Original Article

Effects of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients: A randomized clinical trial


Background & Aim: Most mechanically ventilated patients reported decreasing comfort during their treatments, especially in Muslim patients. Nursing comfort care needs to be addressed by integrating the principles of Islamic daily rituals to fulfill the spiritual need and also to promote holistic comfort of Muslim patients with mechanical ventilation. This study aimed to investigate the effect of nursing comfort care integrating with the Islamic daily rituals on comfort among mechanically ventilated Muslim patients.
Methods & Materials: A pretest-posttest with a control group design was used. Fifty-six participants recruited from intensive care units of three public hospitals in Indonesia were randomly assigned into either the experimental group (n=28) or control group (n=28) by matching technique based on gender, age, and duration using a ventilator. Those in the experimental group received nursing comfort care developed based on Kolcaba’s Theory of Comfort integrating with the Islamic daily rituals while those in the control group received usual care. Comfort was measured on the first day before receiving the intervention, and on the second day after the intervention was completed by using Comfort Questionnaire for Mechanically Ventilated Patients (CQMVP).
Results:  Data analysis by using an independent t-test found there is no significant difference in data between the experimental group and control group at baseline (t = .134, p .894). The mean comfort score of patients in the experimental group after receiving the intervention was significantly higher than those in the control group (t=6.70, p<.05).  
Conclusion:  Nursing comfort care integrated with Islamic daily rituals increased comfort in Muslim patients while receiving mechanical ventilation. Thus, this nursing comfort care program can be recommended to use in practice.

