From operating room to recovery: Evidence and gaps in cardiac surgical nursing integrative psychological support

Table 1 Details of integrative psychological support during the perioperative period of cardiac surgery

Intervention timing	Participants	Methods	Details (frequency, duration, specific operations)
Preoperative intervention	Children aged 6–12 years	Comic story[15]	Each child receives a free educational comic book, "An Introductory Trip to the Operating Room", and spends 10–15 minutes reading it
	Patients aged 40–70 years undergoing coronary artery bypass graft (CABG)	Multidisciplinary education program[17]	Single intervention including educational booklet, nurse training, and routine care. Educational booklet: Patients in the intervention group receive guidance on the surgical process, expected outcomes, and postoperative care. Nurse training: Nurses train patients preoperatively to understand the booklet's content
	Cardiac rehabilitation patients aged 21 years who had heart surgery in the past 12 months	Mindfulness-based stress reduction (MBSR)[18]	Weekly 2.5-hour sessions for 8 weeks, plusa 65-hour retreat. MBSR courses are led by trained and certified instructors
	Patients aged 29–70 years undergoing CABG	Cognitive training[19]	Weekly sessions lasting 30–40 minutes for 6 weeks. Includes three one-on-one mindfulness exercises: Body scanning (during hospitalization), mindfulness breathing, and seated meditation (via phone post-discharge)
Intraoperative intervention	Patients undergoing cardiac surgery aged 35–89 years	Verbal suggestion and touch therapy[21]	Face-to-face interview about 2 weeks preoperatively to collect medical history, socioeconomic background, general health, health behaviors, function, and preoperative anxiety symptoms. A phone call 48 hours preoperatively to assess character strengths and perceived social support
	Patients undergoing cardiac surgery aged 20–86 years	Providing transparent and timely information[24]	One-time intervention during the middle of the surgery and postoperatively. The nurse provides brief information updates to family members during the middle of the surgery, including progress to halfway and the location of the recovery room. No clinical data or results are included
	Patients undergoing cardiac surgery aged 18–78 years	Music therapy[27]	On the first afternoon post-surgery, from 3:00 to 4:00 PM, patients lie in bed at a 30- to 40-degree angle for 30 minutes. Patients select their preferred music from 20 options provided by researchers, played via portable recorder and headphones at 50–60 dB
Postoperative intervention	Patients requiring cardiac surgery, including CABG or other cardiac surgeries	Nonpharmacological multicomponent interventions (restoring circadian rhythms, activating body and mind, inducing relaxation)[30]	All are one-time interventions. Virtual reality (VR) relaxation training: Patients receive VR relaxation training preoperatively, experiencing a relaxing virtual environment via VR devices to alleviate anxiety. Artificial intelligence (AI) emotion monitoring: AI technology monitors patients' emotional states, providing real-time feedback and intervention suggestions. Mobile application (app): Patients use a mobile app for postoperative recovery management, including pain management, activity monitoring, and emotional support. Wearable devices: Patients wear devices like smartwatches to monitor physiological parameters such as heart rate and blood pressure, with data support provided via the mobile app
	Patients with severe illness unable to communicate	Communication alternatives[35]	Communication tools (e.g., writing boards, picture communication systems, electronic devices) are provided and used as needed, with guidance on proper use. Tool usage duration varies from minutes to hours based on patient needs and communication complexity, with timely adjustments based on feedback
	Patients aged 52–68 years undergoing cardiopulmonary bypass surgery	Theory-based nursing interventions[36]	Health education: Includes twice-weekly 30-min face-to-face interviews during hospitalization and home visits post-discharge. Topics cover disease knowledge, postoperative recovery, and a healthy lifestyle (e.g., exercise, diet, smoking cessation, weight management). Psychological support: Provides psychological support to help patients cope with postoperative anxiety and depression, using techniques like feedback listening, inductive questioning, and conflict analysis to resolve contradictions between health behaviors and recovery goals. Behavioral incentives: Motivates patients to change health behaviors through specific health goals, educational materials, self-monitoring, and self-efficacy enhancement. Frequency and duration: Twice-weekly 30-minutes interviews during hospitalization. Post-discharge home visits: Weekly in month 1, biweekly in months 2–3, every three weeks in months 4–5, and monthly in month 6, each lasting 20 min
	Patients aged 50–70 years who have undergone CABG	Cognitive behavioral therapy[37]	Through face-to-face interviews, homework, relaxation training, and cognitive restructuring, patients learn to identify and change maladaptive cognitive patterns and behaviors. Preoperative intervention includes 5 weekly 30-minutes face-to-face interviews. Postoperative intervention includes 12 weekly 60-minutes interviews for 3 months or 4 weekly 30-min interviews for 4 weeks

CABG: Coronary artery bypass graft.