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Background & Aim: Adverse childbirth experiences as a trauma can evoke fear and post-traumatic stress disorder in some women. This study was conducted to investigate the effect of counseling on post traumatic stress disorder after a traumatic childbirth.

Methods & Materials: This research was a clinical trial which was conducted at Kamaly hospital in Karaj. Samples (300 women) who had experienced a traumatic childbirth were selected by a convenient sampling method and were randomized into an intervention (n=150) and a control (n=150) group. The intervention group received face-to-face counseling within 72 hours of birth for forty to sixty minutes in a session. The control group just received usual care after childbirth. The data collection tool was questionnaire, which was completed via interview. The measuring variables were demographic characteristic, reproductive history, maternity social support, and post-traumatic stress disorder. Data were analyzed using descriptive statistics and inferential tests (Chi-square, Fisher&aposs exact test, and generalized Fisher&aposs exact test) by SPSS v.13 software.

Results: After 4-6 weeks of follow-up there was no significant difference regarding post-traumatic stress disorder between two groups (P=0.295). At 3-month of follow-up, the intervention group reported less post-traumatic stress disorder comparing with the control group (P=0.001).

Conclusion: A midwife-led counseling plan is effective in reducing post-traumatic stress disorder during a long term.

 

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Background & Aim: Childbearing is a potentially traumatic event in the lives of women and can lead to post traumatic stress disorder in some women. This study aimed to determine the prevalence and predisposing factors of post traumatic stress disorder after childbearing in women in Bushehr.

Methods & Materials: In this cross-sectional study, 400 women who attended the medical centers 6-8 weeks after delivery were recruited to the study. Participants with traumatic delivery were included in the study. They completed the posttraumatic symptoms scale-I (PSS-I), and predisposing factors questionnaire. Data were analyzed in two groups of women with the PTSD and without PTSD using Chi-square and Fisher&aposs exact test with P=0.05.

Results: The results of this study showed that 54.4% of women had experienced a traumatic delivery and one-third of the women were affected to PTSD after childbearing. There were significant differences between obstetrical factors including complications of pregnancy, wanted pregnancy, post-partum complications, interval of the last two pregnancies less than two years neonatal factors including type of feeding, issues of child care, birth weight and psychological factors including stressful life events, and maternity social support with the PTSD (P<0.05). Income had statistically significant association with the PTSD (P<0.05).

Conclusion: Some of obstetrical, neonatal and psychological factors are associated with occurrence of the PTSD after delivery

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  Background & Aim: Insertion of chest tubes is a necessary measurement in chest trauma. The trauma patients need specific skills for self-care. This study aimed to determine the effect of using supportive-educative system on self-care skills in trauma patients with chest drainage system .

  Methods & Materials: In this quasi-experimental study, 62 trauma patients with chest-tube were selected from three surgery wards of Besat hospital in Hamadan from December 2012 to May 2013. Two wards were randomly allocated into the experiment group (n=31) and one ward was allocated into the control group (n=31). Participants were selected using convenience sampling. The supportive-educative system was designed based on the patients’ needs and was implemented to the experimental group in three consecutive days. The study instruments included self-care needs assessment form and self-care skills checklist. Measurements were completed once the patients were admitted to the wards and three days later by an external observer. Data were analyzed using t-test, Chi-squared test, Mann-Whitney and Wilcoxon tests with a 95% confidence level in the SPSS-16 . 

  Results: There were no significant differences between the two groups in the study variables at baseline (P>0.05). Although self-care skills in both control (P<0.01) and experiment (P<0.001) groups were improved, using educative-supportive system led to better self-care skills in the intervention group in compare to the control group (P<0.001) .

  Conclusion: In general, self-care skills of patients with chest drainage system could be improved by supportive-educative system. The improvement in the control group can be attributed to self-care trainings conducted routinely by doctors and nurses .

  

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Background & Aim: Post-traumatic stress disorder is one of the psychiatric disorders and exposure to trauma is a key factor in its development. This disorder affects important aspects of a person’s life such as professional quality of life. The aim of this study is to determine the relationship between post-traumatic stress symptoms and professional quality of life among psychiatric nurses.

Methods & Materials: In this descriptive analytical study, 160 nurses in psychiatric wards affiliated to Kerman University of Medical Sciences, were selected using census sampling in 2013. Data were collected using questionnaires including professional and demographic characteristics, the Weathers’ PTSD checklist (PCL-C) and Hudnall Stamm’s Professional Quality of Life (PQOL). Data were analyzed by the SPSS software v.20 using the Pearson correlation coefficient, independent t-test, one-way ANOVA and linear regression.

