Effects of Psychosocial Nursing Interventions on Sleep, Anxiety and Delirium in Patients Undergoing Open Heart Surgery: A Randomised Controlled Trial.

BACKGROUND

Postoperative delirium remains a frequent and serious complication following open heart surgery, often linked with prolonged hospital stays and increased morbidity. Since the causes are multifactorial, non-pharmacological strategies such as psychosocial nursing interventions are being explored for their preventive potential.

AIM: This randomised controlled trial aimed to evaluate the effectiveness of psychosocial nursing interventions on sleep quality, anxiety levels and the occurrence of delirium in patients undergoing open heart surgery.

STUDY

DESIGN

A prospective, two-arm randomised controlled trial. Sixty patients scheduled for elective open heart surgery at a university hospital in southern Türkiye were randomly assigned to the intervention group (n = 30) or the control group (n = 30). The control group received standard nursing care. The intervention group received structured psychosocial care including eye masks, earplugs and brief 45-min cognitive behavioural therapy (CBT) sessions before and after surgery. Anxiety was assessed before surgery and on day 2 after surgery, while sleep quality was assessed before surgery and on days 1 and 2 after surgery. Patients' anxiety and sleep quality were assessed before and after surgery using the Richard Campbell Sleep Questionnaire and the State Anxiety Inventory. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to assess delirium after surgery. Adherence to sensory aids was monitored via nursing checklists. Outcome assessors for delirium were blinded to group assignment.

RESULTS

Groups were demographically and clinically comparable at baseline (p > 0.05). Post-intervention, anxiety and pain levels significantly declined in the intervention group, with improved sleep scores (p < 0.001). Delirium incidence was 0% in the intervention group versus 30% in controls (p < 0.05). Duration of mechanical ventilation and hospital stay was significantly reduced in the intervention group. Effect sizes (Cohen's d) and 95% confidence intervals were reported for major outcomes.

CONCLUSIONS

Psychosocial nursing interventions combining cognitive and sensory strategies effectively enhance postoperative outcomes by reducing anxiety, improving sleep quality and preventing delirium. These findings support integrating such non-invasive, low-cost strategies into routine nursing care for patients undergoing cardiac surgery.

RELEVANCE TO CLINICAL PRACTICE: Delirium is a critical postoperative complication after open heart surgery. Psychosocial interventions can be incorporated into nursing care to prevent delirium in intensive care units.