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Abstract Traumatic brain injuries are among the most common causes of disability, mortality, and hospitalization in intensive care units (ICU) around the world (CDC, 2022). Most patients with traumatic brain injuries experience alterations in the level of consciousness (LOC) for different periods. Altered LOC is associated with adverse effects on normal functioning the longer the length of altered consciousness, the sever the functional dysfunction, the slower the recovery,and the poorer the prognosis (Sedghi et al., 2020). One of the most serious problems among comatose patients is sensory deprivation. It can cause different mental and perceptual problems and life-threatening conditions for patients hospitalized in ICUs. Consequently, there is a strong need to improve coma arousal after traumatic brain injury to prevent these complications. Auditory stimulation is a kind of stimulation that can enrich the environment to improve arousal and awareness state in patients with coma and has been proved to be an effective method and widely used (Zhu et al., 2019 & Stokes et al., 2018). Purpose of the Study The purpose of the current study is to examine the effect of direct auditory stimulation program on coma arousal among patients with traumatic brain injury.Research Design A quasi experimental design (study / control) was utilized. Setting The research was carried out in the neurosurgical intensive care units, at Menoufia University Hospital, Shebin El-Kom, Menoufia. Sample A convenient sample of sixty patients who were admitted to the neurosurgical ICU of the university hospital of Menoufia University These patients met the following criteria a) Aged between 18 and 65years, b) Admitted to neurosurgical intensive care units, c) Patients who had Bispectral index score more than 60. Patients were excluded to participate in this study if they had any of the following conditions a) history of previous neurological disorders or reduction of auditory function because those patients cannot respond to the designed auditory stimuli; b) Non-traumatic coma, c) history of cardiac arrest of longer than 4 minutes because their brain function may be affected as a result of prolonged hypoxia, d) patients who have brain stem infarction, e) auditory area radiological affection reflected by CT or MRI. Instruments In order to achieve the purpose of the present study the following Instruments were used:I. A Semi Structured Demographic: Developed by the researcher to collect data including patient’s age, gender and ICU length of stay from patient’s clinical record. II. Revised Trauma Score: to assess the absolute survival probability of traumatic patient. III. Bispectral Index: to assess depth of sedation and arousal using EEG electrodes. IV. Glasgow Coma Scale: to assess the depth and duration of impaired consciousness and coma. Three aspects of behavior are independently measured; motor responsiveness, verbal performance, and eye opening. Ethical Consideration The Research Ethics Committee at the Faculty of Nursing granted written clearance to conduct the study and after the study purpose was explained to the hospital director, the researcher was given official authorization to proceed. A written/oral consent obtained from the patient’s family after informed about the aim, procedure and benefits of the study. The researcher stated that participation in the study was voluntary and they may leave the study at any time without incurring any penalties. Coding the data and keeping it in a locked cabinet helped ensure the confidentiality and anonymity of the patient information.Data Collection: Data was collected over a period of 11 months. Subjects were recruited to share in the study after 24 hours of ICU admission and stabilization of the condition. The subjects were matched against the inclusion and exclusion criteria of the study. The investigator dealt with the control group first who received standard care provided by hospital including patient repositioning, eye care, DVT prophylaxis and fluid &nutritional management to prevent contamination of data. Study group received the direct auditory stimulation program five sessions per day for five consecutive days along with the routine hospital care. Results: The mean age of the experimental subjects and control group was (29.33 ± 7.07 and 29.33 ± 7.07) years old respectively. Regard to gender, most of the subjects in experimental and control group were males 90.0% and 86.7% respectively. Regarding the GCS, about 66.7% and 63.3% in studied sample had 8-9 GCS respectively and about 33.3% and 36.7% had 10-12 GCS respectively. There was no significant variation between the studied sample regarding their demographics. Glasgow Coma Scale mean score in the experimental group (13.40 ±1.22) was significantly improved in comparison with control group (9.90 ±1.47) after intervention (P <0 .001). The mean score of Bispectral Index Number in the experimental group (86.26 ±7.29) was significantly improved in comparison with the control group (73.06 ±7.01) after intervention (P< 0.001). Experimental group had a significantly lower mean ICU length of stay in days (9.630 ±2.59) in comparison with the control group (13.30 ±2.77), following the intervention (P< 0.001). A significant negative correlation between GCS score and age between experimental and control group after intervention with r = -0.372 (P < 0.035) and r = -0.223 (P <0.236) respectively. In addition, there is a significant negative correlation between Glasgow Coma Scale score and ICU length of stay between experimental and control group after intervention with r =0.179 (P < 0.345) and r = -0.559 (P <0.001) respectively. A significant negative correlation between Bispectral Index Number and age between experimental and control group after intervention with r = -0.603 (P < 0.000) and r = -0.277 (P <0.139) respectively. In addition, there is a significant negative correlation between Bispectral Index Number and ICU length o f stay between experimental and control group after intervention with r = -0.571 (P <0.001) and r =-0.086 (P < 0.652) respectively.Conclusion: - Based on the result of the current study, it can be concluded that direct auditory stimulation program has a positive effect on Glasgow Coma Scale Mean Score and Bispectral index number among patients with traumatic brain injury. Recommendations: - Design clinical practice guidelines for nurses working in the ICU to use auditory stimulation program as a routine care for comatose patients and also findings of the current study will enable critical care nursesto be aware of the prototype and variation in traumatic brain injury patients’ responses and thus nurses can develop individualized interventions. Implications of Nursing Practice: - Organize regular in-service education courses to educate critical care nurses about the practice of auditory stimulation program as partof their daily routine care for TBI. Implication for future research: - Using Sensory Stimulation Assessment Measure (SSAM) scale to assess arousal in the future studies instead of GCS whereas SSAM better detects slight neurological improvements after auditory stimulation than the GCS. |