1. Stites M. Observational pain scales in critically ill adults. Critical care nurse. 2013 Jun;33(3):68-78.
2. Pan C, Qiu H. Improve survival from prolonged mechanical ventilation: Beginning with first step. Journal of Thoracic Disease. 2015; 7(7):1076-9.
3. Rustam JS, Kongsuwan W, Kitrungrote L. Comfort in patients receiving mechanical ventilation: A literature review. Crit Care Nurs J. 2018;11(2):64159.
4. Ma P, Liu J, Xi X, Du B, Yuan X, Lin H, Wang Y, Su J, Zeng L. Practice of sedation and the perception of discomfort during mechanical ventilation in Chinese intensive care units. Journal of Critical Care. 2010 Sep 1;25(3):451-7.
5. Wang Y, Li H, Zou H, Li Y. Analysis of complaints from patients during mechanical ventilation after cardiac surgery: a retrospective study. Journal of cardiothoracic and vascular anesthesia. 2015 Aug 1;29(4):990-4.
6. Maximous R, Miller F, Tan C, Camargo M, Ross K, Marshall C, et al. Pain, agitation and delirium assessment and management in a community medical-surgical ICU: Results from a prospective observational study and nurse survey. BMJ Open Qual. 2018 Oct 1;7(4) :e000413.
7. Masters K. Nursing theories: A framework for professional practice. Jones & Bartlett Publishers; 2014 Jul 15.
8. Kolcaba K. Comfort theory and practice: a vision for holistic health care and research. Springer Publishing Company; 2003.
9. Chandra M, Raman K. Application of katharine kolcaba comfort theory in post operative child: Delivering integrative comfort care Intervention by Using the Theory of Comfort-A aase Study of a 5 Years Old child admitted in picu with laparotomy experiencing post operative discomfort. International Journal of Science and Research. 2016;5(6):1714-20.
10. Rustam JS, Makmee W, Jugjali R, Kongsuwan W. Implementation of innovative nursing care program for relieving discomfort in mechanically ventilated patients: an exemplar in practice. The Malaysian Journal of Nursing. 2018 Jan 3;9(3):34-44.
11. Rustam JS, Kongsuwan W, Kitrungrote L . Effect of comfort care integrated with the Holy Qur’an recitation on comfort of Muslim patients under mechanical ventilation: A pilot study. Medical Surgical Nursing Journal. 2017; 6(1):34-40.
12. Jamaati H, Vahedian-Azimi A, Ebadi A, Ahmadi F, Saadat S, Kashafi MB, et al. Therapeutic effect of massage on the patients in Intensive Care Unit. Archives of Critical Care Medicine. 2015;1(1):e519.
13. Çiftçi H, Öztunç G. The effect of music on comfort, anxiety and pain in the intensive care unit: A case in Turkey. International Journal of Caring Sciences. 2015 Sep 1;8(3):594-602.
14. Mohamed CR, Nelson K, Wood P, Moss C. Issues post-stroke for Muslim people in maintaining the practice of salat (prayer): A qualitative study. Collegian. 2015 Sep 1;22(3):243-9.
15. Ayasrah S. Care-related pain in critically ill mechanically ventilated patients. Anaesthesia and intensive care. 2016 Jul;44(4):458-65.
16. Hematti S, Baradaran-Ghahfarokhi M, Khajooei-Fard R, Mohammadi-Bertiani Z. Spiritual well-being for increasing life expectancy in palliative radiotherapy patients: a questionnaire-based study. Journal of Religion and Health. 2015 Oct;54(5):1563-72.
17. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins; 2017.
18. Cho S, McCracken LM, Heiby EM, Moon DE, Lee JH. Pain acceptance-based coping in complex regional pain syndrome Type I: daily relations with pain intensity, activity, and mood. Journal of Behavioral Medicine. 2013 Oct 1;36(5):531-8.
19. Bradt J, Dileo C. Music interventions for mechanically ventilated patients. Cochrane Database of Systematic Reviews. 2014(12): CD006902
20. Lombardo V, Vinatier I, Baillot ML, Franja V, Bourgeon-Ghittori I, Dray S, et al. How caregivers view patient comfort and what they do to improve it: a French survey. Annals of Intensive Care. 2013 Dec;3(1):1-8.
21. Grossbach I, Chlan L, Tracy MF. Overview of mechanical ventilatory support and management of patient-and ventilator-related responses. Critical Care Nurse. 2011 Jun;31(3):30-44.
22. Rustam JS, Kongsuwan W. Communication in Patients with Ventilation Support: An Integrative Review. Songklanagarind Journal of Nursing. 2017 Dec 23;37(Supplement):25-31.
23. Mårtensson IE, Fridlund B. Factors influencing the patient during weaning from mechanical ventilation: a national survey. Intensive and critical care Nursing. 2002 Aug 1;18(4):219-29.
24. Brien MEO. Spirituality in Nursing: Standing on Holy Ground. Jones & Bartlett Learning; 2011.
25. Andrade C, Radhakrishnan R. Prayer and healing: A medical and scientific perspective on randomized controlled trials. Indian Journal of Psychiatry. 2009 Oct;51(4):247-53.
26. Simão TP, Caldeira S, De Carvalho EC. The effect of prayer on patients’ health: systematic literature review. Religions. 2016 Jan;7(1):11.
27. Awa SB. Effects of holy quran listening on physiological stress response among muslim patients in intensive care unit. E-proceedings of the Conference on Management and Muamalah, 26-27 May 2014. 2014;(May):978–83.
28. Mahjoob M, Nejati J, Hosseini A, Bakhshani NM. The Effect of Holy Quran Voice on Mental Health. J Relig Health. 2016 Feb;55(1):38-42.
29. Zulkurnaini NA, Kadir RSSA, Murat ZH, Isa RM. The comparison between listening to Al-Quran and listening to classical music on the brainwave signal for the alpha band. Proc - 3rd Int Conf Intell Syst Model Simulation, ISMS 2012. 2012;181–6.
30. Couchman BA, Wetzig SM, Coyer FM, Wheeler MK. Nursing care of the mechanically ventilated patient: What does the evidence say?: Part one. Intensive and Critical Care Nursing. 2007 Feb 1;23(1):4-14.
IssueVol 8 No 4 (2021): Autumn QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v8i4.6708
comfort; Islamic rituals; mechanical ventilation; Muslim; nursing

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Rustam J, Kongsuwan W, Kitrungrote L. Effects of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients: A randomized clinical trial. NPT. 2021;8(4):322-332.