Syed Tajuddin Syed Hassan

Mental Trauma Experienced by Caregivers of patients with Diffuse Axonal Injury or Severe Traumatic Brain Injury.

Context As with care giving and rehabilitation in chronic illnesses, the concern with traumatic brain injury (TBI), particularly with diffuse axonal injury (DAI), is that the caregivers are so overwhelmingly involved in caring and rehabilitation of the victim that in the process they become traumatized themselves. This review intends to shed light on the hidden and silent trauma sustained by the caregivers of severe brain injury survivors. Motor vehicle accident (MVA) is the highest contributor of TBI or DAI. The essence of trauma is the infliction of pain and suffering and having to bear the pain (i.e. by the TBI survivor) and the burden of having to take care and manage and rehabilitate the TBI survivor (i.e. by the TBI caregiver). Moreover many caregivers are not trained for their care giving task, thus compounding the stress of care giving and rehabilitating patients. Most research on TBI including DAI, focus on the survivors and not on the caregivers. TBI injury and its effects and impacts remain the core question of most studies, which are largely based on the quantitative approach. Evidence Acquisition Qualitative research can better assess human sufferings such as in the case of DAI trauma. While quantitative research can measure many psychometric parameters to assess some aspects of trauma conditions, qualitative research is able to fully reveal the meaning, ramification and experience of TBI trauma. Both care giving and rehabilitation are overwhelmingly demanding; hence , they may complicate the caregivers’ stress. However, some positive outcomes also exist. Results Caregivers involved in caring and rehabilitation of TBI victims may become mentally traumatized. Posttraumatic recovery of the TBI survivor can enhance the entire family’s closeness and bonding as well as improve the mental status of the caregiver. Conclusions A long-term longitudinal study encompassing integrated research is needed to fully understand the traumatic experiences of caregivers. Unless research on TBI or DAI trauma is given its proper attention, the burden of trauma and injury on societies will continue to exacerbate globally.

Depression, anxiety and quality of life in stroke survivors and their family caregivers: A pilot study using an actor/partner interdependence model

Background Depression and anxiety are common in stroke survivors as well as their family caregivers. However, it is not known whether each person’s emotional distress contributes to their partner’s quality of life (QOL). Objective This study aimed to examine the effect of depression and anxiety on QOL in stroke survivor-caregiver dyads using dyadic analysis technique - the Actor-Partner Interdependence Model (APIM). Methods This was a cross-sectional pilot study with a total of 30 participating dyads (30 stroke survivors and 30 family caregivers) from Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia. This pilot study was conducted over a period of 3 months, between December 2014 and February 2015. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). QOL was assessed using the Short Form-12 Health Survey (SF-12). All analyses were carried out using IBM SPSS version 22. Dyadic data were analysed using multilevel modelling (MLM). Results Depression was uniquely associated with an individual’s own QOL. Survivors and caregivers with higher depression had poorer physical component summary (PCS) scores and mental component summary (MCS) scores. Stroke survivor’s depression exerted a significant actor effect on their PCS (b=−1.42, p=0.001) and MCS (b=−1.52, p<0.001). Caregiver’s depression exerted a significant actor effect on their PCS (b=−2.53, p<0.001) and MCS (b=−1.51, p=0.004). Caregivers’ anxiety negatively influenced their own MCS (b=−0.58, p=0.031). Furthermore, depression exerted a significant partner effect on PCS in stroke survivors (b=−1.19, p=0.003). Caregivers’ depression was also related to their stroke survivors’ poorer QOL, particularly PCS. Conclusion The findings suggest that depression affects the QOL of both stroke survivors and caregivers, not only emotionally but also physically. This dyadic study also has evidence pointing to depression in caregivers and its association with stroke survivors’ physical QOL.

The Effect of Educational Intervention on Nurses' Attitudes Toward the Importance of Family-Centered Care in Pediatric Wards in Iran.

