A comparative study of the effect of sensory stimulation by family members and nurses on the level of consciousness and vital signs of patients admitted to the ICU - a clinical trial

Number of pages: 111 File Format: word File Code: 31959
Year: 2012 University Degree: Master's degree Category: Paramedical
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  • Summary of A comparative study of the effect of sensory stimulation by family members and nurses on the level of consciousness and vital signs of patients admitted to the ICU - a clinical trial

    Dissertation

    Master's course in special care nursing

    Abstract:

    Introduction: The patient who is admitted to the special care unit is exposed to sensory deprivation for various reasons. The results of the studies indicate the positive effect of sensory stimulation in preventing sensory deprivation, but the role of the family compared to nurses in performing sensory stimulation has not yet been measured in a separate study in Iran. The aim of this study is to compare the effect of sensory stimuli by family members and nurses on the level of consciousness and vital signs of patients hospitalized in the special care department and the general health status of the family. Materials and methods: In this study, which was conducted using a clinical trial method, 69 patients admitted to the special care department of Ashair and Shafa Khorramabad Hospitals in 2013-2016 were examined by stratified block method based on age group in 2 test groups and a control group. were placed One group received Diang sensory stimulation by the family and one group by the nurse. No intervention was done for the control group.  De Young's sensory stimulation program for the test groups was carried out for 2 hours a day at 4 to 5 in the evening and 8 to 9 at night, with an interval of 3 hours and for 6 days. For all the research units in three groups, the level of consciousness and vital signs were measured in two stages, 5 minutes before the intervention and 30 minutes after the end of the intervention, by the research assistant, and the general health status of the family members in the test and control groups was evaluated by the research assistant through interviews using a general health questionnaire immediately before and after the visit in the first, sixth and twelfth visits. To analyze the data, statistical tests of one-way analysis of variance, independent t-test, repeated measures analysis test and SPSS No. 18 software were used.

    Findings: Based on the results of covariance analysis, there was a significant difference between the experimental groups in terms of the average increase in GCS level and the difference in vital signs before and after the intervention (p>0.001). From this point of view, the family group was the best treatment group, the nurse group was the next, and the control group was the last. However, based on the results of repeated measures analysis, the effect of intervention on different days on the level of alertness and vital signs of patients before and after the intervention was the same. The results of the independent t-test showed that there was a statistically significant difference between the average general health score of the control group patients and the test on the sixth day after the intervention (p=0.003). This average in the test group (19.6522) was lower than the control group (29.4783).

    Conclusion: sensory stimulation by family members is more effective than nurses in improving the level of consciousness of the studied comatose patients. Also, the presence of family members at the patient's bedside can greatly reduce their worries and help them relax. Therefore, it is suggested to provide conditions that the closest member of the family with sufficient training can carry out the sensory stimulation program at the right time for the patient hospitalized in the ICU.

    Key words: sensory stimulation, level of consciousness, family, special care unit

    1. Statement of the problem:

        In America, in 66% of patients who were hospitalized in ICU for at least 10 days, complications due to sensory deprivation during hospitalization and after discharge have been observed [9].  One of these complications is psychosis [3], 30 to 80 percent of psychosis cases depend on concomitant diseases, prescription of various drugs and sensory deprivation. A study in Denmark showed that 39% of patients hospitalized in the ICU suffer from psychosis. The side effects of sensory deprivation [4] can affect the level of consciousness [10].

    There are no exact statistics regarding the sensory deprivation of ICU patients in Iran, but Aghazadeh et al. showed that ICU patients in more than 80% of cases experience unpleasant sensory reception in no way, very little or only in some cases (lack of sensory overload). But the examination of emotional reactions showed that 39.8% experienced pain, 18.5% anxiety, 12% fear, 7.4% violence and anger, and 9% hatred, which seems to be due to sensory deprivation caused by the lack of family visits. Therefore, they suggested increasing the visits of special ward patients [11].

        First in the 1950s, the Institute for Human Potential in Pennsylvania[5] supported the idea that the use of coma stimulation programs by providing environmental inputs to all five senses at the same frequency, intensity and duration, could improve the rate and degree of recovery from coma and possibly synaptic innervation. to give The research results of Carter and D. Young [6] (1989) also support the above idea [14-12].

