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CRITICAL APPRAISAL SKILL PROBLEM

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CRITICAL APPRAISAL SKILL PROBLEM
Nama : PRIMA ALFIANITA
NIM
: P1337420616019
1. The Effect Of Religious Intervention on the level of Comatose Patients
Hospitalized In Intensive Care Unit
Pertanyaan Fokus
Yes
No
Unknown
Keterangan
Bagian A: Apakah hasilnya valid?
1. Apakah
studi
tersebut
v
Penelitian
ini
menjelaskan secara fokus?
menunjukkan
fokus
(Studi populasi, intervensi,
masalah
tepat.
kelompok
Dapat dilihat dari abstrak
control/intervensi, hasil)
yang tertera dalam jurnal
penelitian.
yang
Penelitian
mengenai
pemberian
religi
Efek
intervensi
terhadap
status
kesadaran pasien koma.
Desain studi, populasi,
sample
intervensi
kelompok
control/intervensi
dan
hasil dijelaskan cukup
detail.
2. Apakah pembagian pasien
ke dalam
intervensi
kelompok
dan
control
v
Berdasarkan jurnal
tersebut, kelompok
control dan intervensi
dilakukan
secara
(bagaimana
apakah
acak
dilakukan secara acak.
dilakukan,
alokasi
dilakukan
Alokasi pasien
pasien
dijelaskan sejumlah 66
secara
pasien dimana 33 orang
tersembunyi oleh peneliti
masuk ke dalam
dan pasien)
kelompok control dan
33 orang lainnya
menjadi kelompok
intrevensi
3. Apakah
yang
semua
terlibat
penelitian
akan
dengan
benar
kesimpulan
dihentikan
pasien
v
dalam
dicatat nilai GCS nya.
dicatat
Karena data yang
di
ditampilkan sudah
(apakah
lebih
Tidak semua pasien
dalam bentuk rata rata.
awal
apakah pasien dianalisis
dalam kelompok untuk
yang mereka acak)
4. Apakah pasien, petugas
kesehatan,
dan
respondenn
pada
penelitian
ini
“blind”
v
Tujuan dan manfaat
studi dijelaskan kepada
semua keluarga, kerabat,
dan wali sah dari
terhadap intervensi yang
peserta Keluarga sampel
dilakukan
yang berpartisipasi
dalam penelitian ini,
keluarga/wali
menandatangani
informasi
formulir persetujuan,
secara sadar.
Untuk pencegahan bias,
sampel intervensi dan
kelompok kontrol
menggunakan
headphone dan pemutar
MP3.
5. Apakah pelaksanaan untuk
Kelompok intervensi
v
setiap grup sama?
diberikan murotal
AlQur’an dan medikasi
lainnya sementara
kelompok control hanya
mendapatkan
pengobatan medis. .
6. Selain
intervensi
dilaksanakan
yang
v
apakah
Tidak dijelaskan secara
mendetail apakah
setiap grup diperlakukan
setelah penelitian selesai
dengan adil/sama?
kelompok control
mendapat perlakuan
yang sama.
Bagian B: Apa Hasilnya?
1. Seberapa Besar efek dari
v
Studi
ini
melaporkan
intervensi
tersebut
pengaruh
(outcome,
hasilnya
agama pada pasien koma
dijelaskan spesifik, hasil
yang dirawat di ICU
yang ditemukan, hasil dari
Rumah
setiap
Modarres
diukur
outcome
yang
intervensi
Sakit
Shahid
di
Saveh
melalui
stimulasi
murotal Al Qur’an.
Hasil
penelitian
menunjukkan
bahwa
tingkat kesadaran ratarata
dalam
intervensi
kelompok
sebelum
intervensi 3,73 ± 0,63
dan setelah intervensi
adalah 7,82 ± 1,40 (P =
0,01)
dan
kelompok
awal
pada
kontrol
dan
di
akhir
penelitian,
masing-
masing 3,52 ± 0,67 dan
5,36 ± 1,6 (P = 0,09).
Setelah 10 hari, tingkat
kesadaran
dalam
intervensi
kelompok
meningkat
secara
signifikan (P = 0,01).