Introduction: Family-centered care sustains the unity of the child’s and the family’s health. The aim of this study was to determine nurses’ attitudes toward parents’ participation in the care of their hospitalized children in Iran in 2015. Methods: In this experimental study, 200 pediatric nurses from hospitals affiliated with the Shaheed Beheshti University of Medical Sciences in Tehran were selected using the multi-stage, random-sampling method. Data were gathered using a questionnaire that covered demographic information and nurses’ attitudes. The questionnaire consisted of 31 items and was completed by the nurses in three stages: 1) before intervention (pre-test), 2) immediately after intervention (post-test), and 3) three months after intervention (follow-up). The data were analyzed via SPSS software and using descriptive and analytical methods. Descriptive statistics, the Spearman Correlation Coefficient, and Repeated Measure Analysis (the Bonferroni method) were used to assess the data. Results: The results indicated that there was a significant increase in the mean score of attitude after intervention [M (pre) = 3.35%, M (post) = 3.97%, p < 0.001)]. Most of subjects had neutral attitudes toward family participation in their children’s care. There were no significant relationship between the nurses’ socio-demographic characteristics and their attitudes. Conclusion: The nurses’ attitudes toward the family’s participation in the care of their hospitalized children were moderate. The nurses’ attitudes should be improved by taking part in continuous training programs.

EFFECTS OF FAMILY-CENTERED CARE ON THE SATISFACTION OF PARENTS OF CHILDREN HOSPITALIZED IN PEDIATRIC WARDS IN A PEDIATRIC WARD IN CHALOOS IN 2012

Background: Family-centered care (FCC) involves holistic care and requires cooperation with the family in planning, intervention, and the evolution of the care that is being provided. Many previous studies have provided results that indicate the importance of the family’s involvement in pediatric care, but there is still resistance in doing so within the organizational culture of the hospitals in Iran. The aim of this study was to determine the effects of FCC on the satisfaction of parents of children hospitalized in 2012 in the pediatric ward at Razi Hospital in Chaloos, Iran. Methods: This Quasi-experimental study was conducted in 2012 in the pediatric ward at Razi Hospital in Chaloos, Iran. Seventy hospitalized children between the ages of 1 and 3 who suffered from diarrhea, vomiting, or pneumonia were selected through convenience sampling. They were divided randomly into two equal groups, a control group (routine care) and an experimental group (family-centered care). SPSS Statistics 14 software was used to analyze the data, and p<0.05 was considered to be significant. Results: In the FCC group, the mean score of satisfaction among the parents of the children was 20 out of 90 before the intervention, but, after the FCC method was used, it increased to 83.2 out of 90. In addition, a significant difference was found between the scores of satisfaction for the control and experimental groups (p<0.001), and all parents of children in the experimental group expressed high satisfaction. Conclusion: Our findings showed that the practice of FCC in caring for the sick children can increase the satisfaction of their parents significantly. The role of the family’s involvement is critical in every component of the intervention efforts, as shown by the constructs of participatory support, educational support, and psychological support. Thus, a notable implication here is that FCC may lead to increased quality of care and should be included in the educational programs of the nursing staff in pediatric ward

A problem -based approach to teaching research methodology to medical graduates in Iran

Physicians are reticent to participate in research projects for a variety of reasons. Facilitating the active involvement of doctors in research projects is a high priority for the Iranian Blood Transfusion Organization (IBTO). A one-month training course on research methodology was conducted for a group of physicians in Mashhad, in northeast Iran. The participants were divided in ten groups. They prepared a research proposal under the guidance of a workshop leader. The quality of the research proposals, which were prepared by all participants, went beyond our expectations. All of the research proposals were relevant to blood safety. In this brief report we describe our approach.

