the midst of all these crises (Jabbour et al, 2021). Moreover, around 80% of registered nurses in Lebanon being women (Order of Nurses in Lebanon, 2021), they also bear the responsibility of caring for their own families. Thus, it is not surprising that many suffer from non-communicable diseases as per the preliminary results from the Nurses’ Health Study. Unfortunately, there is no structured initiative by key stakeholders (e.g. Ministry of Public Health) to sustain nurses’ wellbeing. 5. Significance: This Wellness Program has several ramifications. Promotion of healthy lifestyle is intended to help nurses attain better physical and mental health outcomes, thus “wellness”. As nurses experience improved wellness, there will be improved work environment and nurse satisfaction, leading to retention of nurses. Retaining professional nurses would encourage new graduates to join the workforce thus improving “nurse to patient ratio”, which will translate into improved quality care and patient outcomes. These endeavors will contribute to the sustainability of the healthcare sector in Lebanon. 6. Project Description: 6.1. The project will have two objectives: Objective 1: Design a Wellness Program targeting practicing nurses. Objective 2: Pilot the Wellness Program on a group of practicing nurses at AUBMC and test their knowledge, attitude and intention to practice wellness behaviors using pre-posttest approach. 6.2. Theory: Health Promotion Model 6.3. Methods/Activities: For objective 1- We will conduct a narrative review of the literature to identify evidence-based components of programs associated with improved wellness among nurses. This activity is expected to take place over 6 months. The mentorship will be provided by expert faculty members from HSON, Family Medicine Department, Psychology Department at AUB. Activities: a- Based on this narrative review, we will develop module-based training sessions likely containing elements related to lifestyle self-care, such as proper diet/weight management, exercise, smoking cessation, sleep hygiene, mental health, and ergonomics in workplace. b- The materials will be reviewed by experts in each field, from HSON and AUB c- The speakers for each session will be identified d- The pre-posttest will be developed For objective 2: We will pilot the Wellness Program at AUBMC. This activity is expected to continue over the next 6 months Activities: We will: a- Identify with AUBMC nursing administration the sample of nurses to participate in the pilot. We will sample nurses working in-patient, outpatient, from different age groups, who have been in service for at least one year. b- Coordinate with the Continuous Professional Development Center on the venue, schedule, supplies needed for the training c- Coordinate with the speakers their availability for the session d- Monitor the implementation including the pre-posttest data collection e- Conduct the data analysis for the pre-posttest f- Write the report to be submitted as a thesis for the graduate studies. 7. The Advancement of Scientific Knowledge and Broader Impact: There is scarce literature on interventions addressing nurses’ wellbeing in Lebanon and the region. Results of this pilot work will address this gap. In addition, the product (training modules) will be incorporated into continuing education programs at AUBMC and other organizations. Targeting risk factors of non-communicable disease (NCDs) among nurses will have the potential to enhance the prevention and control of NCDs, first among nurses and ultimately transcending to their patients. Importantly, this project forms the foundation for long-term initiatives addressing nurses’ sustainability. 9. Leveraging Resources: We will collaborate with different departments at AUB: AUBMC as a resource center: Wellness Center (Department of Family Medicine, particulary Dr. Maya Romani), the Clinical and Professional Development Center, the Smoking Cessation Program, Dietitian Clinics. AUB resources: Department of Psychology (Dr. Brigitte Khoury), Saab Medical Library (availability of evidence and expert librarian), the Charles Hostler Center (sports facility) Major external resources: Order of Nurses in Lebanon and the Ministry of Public Health in Lebanon, World Health Organization (WHO). 10. Deliverables: • Dissemination through publication in refereed journals and presentations in local and international conferences. • A module-based program tailored to nurses’ Wellness 11. Professional Development and Mentoring Plan: Student(s) will complete a clinical residency at the Wellness Center at the Department of Family Medicine, AUB, and will have the option to join teaching workshops and obtain a teaching certificate through the Center for Teaching and Learning at AUB. The student(s) will be encouraged to attend writing seminars and library search coursework as provided on AUB campus.