    In general, it can be concluded that one of the main and decisive needs in the recovery process of ICU patients and preventing sensory deprivation and its complications such as delirium and impaired consciousness is to perform appropriate and balanced sensory stimulation for patients and nursing strategies to reduce the effects of sensory deprivation such as delirium and disorder in Consciousness includes re-awareness, adjustment of stimuli, providing suitable cognitive activities, providing natural sleep and wake cycle, pain treatment and the presence of relatives next to the patient [15].

  • Contents & References of A comparative study of the effect of sensory stimulation by family members and nurses on the level of consciousness and vital signs of patients admitted to the ICU - a clinical trial

    List:

    Chapter one:

    Statement of the problem .. 1

    1-1. Statement of the problem.. 1

    1-2. The importance and necessity of the study. 4

    Chapter Two:

    Conceptual framework and review of texts. 8

    2-1. Conceptual framework.. 9

    2-1-1. The structure of the brain and its protective layers. 9

    2-1-2. Cerebral circulation. 9

    2-1-3. Head injury.. 11

    2-1-3-1. Types of head injuries based on the type of injury. 11

    2-1-3-2. Classification of brain injuries based on the location of the impact. 12

    2-1-3-3. Diffuse brain damage. 12

    2-1-3-4. Central brain damage. 13

    2-1-3-5. Effects of head injury on level of consciousness. 14

    2-1-4. Diagnostic methods in head trauma patients. 16

    2-1-5. Sensory deprivation in ICU and the role of sensory stimuli. 19

    2-1-6. The role and needs of the family of ICU patients. 20

    2-2. Review of texts .. 23

    Chapter three:

    Materials and methods .. 29

    3-1. Objectives, presuppositions and assumptions of the research. 30

    3-1-1. General purpose.. 30

    3-1-2. Minor goals .. 30

    3-1-3. Presuppositions.. 30

    3-1-4. Research assumptions according to the goals of the plan. 31

    3-2-1. Theoretical definition of words. 31

    3-2-2. Practical definition of words. 32

    3-4. Methodology and implementation methods. 32

    3-5-1. Sample acceptance criteria. 33

    3-5-2. Sample exit criteria. 33

    3-7. How to analyze information. 37

    3-8. Design limitations and problems. 37

    3-9. Ethical points. 38

    Chapter four:

    Results and findings.. 39

    4-1. Comparison of the subjects in terms of background variables by the study group. 40

    4-2. Comparison of the subjects in terms of response variables according to the study group. 47

    4-3. Modeling the effect of groups on response variables using repeated measures analysis. 60

    4-3-1. The effect of therapeutic groups on the level of consciousness of patients. 60

    4-3-2. The effect of treatment groups on the systolic blood pressure of patients. 62

    4-3-3. The effect of treatment groups on diasystolic blood pressure of patients. 64

    4-3-4. The effect of treatment groups on the body temperature of patients. 66

    4-3-5. The effect of treatment groups on breathing rate of patients. 68

    4-3-6. The effect of treatment groups on the pulse number of patients. 70

    4-3-7. The effect of treatment groups on the GHQ score of family members. 72

     

    Chapter five:

    Discussion, conclusions and suggestions. 75

    5-1. The effect of intervention on the level of consciousness of patients. 77

    5-2. The effect of intervention on patients' vital signs. 80

    5-3. The effect of intervention on the duration of hospitalization of patients in ICU. 81

    5-4. The effect of intervention on the general health of patients' families. 82

    5-5. Application of research results in nursing. 83

    5-6. Suggestions for future research. 84

    List of sources .. 85

    Appendices .. 93

    Appendix A (GHQ questionnaire). 94

    Appendix B (Glasgow coma table). 96

    Appendix C (Diang sensory stimulation table). 97

    Appendix D (family information collection form). 98

    Appendix and (patient information collection form). 99

    English abstract .. 100

     

    Source:

     

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A comparative study of the effect of sensory stimulation by family members and nurses on the level of consciousness and vital signs of patients admitted to the ICU - a clinical trial