Penelitian
ini
menunjukkan
bahwa
suara
Al-Quran
mempengaruhi
tingkat
kesadaran pasien koma
yang dirawat di rumah
sakit
di
ICU
dan
mengarah
ke
peningkatan progresif di
tingkat kesadaran pada
pasien
ini.
penelitian
ini
digunakan
manajemen
klinik
Hasil
dapat
dalam
pasien
serta
di
dalam
Pendidikan
keperawatan. Perawatan
spiritual
dianggap
sebagai perawatan yang
komprehensif
2. Seberapa tepat dan akurat
v
efek intervensi?
Penelitian ini tepat
dilaksanakan berkaitan
dengan agama yang
dianut oleh klien.
Sementara keakuratan
efek intervensi
sebenarnya sudah
dijelaskan di jurnal,
namun masih ada
kekurangan yaitu tidak
dicantumkannya hasil
pengukuran GCS setiap
pasien baik sebelum dan
sesudah intervensi.
Bagian
C:
Apakah
hasil
membantu secara local?
1. Bisakah
hasilnya
v
Hasil penelitian bisa
diterapkan pada populasi
diterapkan pada kondisi
local, atau konteks saat ini
saat ini karena yang
di lingkungan sekarang
menjadi syarat utama
(apakah
adalah pasien beragama
karaketristik
pasien
sama
dengan
tempat
bekerja/populasi
islam. perbedaan yang
mendaasar adalah
anda, jika berbeda, apakah
budaya tempat peneltian
perbedaannya)
yaitu di Iran. Sementara
penelitian saya
diencanakan akan
dilaksanakan di
Indonesia.
2. Apakah hasil penelitian ini
v
Hasil penelitian ini
penting secara klinis untuk
penting secara klinis
dipertimbangkan (apakah
untuk dipertimbangkan.
informasi
Terapi murotal ini dapat
yang
anda
inginkan sudah terdapat
memberikan efek yang
dalam penelitian ], jika
cukup signifikan pada
tidak
tingkat kesadaran pasien
apakah
berpengaruh
akan
terhadap
yang mengalami koma.
pengambilan keputusan)
Namun ada beberapa
informasi yang belum
tercantum yaitu nilai
GCS masing-masing
pasien sebelum dan
sesudah intervensi
maupun pada kelompok
control, karena dalam
jurnal tersebut sudah
ditampilkan dalam
bentuk rata-rata (mean)
3. Apakah
manfaatnya
v
Pada penelitian ini tidak
sepadan dengan bahaya
ditemukan
dan biaya yang dibutuhkan
membahaykan
(meskipun
tidak
pasien.
tercantum
dalam
penelitian
,
menurut anda?
bagaimana
effek
bagi
Lampiran Jurnal
Accepted Manuscript
Title: The effect of religious intervention on the level of
consciousness of comatose patients hospitalized in Intensive
Care Unit: A randomized clinical trial
Authors: Vahid Naseri-Salahshour, Shokoh Varaei, Mahbobeh
Sajadi, Setareh Tajdari, Masoumeh Sabzaligol, Neda Fayazi
PII:
DOI:
Reference:
S1876-3820(18)30124-0
https://doi.org/10.1016/j.eujim.2018.06.008
EUJIM 813
To appear in:
Received date:
Revised date:
Accepted date:
12-4-2018
22-6-2018
22-6-2018
Please cite this article as: Naseri-Salahshour V, Varaei S, Sajadi M, Tajdari S,
Sabzaligol M, Fayazi N, The effect of religious intervention on the level of
consciousness of comatose patients hospitalized in Intensive Care Unit: A randomized
clinical
trial,
European Journal
of
Integrative Medicine
(2018),
https://doi.org/10.1016/j.eujim.2018.06.008
This is a PDF file of an unedited manuscript that has been accepted for publication. As
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apply to the journal pertain.
The effect of religious intervention on the level of consciousness of comatose
patients hospitalized in Intensive Care Unit: A randomized clinical trial
Running title: The effect of religious intervention on the level of consciousness
Author(s):
Vahid Naseri-Salahshour1, Shokoh Varaei2*, Mahbobeh Sajadi3, Setareh Tajdari4, Masoumeh
Sabzaligol5, Neda Fayazi6
Affiliations:
1
MSc of Medical Surgical Nursing, School of Nursing and Midwifery, Arak University of
Medical Sciences, Arak, Iran.
Email: [email protected]
2
Assistant professor, School of Nursing and Midwifery, Tehran University of Medical Sciences,
Tehran, Iran.
Email: [email protected]
3
Assistant professor, School of Nursing and Midwifery, Arak University of Medical Sciences,
Arak, Iran.