Results: There was a significant correlation between PTSD score and professional quality of life scores in psychiatric nurses (r=0.32, P<0.001). Also, PTSD was positively correlated with burnout (r=0.36, P<0.001) and secondary traumatic stress (r=0.61, P<0.001), and conversely correlated with compassion satisfaction (r=-0.29, P<0.001). After removing the effects of age, work experience, previous experience of traumatic events, the correlation between two main research variables was significant as well (P<0.001).

Conclusion: Post-traumatic stress has a correlation with professional quality of life in psychiatric nurses. Therefore, factors related to PTSD are suggested to be identified and prevented.

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Background & Aim: Anxiety is one of the most common psychiatric disorders in the family of patients with traumatic brain injury. This study aimed to determine the effect of providing information about the patient’s condition on the anxiety level of the family members of hospitalized patients with traumatic brain injury.
Methods & Materials: This quasi-experimental study was conducted on 90 family members of traumatic brain injury patients admitted to Shahid Bahonar hospital in Kerman in 2016. The participants were selected by the consecutive sampling method and were assigned to intervention and control groups. In the intervention, the participants were informed by the nurse about changes in the patient’s condition during the first three days of admission to intensive care unit. During this period, the control received routine care. Data collection tool was the Spielberger anxiety inventory. Independent and paired t-test were used to compare the mean scores of anxiety using the SPSS software version 16.
Results: There was no statistically significant difference in the mean scores of overt, covert and general anxiety between the two groups before the intervention (P>0.05). However, after the intervention in the experimental group, the mean scores of overt anxiety (45.51±7.26), covert anxiety (45.42±6.51) and general anxiety (90.93±12.72) decreased (P<0.05) compared to the mean scores of overt anxiety (49.22±9.42), covert anxiety (49.02±9.15) and general anxiety (98.24±17.67) in the control group.
Conclusion: Providing planned information on changes in the condition of hospitalized patients with traumatic brain injury can reduce the anxiety of family members of these patients.
Clinical trial registry: IRCT20180206038642N2
 

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Background & Aim: Brain injury is one of the most common traumas and the most important cause of death in traumatic events. Ventilated patients are susceptible to pressure ulcers caused by endotracheal tube fixation (ETF). The aim of the present study is to compare three methods of ETF (band, adhesive and holder) on the incidence of pressure ulcers in patients with head injury.
Methods & Materials: This randomized clinical trial was performed in a hospital in Mashhad in 2017. A total of 108 hospitalized patients with head trauma were included in the study by convenience sampling. The patients were randomly divided into three groups of ETF using holder, band and adhesive. In three groups, the incidence of pressure ulcers caused by fixation method was assessed at 6, 12, 18, and 24 hours after the intervention. The grade of ulcer was measured by pressure grading scale (EPUAP/NPUAP). The data were analyzed using the SPSS software version 16.
Results: The incidence of pressure ulcers at 6, 12, 18, and 24 hours after the intervention was significantly different in the three groups (P<0.05). At six and 12 hours after the intervention, the three groups had a grade one ulcer. However, after 18 hours, 10% in the adhesive group and band group and 24 hours after the intervention, 25% in the band group and 12.1% in the adhesive group had a grade 2 pressure ulcer, but this amount was 0% in the holder group.
Conclusion: Use of holder rather than adhesive and band for ETF in mechanically ventilated patients causes less pressure ulcers.
Clinical trial registry: IRCT20171015036800N1
 

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Background & Aim: Improving clinical decision-making is one of the challenges of the pre-hospital emergency system. Therefore, the aim of this study was to determine the effect of pre-hospital trauma management training program on the capability of clinical decision- making in emergency medical technicians.
Methods & Materials: In a randomized controlled field trial study, 64 pre-hospital emergency technicians from Gonabad University of Medical Sciences, were randomly assigned to either intervention or control groups by the stratified sampling method in 2018. For the intervention group, a pre-hospital trauma management training program was administered based on existing domestic and global standards in a two-day crash course with a combination of learning techniques including lecture and simulation. The research instruments were a demographic questionnaire and a researcher-made questionnaire on clinical decision-making, completed before the course, immediately and one month after the completion of the course. Data were analyzed by the SPSS software version 19 using independent t-test, the repeated analysis of variance and Bonferroni's post-test.
Results: The mean changes in clinical decision-making scores before and immediately after the intervention (9.31 vs. 0.3), before and one month after the intervention (7.86 vs. 1.1) and immediately after the intervention and follow-up one month after the intervention (1.62 in. vs. 1.39) were significantly higher in the intervention group than in the control group (P<0.001).
Conclusion: The pre-hospital trauma management training program can improve clinical decision-making in pre-hospital emergency medical technicians. Therefore, this program can be integrated into the technicians’ training programs.
Clinical trial registry: IRCT20180802040677N1
 

