00000cam a22000004a 4500 UP-1685523046125428720 Buklod 20230503092606.0 a r |||| u| ta 071031s xx d r |||| u| UPMain LG 995 1998 N8 V55 Villamiel, Joseph Walter M. Physiologic responses of comatose patients to liturgical text reading as a biobehavioral nursing intervention Joseph Walter M. Joseph Villamiel. 193 leaves. Thesis (Master of Arts in Nursing)--University of the Philippines Manila. The rising rate of accidents and lifestyle-related diseases that may lead to a comatose state, the advances in neurodiagnostic and treatment technologies vis-a-vis the emotional and economic burden on the family, and the bioethical dilemmas on clinical decisions are some reasons behind the growing concern for the comatose patients in the health care field. Despite such a concern, there remains a difficulty among nurses in operationalizing psychosociospiritual interventions for comatose patients, especially in ICU settings as much as they do physical care. Part of the hindrance to such a holistic care lies in questions regarding the actual sensory capability of these patients, the pertinent biobehavioral strategies that will address their psychospiritual needs, and the appropriate but feasible method of evaluating their responses. Inspired by these intensive care nursing concerns regarding comatose patients, this study was conducted to: (1) determined the significant physiologic responses of comatose patients to spiritual reading, particularly from liturgical texts, using blood pressure, heart rate, respiratory rate and overt motor movement as parameters; (2) to ascertain whether the physiologic responses of comatose patients to liturgical text reading, as manifested by the selected parameters, differ significantly from their corresponding physiologic response to non-liturgical text reading; and, (3) to identify some of the possible variables, pathophysiologic and sociodemographic, that may affect the comatose patients' physiologic responses to liturgical text reading. The study utilized a double-blind repeated measures experimental design and was conducted in selected intensive and special care units of a tertiary public hospital (UP-PGH). Complete enumeration of comatose patients confined within the 10-week period of data gathering and who met the 10-point subject inclusion criteria was implemented. This generated a sample size of 30, with the subjects equally but randomly assigned to the control and study (experimental) groups. The data collection methods included review of charts, interview of significant other/watcher, observation of motor responses, and measurement of physiologic response parameters. Subjects in the study group were given two types of auditory stimulus, liturgical (Psalms 23, 130 and 16) and non-liturgical (contemporary poetry) text readings. Both were tape-recorded in Filipino lasting 15 minutes per set, each one randomly administered to complete three morning and three evening sessions using a walkman cassette player with earphones and a pre-set fixed volume. The same schedule and audio equipment were given to the control group, but for them, blank tapes were played. A pilot-tested intervention protocol was followed, with the blinding approach applied by trained nurse research assistants to measure the physiologic response parameters and observe for motor movement, without knowing to what group did a subject belong and what particular record was being played. Physiologic responses were measured immediately prior to, at 10 minutes of, at the end of 15 minutes of, and at 15 minutes after the intervention. The results of the study showed that compared to the control group who did not receive any intervention, the study group exhibited more changes in parameter values during both liturgical and non-liturgical readings. However, for the study group, the change in parameter values during liturgical reading was greater than during non-liturgical reading. This was especially manifested by systolic and diastolic blood pressure mean values which tended to decrease more with liturgical readings than with non-liturgical reading sessions. This appears to denote a calming or relaxing effect brought about by both types of recorded reading interventions, but which was more apparent during the liturgical reading. The changes were less apparent for HR and RR. These physiologic response differences were found to be statistically significant at p .0001, using repeated-measures analysis of variance. For overt motor response, a bigger percentage of the study group exhibited more neuromuscular movement than the control group during sessions with both types of readings. However, the proportion of those who exhibited motor movement during liturgical reading sessions were particularly greater than the proportion of those who did during non-liturgical reading sessions. Chi-square tests revealed that there is indeed a significant difference among the three treatment situations (control vs. liturgical vs. non-liturgical) as far as motor responses are concerned and this is significant at p .05 level in 10 out of 12 body parts specified. Results of multivariate analyses--stepwise multiple regression for BP, HR and RR, and logistic regression for overt motor response--revealed that six extraneous variables influence physiologic responses to liturgical reading, not independently but in varying combinations and degrees. Based on their relative contributions to the variability of the independent variables, they may be ranked as follows: (1) type of coma, socioeconomic status; (2) age, educational attainment; (3) degree of religiosity; and, (4) duration of coma. Variables that were found to be not contributing any effect include: stimulation timing, duration of intervention, and for statistical reasons, also gender and coma level. Based on these findings, it is recommended that nurses and others who are involved in caring for patients in coma, including the family and other health team members, continue to provide auditory stimulation of various contents and methods, both casually and in an organizaed program. However, to meet the psychospiritual needs of the patients, actual or recorded scriptural readings will be an effective auditory stimulus. Vocal prayer, religious music, and pastoral care of the sick with the participation of a priest or a minister and the family may also be resorted to. Nurse managers are encouraged to facilitate the staff's use of auditory stimulation and related psychospiritual interventions by administrative support: a better staffing pattern; structural modification and audio equipment purchase if funds are available; encouraging participation in related continuing education programs; and, policy modification particularly on the length of time watchers are allowed at the bedside. The responsibility of nurse educators is to reinforce biobehavioral nursing interventions such as the use of auditory and other stimulation techniques in the light of psychospiritual models in the nursing curricula, classroom discussions, and learning experiences of both the graduate and undergraduate levels. They should also be more actively participating in research undertakings and in the continuing training of nurses towards caring for comatose patients using various biobehavioral stimulation methods, including those that address psychospiritual needs. Researches on coma stimulation in general and on auditory spiritual intervention in particular were suggested to encompass better research methodology and controls, a variety of intervention instruments, parameter evaluation and a multidisciplinary approach. Holistic nursing care. Pyshospiritual nursing. Comatose patients. UPMNL NURS LG 995 1998 N8 V55 UPMNL UPMNL-MAIN LG 995 1998 N8 V55 Book