Email: [email protected]
4
MSc of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of
Medical Sciences, Tehran, Iran.
Email: [email protected]
5
MSc of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of
Medical Sciences, Tehran, Iran.
Email: [email protected]
6
MSc of Critical Care Nursing, School of Nursing and Midwifery, Saveh University of Medical
Sciences, Saveh, Iran.
Email: [email protected]
*
Corresponding Author
Shokoh Varaei, Ph.D. of Nursing Education, Tehran University of Medical Science, Tehran,
Iran.
Address: School of Nursing and Midwifery of Tehran University of Medical Sciences, Nosrat St,
Tohid Sq, Tehran, Islamic Republic of Iran (IRI).
Phone numbers: 0098 21 66914368
E-mail address: [email protected]
Fax number: 0098 86 42302967
Clinical Trial registration number:
IRCT2016122331522N1
Abstract
Introduction: The Qur'an is regarded as the central religious text of Islam and referred to as the
celestial book of Muslims that covers the entire dimensions of human life.The aim of this study
was to determine the religious intervention on the level of consciousness of the comatose patients
hospitalized in the Intensive Care Unit.
Methods: This randomized clinical trial was performed with 66 comatose patients hospitalized in
the Intensive Care Unit who were randomly divided into intervention and control groups. For the
samples of the intervention group, Surah Raad, with the voice of Master Shahriyar Parhizgar, was
broadcast daily for 17 minutes via headphones. The level of consciousness of both groups was
recorded before and after the intervention.
Results: By comparing the changes in the level of consciousness in patients in both groups, there
was no significant difference between the mean level of consciousness in the both groups before
intervention (P=0.13). After 10 days, the level of consciousness in the intervention group increased
significantly (P=0.01). But, the increase in level of consciousness in the control group after
intervention (10 days) was not significant (P=0.09).
Conclusion: The results showed Quran sound can improve the level of consciousness of comatose
patients. Therefore, it can be used as an easy and practical way to employ the spiritual care of
patients.
Keywords: religious intervention; level of consciousness; comatose patients; intensive care unit;
randomized clinical trial
1. Introduction
Coma is a condition in which the patient has been long unaware of himself and the environment,
and is a dream-like condition that the eyes are closed. The causes of coma can be divided into two
categories, neurological causes including: meningeal irritation due to infection or hemorrhage in the
arachnoid space, massive hemiplegic and brain stem lesions, stroke and metabolic causes including:
vitamin deficiency, uremia, liver encephalopathy, elevated levels of carbon dioxide, alcohol and
drug poisoning, hypothyroidism and hyperthyroidism, and water, electrolyte and acidic and alkaline
disorders. In this case, the person is exposed to many possible complications, including respiratory
failure, pneumonia, pressure ulcers, and aspiration and sensory deprivation (1). The most common
cause of coma in Iran and the world is injuries and a variety of poisoning. According to present
statistics, more than 811 people per 100 000 people in Europe suffer from head injuries each year
(2). According to the available evidence, in Iran, 3,300 people die annually due to motor injuries
(3). Considering the complications of long-term inertia and high cost for the patient and the health
system, the rapid recovery of these patients is very important (4). Hospitalized patients have physical
needs in addition to spiritual needs, which can affect the patient's recovery (5). Spirituality is an
essential component of health and well-being(6).
In the last decade, some medical team members, psychologists, nurses and sociologists have found
that spirituality can have a significant impact on various aspects of medical care (7-9). In this regard,
we can mention the study of Sajjadi et al. (10). The study found that spiritual counseling had a
positive impact on the health and well-being of cancer patients. Another study by Darabi Nia et al.
found that recitation of the Qur'an led to an improvement in the mental health of health personnel
(11). Today, the role of spirituality in improving the health of the patient is more focused and helping
to meet the spiritual needs of patients and their families is considered as an essential element of
clinical care (12). Paying attention to the spiritual needs of patients is an integral part of
comprehensive nursing care (13). Spiritual care is one of the essential components of nursing
practice (14, 15). Florence Nightingale believes that the nurse plays an important role in improving
the patient's health, taking into account the mental and psychological aspects of the patient (16). The
American Nursing Association has also considered the spiritual dimension as a nursing examination
center in expressing clinical practice standards (17). Therefore, nurses should perform their duties
with regard to the spiritual aspects of the patient and respect for the patient's values and beliefs. In
addition to other nursing interventions, spiritual intervention will balance the body and soul and
provide a comprehensive step for health. One of the spiritual interventions in the treatment of
patients is the use of the voice of the Holy Qur'an. The Qur'an is a celestial book of Muslims that
covers the entire dimensions of human life, and treatment of illnesses can be the next dimension of
the countless Qur’an dimensions. Muslim scholars have used divine verses to treat patients, and in
religious texts of Muslims, they have also emphasized the healing effects of Quran verses (18, 19).