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Background & Aim: Decreased level of consciousness is one of the life-threatening complications associated with brain injuries. The aim of the study was to explore the effect of auditory and tactile stimulation by a family member on patients’ consciousness level.
Methods & Materials: This quasi-experimental study was conducted on 80 comatose patients with traumatic brain injury hospitalized in the intensive care units of Zahedan educational hospitals in 2019. Samples were selected by the convenience sampling methods and then randomly divided into experimental or control groups. Data collection tool included a demographic information questionnaire, and FOUR criteria for the level of awareness. For the experimental group, the intervention including auditory and tactile stimulation was performed by a family member for 10 minutes for seven consecutive days. The control group received routine interventions. To analyze the data, descriptive and inferential statistical tests (independent t-test, paired t-test, analysis of covariance, chi-square and repeated measures ANOVA) were used through the SPSS software version 21.
Results: The results indicated no significant differences in the level of consciousness between the two groups on the first and fourth days. Yet, independent t-test, analysis of covariance and repeated measures ANOVA showed that the intervention group had significantly a higher level of consciousness on the fifth, sixth and seventh days compared to the control group (P<0.001).
Conclusion: Findings showed that auditory and tactile stimulation by a family member is effective in increasing the level of consciousness in comatose patients with brain injury. So, this technique is recommended as an intervention in nursing care to increase the consciousness level in these patients.
 

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Background & Aim: Traumatic brain injury management focuses on the prevention and treatment of secondary brain injuries. The aim of this study was to adapt a clinical guideline (CG) for nursing care of secondary brain injuries in adults.
Methods & Materials: This study was carried out through a multi-stage evolutionary study at Isfahan University of Medical Sciences in 2017. Based on the opinions of experts using AGREE tool, the quality of 8 out of 13 CGs for the treatment and care of head injuries was assessed as optimal. These were used in drafting the adaptive CG. In addition, 12 CGs, 13 articles and 5 books were used to complete the recommendations of the mentioned guideline. The CG draft was evaluated using the Delphi method and the panel of experts. Finally, it was presented as an adaptive CG.
Results: The adaptive CG for nursing care of secondary brain injuries was developed in 158 recommendations and five sections; nursing care to prevent and manage the increased intracranial pressure, nursing care to maintain and increase cerebral blood pressure, nursing care to prevent and control seizures, nursing care to prevent and control brain infections, and nursing care to prevent and control secondary extracranial injuries.
Conclusion: The nursing staff of emergency and neurological wards and intensive care units can apply the recommendations of this clinical guideline to address some of the care needs of the injured patients and improve their health conditions.
 

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Background & Aim: The utilization of emotional expression methods, including narrative counseling and written emotional expression, has been shown to be efficacious in mitigating the intensity of diverse psychological issues such as depression and acute stress, particularly following traumatic events. Additionally, emergency cesarean section is commonly acknowledged as a traumatic event that may lead to psychological challenges for the mother. The purpose of this research was to compare the effectiveness of emotional expression through writing and narration in reducing post-traumatic stress and postpartum depression among women undergoing emergency cesarean section.
Methods & Materials: This quasi-experimental study was conducted in Zahedan, involving a total of 120 women who underwent emergency cesarean section and were admitted to Ali Ibn Abi Talib (AS) hospital during the period of 2021-2022. The participants were selected using convenience sampling and were randomly divided into three groups: written emotional expression, narration and control, with each group consisting of 40 participants. The intervention consisted of one face-to-face session and two non-face-to-face sessions. Data collection involved the use of the Edinburgh Depression Questionnaire and PTSD assessments, administered before and six weeks after the intervention across all three groups. The data were analyzed using SPSS version 24, employing descriptive and inferential tests such as ANOVA and Tukey's post hoc analysis.
Results: The results showed a significant decrease in the average scores of post-traumatic stress and postpartum depression in the written emotional expression and narration groups, compared to the control group, after the intervention (P<0.05). However, before the intervention, there were no significant differences observed among the three groups (P>0.05). Furthermore, a higher mean difference was observed in both post-traumatic stress and postpartum depression scores before and after the intervention in the written emotional expression group, compared to the narration group, indicating a greater effect of written emotional expression (P<0.001).
Conclusion: Based on the research findings, highlighting the positive effect of both narration and written emotional expression, it is recommended to incorporate these techniques as supplementary components within comprehensive educational and care programs for women experiencing traumatic childbirth.