TRAUMA AND DRAMA IN 13-YEAR CAREGIVING OF SEVERELY BRAIN-INJURED SON: A POETRY

The inspiring movie “The Big Short” posits truth as poetry, although many people do not like poetry. However, poetry sparkles like the opening of a flower, imbued with beauty and mysterious biological and natural phenomena. Reading poetry can promote social bonding and soothing of the mind. Moreover, poetry comes alive with emphasis and rhythm embedded within word inflection, intonation, and rhymes. Hence, elements of poetry, such as creating mental images, diction, form, cadence, rhyme, rhythm, stanza, and verses, are selected and generated carefully and seamlessly embedded here. Quality characteristics, such as imaginative, creative, thought-provoking, figurative language, and experience-empathizing characteristics, are also emphasized. The theme of the poetry presented here encapsulates an evocative auto-ethnography of caregiving for a severely braininjured son. It portrays the drama and trauma in a 13-year period, commencing with the initial time of infliction of the traumatic brain injury. Over a 10-year period, continuous recordings of events and happenings and of oral and visual events enable snapshots that integrate and synthesize the entire “story.” The poetry contains a number of stanzas (paragraphs), i.e., the emotional and physical tsunami at the beginning; despairing the loss of our second son; imploring divine intervention and salvation; sojourning in the intensive care unit (ICU) in a minimum state of consciousness; the ICU setting and its surrounding; life’s quandaries; reflections on quagmires of the mind; the healing process and rehabilitation; and subsequent long-term trepidation. The underlying autoethnographic account is predicated on the critical analytical practice (CAP) methodology of Carolyn Ellis. This poetry is narrated in the present tense, thus evocating immediacy and intimacy. We believe this poetry evokes peoples’ emotions and informs them of the overwhelming demand of caring for a severely brain-injured person, hence sensitizing and uplifting their perception and understanding towards the process and task of caregiving.

Aging parents' caregiving and rehabilitating a brain-injured son: an autoethnography of a 10-year journey.

This autoethnography withdraws from information accumulated through a 10-year period of daily-weekly-monthly descriptive observation-recording (triangulated- parents & house-helper) of caregiving and rehabilitating of our brain injured son (survivor/care-receiver). We present it as an interactive voice of verbal conversation, thoughts, insights, and interpretations. It is delivered as a series of articulation intra-pulsated with our interrogation of societal-cultural-religious perspectives, norms and biases, and aligns with the CAP (Creative Analytical Practices) method of Ellis. This autoethnography glows from the richness of information which encapsulates the challenges confronting us the aging parent caregivers, the gradual incremental mind mending achievement of our son, and the interactive verbalizations and thoughts, of the caregivers, care-receiver, and other persons. The overwhelming mental and physical pain and struggle of the survivor and the aging caregivers and their sense of celebratory-satisfaction with rehabilitation progress are highlighted. Interpretation and valuation of positive and negative responses of other persons provide a critical matrix to this autoethnography. We intend to inform other caregivers and relevant healthcare professionals through this autoethnography.

Comments on Adverse reactions in blood donors.

Isabella Crocco and her colleagues recently reported a considerably low prevalence of adverse reactions to blood donations in Italy based on secondary data from two blood centres1. We have no idea about the conditions of blood donation facilities in Italy but it was shown by other studies that up to 36 percent of blood donors might experience adverse reactions to blood donation2. Similarly, a 2008 cross-sectional study on whole blood donation showed the reaction rate to be 13.4 percent3. From our undocumented experience, the conditions of blood donation facilities, the personnel, type of blood donation, type of blood donor (i.e., first-time, frequent, and repeated donors), age, gender and seasonal variations are potential predictors of such reactions. These hypotheses could be tested in a case-control study considering all the potential, confounding factors of adverse reactions to blood donations. However, the results from the Italian study led us to formulate a new hypothesis: perhaps race, geographical differences and climate may play a role in the occurrence of such reactions. A comparative evaluation in the form of a case-control study or with a controlled interventional design between two countries is recommended to test the above mentioned hypotheses.