One of the most beautiful, most enjoyable, attractive and most natural music is the recitation of the
Holy Quran. The undisputed effect of this Divine Blessing in the treatment of diseases is to a point
where, today, some countries and communities have turned to Prayer and Quran for the treatment
of patients' mental and physical illnesses, as is now scientifically proven. That hearing the sound of
the holy Qur'an can reduce mental stress in human (20). In this case, Sabry et al. showed that the
Qur'an can be used to treat various psychiatric disorders in patients (21). Now Quran therapy is an
active and growing process in various countries (22). Since hearing is the strongest sensation of the
five senses and the last sensation that is lost in comatose patients (23), we decided to examine the
effect of Quranic voice on the level of consciousness in patients with coma condition. Therefore,
the purpose of this study was to determine the effect of the religious intervention on the level of
consciousness of the comatose patients hospitalized in the intensive care unit (ICU).
2. Methods
2.1. Study design and setting
This study is a double-blind randomized clinical trial was performed on 66 comatose patients
hospitalized in ICU of Shahid Modarres Hospital in Saveh (Iran). The samples were as
homogeneous in terms of level of consciousness and cause of coma.
2.2. Data collection
After obtaining consent form from first degree relatives (father, mother or legal guardian)
samples were selected by available method and were randomly assigned to two groups of
intervention (n=33) and control (n=33) using blocking method. The inclusion criteria includes: level
of consciousness between 3 and 5 according to Glasgow's Coma Scale, 48 hours after
hospitalization, 20 - 60 years old, no previous history of hospitalization in ICU, no severe change
in the shape of face, patients with opioid poisoning, head trauma and intracerebral hemorrhages, and
belief to the religion of Islam, and exclusion criteria includes: patient discharge before the tenth day,
the transfer of the patient to another health center, surgery after the first 24 hours, uunwillingness
of the patient's family, patients death and hearing impairment.
2.3. Measurement scales
The instruments used in this study were the Demographic Questionnaire and the Glasgow Coma
Scale. The Glasgow Coma Scale (GCS) is a standard scale that consists of three subgroups of motor
response, verbal response and eye contact. GCS is a neurological scale which aims to give a reliable
and objective way of recording the conscious state of a person for initial as well as subsequent
assessment (24) (Table 1).
2.4. Ethical approval
It should be noted that the present study was approved by the Ethics Committee of Tehran
University of Medical Sciences with the code of: IR.TUMS.FNM.REC.1395.1042 and registered in
the Iranian Registry of Clinical Trials.
The aims and benefits of study explained to all families, relatives, and legal guardians of
participants. The families of samples who are participated in this study, signed an informed consent
form, consciously.
2.5. Intervention
48 hours after the hospitalization, intervention was initiated. At first, patients' level of
consciousness was measured using the GCS. Then, for the patients in the intervention group, along
with the standard care, daily for 17 minutes (up to 10 days), the verses of Sura Raad was broadcast
through headphones with the voice of Master Shahriyar Parhizgar (23). The reason for using surah
Raad verses in this research was the meaning of the verses. After completing the recite of the Holy
Quran verses, again the level of consciousness of the patients was examined. In the control group,
standard care was also performed. It should be noted that for prevention of bias, both the intervention
and control group samples used headphones and MP3 players, with the difference that in the control
group, the device did not recite Quranic verses or did not broadcast any other music. The
demographic information questionnaire was completed by interviewing with the patients' families
and using the medical documents of the patients.
2.6. Data analysis
Statistical analysis was conducted using SPSS version 16. Descriptive statistics are presented as
means and standard deviations for quantitative variables and as frequencies and percentages for
categorical variables. A Kolmogorov-Smirnov (K-S) test was conducted to ensure that the data
were normally distributed. An independent t-test and chi-square or Fisher's tests were used to
determine statistical significant difference when comparing intervention and control patients'
characteristics. Paired and independent sample t-tests were used to examine differences within and
between the intervention and control groups. The α level was set a p<0.05 for statistical significance.
Results
This study reports the effect of the religious intervention on the consciousness of comatose
patients hospitalized in ICU of Shahid Modarres Hospital in Saveh. In this study, 66 patients with
20-60 years old were studied. After random allocation of samples, in the first stage, 2 patients in the
intervention group and 4 patients in the control group were excluded from the study. In the follow
up phase, 4 patients from the intervention group and 2 patients from the control group were excluded
due to transfer to the other Medical Center (CONSORT flow diagram of the participants) and finally,
33 patients remained in each group. Therefore, the response rate was 100%. The results of the study
showed that 54.5% of the patients were male. The age range 51 to 60 years old and high school
degree was the most frequent among them (Table 1). The results of the study showed that the mean
level of consciousness in the intervention group before intervention was 3.73±0.63 and after
intervention was 7.82±1.40 (P=0.01) and in the control group at the beginning and the end of the
study, 3.52±0.67 and 5.36 ± 1.6 respectively (P=0.09). By comparing the changes in the level of
consciousness in patients in both intervention and control groups, there was no significant difference
between the mean level of consciousness in the intervention and control groups before intervention
(P=0.13). After 10 days, the level of consciousness in the intervention group increased significantly
(P=0.01). But, the increase in level of consciousness in the control group after intervention (10 days)
was not significant (P=0.09) (Table 2).
Discussion
The results showed that the mean level of consciousness in the intervention group before
intervention was 3.73±0.63 and after intervention was 8.82±1 (P=0.01). In the study of Hassanzadeh
et al., The results showed the positive effect of familiar stimuli on improving the level of
consciousness of patients with head injuries hospitalized in ICU from 7±2 in the first day to 11.6±6.2
in the sixth day. The results showed an increased level of consciousness in these patients. The results
of this study are consistent with the results of their study (4). The results showed that the mean level
of consciousness in the control group at the beginning and the end of the study was 3.52±0.62 and
5.36±1.6 (P=0.09). Although the level of consciousness increased, this increase was not significant.
In this regard, Hassanzadeh et al. showed that the level of consciousness in the first and sixth day
was 7±7 and 7±2 in the control group, that was not significant (4). The our study showed that there
was no significant difference between the mean level of consciousness in the intervention and
control groups before intervention (P=0.13), but after 10 days, level of consciousness in both groups
increased, but changes in consciousness were significant in the intervention group (P=0.01), while
in the control group, these changes were not significant (P=0.09). Shirvani et al. in their study
showed that the broadcast of the Quran Voice
can cause balance the blood pressure and arterial oxygen pressure of patients hospitalized in ICU
(23). Also, the results of Heidari et al. study showed a positive effect of Quranic and indifferent
music on reducing the anxiety level of patients under endoscopy (25). These findings are consistent
with the results of Goodarzi et al. Their study showed that auditory stimulation with familiar sounds
significantly increased the level of consciousness of patients (26). The results of this studies are
consistent with the results of our study. Many studies have been done on the effects of the Holy
Quran on human health and the treatment of physical and mental illness. The results of these studies
have shown that listening to Qur’an voices has been effective on the balance of vital signs and
increased oxygen pressures in ICU patients (23). In a study, Mirbagher et al. examined the effect of
Quran voice and music on the anxiety and vital signs of patients before abdominal surgery (27). The
results of their study showed that music (Voice of Nature) and Quran Voice were both effective in
decreasing the anxiety and vital signs of the patients, but the Quran voice was more effective. In a
study Momeni et al., examined the relationship between familiarity with Quran and death anxiety
in nurses in the emergency department of Vali-e-Asr Hospital in Arak. Results showed a negative
relationship between familiarity with Quran and the death anxiety of emergency department nurses,
but this was not significant (P=0.47) (28). Majidi et al. in a study examined the effect of Quran
verses on the anxiety of patients before coronary angiography. The results showed a significant
reduction in anxiety level in patients undergoing angiography. These results are consistent with the
results of our study. Spirituality is a complex concept and its definition depends on the individual's
worldview (10). Spirituality and religion are the primary sources of conformity and are often
characterized by prayer and dependence on God (10). The Holy Qur'an contains many verses about
achieving peace. The recitation of the Qur'an causes the peace of mind (28). God says in the Qur'an:
“remembering me will bring peace to your heart”. Spiritual care is a vital component of
comprehensive care, but is often neglected and there is little information in the various texts about
spiritual-centered interventions (29). Targeted sensory stimuli for comatose patients, including
spiritual care, are essential in the ICU have been neglected (4). Since Iran is a religious country and
the majority of its population as Muslims, the use of spiritual care as a branch of comprehensive
nursing care can be effective in improving ICU patients' health (27). Nurses as professionals should
enter spirituality in their care program. Getting spiritual history, paying attention to the religious
beliefs of the patients and their families, and providing spiritual care to them is a way to provide
comprehensive nursing care (30).
Limitations
This study has some limitations. Because the Qur'an is the Muslim scripture, and this study was
conducted only by Muslim patients from an Iranian cultural background. The results cannot be
therefore be generalized to other Muslim populations nor to other religions. In addition, the sample
size is comparatively small, so the present findings must be confirmed in a larger study.
Conclusion and implications for practice
The findings of this study showed that the Quran's voice affects the level of consciousness of
comatose patients hospitalized in ICU and leads to a progressive increase in the level of
consciousness in these patients. This finding can be used in the management of patients in nursing
clinics, as well as in nursing education. Spiritual care is considered as comprehensive nursing
intervention. At present, this issue is neglected due to the heavy workload of nurses. Thus, nursing
care with additional spiritual intervention services is imperative for supporting comatose patients’
hospitalized in Intensive Care Unit.
Funding
The study was supported by: Vice-Chancellor for Research of Tehran University of Medical
Sciences.
Conflict of interest
None of the authors have any conflicts of interest.
Acknowledgements
The present study is the result of a research project approved by the Tehran University of Medical
Sciences. The authors would like to thank the Vice-Chancellor for Research, honorable masters of
Nursing and Midwifery faculty and all patients who participated in this study and their families.
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Figure:
Figure 1 :CONSORT flow diagram of the participants
Tables:
Table 1: The items of the Glasgow Coma Scale
Items
Eye
opening
Score
6
5
4
3
2
1
N/A
N/A
Open
before
stimulus
(Spontaneous)
After spoken
or
shouted
request
After
fingertip
stimulus
(To sound)
(To pressure)
No opening at
any time, no
interfering
factor (None)
Verbal
response
N/A
Correctly
gives name,
place
and
date
(Orientated)
Not orientated
but
communication
coherently
(Confused)
Intelligible
single words
(Words)
Only moans /
groans
(Sounds)
No audible
response, no
interfering
factor (None)
Motor
response
Obey 2-part
request
(Obeys
commands)
Brings hand
above
clavicle
to
stimulus on
head
neck
(Localizing)
Bends arm at
elbow rapidly
but features not
predominantly
abnormal
(Normal
flexion)
Bends arm at
elbow,
features
clearly
predominantly
abnormal
(Abnormal
flexion)
Extends arm
at
elbow
(Extension)
No
movement in
arms / legs,
no interfering
factor (None)
Table 2: Demographic information of the intervention and control group samples
Group
Variable
Intervention (n=33)
Age (year)
Mean±SD
45.6±7.2
Category
Frequency (%)
Sex
Single
19 (28.7)
Married
14 (21.2)
Level
5 (7.5)
Illiterate
of education
Primary education
9 (13.6)
High school degree
12 (18.7)
17 (10.6)
Academic education
Occupational status
Religion
(one of the two main branches
of Islam)
Unemployed
Employee
Self-employment
Others
Shia
Sunni
Control (n=33)
42.7±6.2
Frequency (%)
17 (25.7)
16 (24.2)
4 (6.06)
6 (9.09)
13 (19.6)
10 (15.1)
2 (3.03)
10 (15.1)
8 (12.1)
13 (19.6)
29 (43.9)
1 (1.5)
13 (19.6)
8 (12.1)
11 (16.6)
25 (37.8)
4 (6.06)
8 (12.1)
p
0.96
0.41
0.93
0.48
0.89
Table 3
Mean, standard deviation (SD) and significant level of consciousness of the groups before and after the
intervention
Group
Variable
time
Intervention (n=33)
Control (n=33)
Mean±SD
p
Mean±SD
level of consciousness Before intervention
3.73±0.63
0.1
3.52±0.62
After intervention
8.82±1.4
0.01
5.36±1.6
p
0.1
0.09
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