Emotional support for patients awaiting cardiovascular surgery provided by nurses


Open heart surgery is one of the methods of treatment of cardiovascular diseases, in which special surgical procedures are carried out. In other words, it is a surgical procedure that opens the chest and affects the muscles, valves or arteries of the heart. Patients undergoing heart surgery subconsciously perceive the fact of aggression towards their body, while fully aware of the need and potential benefits of the operation. The preoperative period is especially psychologically difficult for the patient. This period is characterized by a feeling of insecurity, helplessness, fear of anesthesia, surgery and its consequences. The results of studies [1, 2, 3, 4] show that the reduction of fear and anxiety has a positive effect on the success of the operation and rehabilitation after surgery. In this regard, the sensitive and attentive attitude of medical workers towards the patient is of particular importance. The emotional support of health professionals helps to establish a trusting relationship with the patient to create an atmosphere of peace and confidence in the successful outcome of the operation.

In Kazakhstan, emotional support is provided mainly by doctors, but world practice shows that nurses provide the most effective support [1, 4, 5]. It is nurses who spend more time with the patients and have a greater emotional connection with them than doctors. In connection with the large-scale reform of nursing in Kazakhstan, it is possible to delegate this function from doctors to nurses.

Introduction. What is emotional support in general? According to the Psychology Dictionary, emotional support is “the confidence, encouragement and understanding that we give to someone or receive from someone”. In other words, this support is provided to us by people who understand, encourage and reassure us [6]. The emotional support provided by nurses is important for the topic of research. In Mosby's Medical Dictionary [7], this is defined as a sensitive, understanding approach that helps patients to take and fight their diseases; report their anxieties and fears; get comfort from a gentle, responsive, caring person; and increase their ability to take care of themselves. In addition, Emotional support is listed in the nursing interventions of the Nursing Interventions Classification (NIC) and is defined as providing assurance, acceptance and encouragement during stress [8]. Therefore, we can conclude that in the world practice of nursing preoperation support, emotional support is provided by nurses, not doctors, as is the case in Kazakhstan and other postSoviet countries. Unlike a doctor who deals with the medical side of treatment, it is the nurses who spend most of their time with the patient and his or her family - from admission to the discharge itself, day and night. Nurses know the patients more from their personal sides, they know what psychological state they are in, and they talk to them more since nurses come to the ward several times a day. It is not without reason it is called «nursing care”. Therefore, it is crucial that the emotional support is also provided by nurses.

In this study, a narrower area is being considered - emotional support just before open heart surgery.

According to an Ascari RA et al. study [9], any operation is essentially a fact of aggression against the body of the patient. Therefore, anxiety, doubts, and fears of patients are natural companions of each surgical procedure. The preoperative period is especially emotionally difficult for the patient. This period is characterized by a feeling of uncertainty, helplessness, fear of anesthesia, the operation itself and its consequences. In this regard, it is of important to be sensitive and attentive to the patient on the part of healthcare professionals.

Therefore, preoperative emotional support of the patient is aimed at the wellbeing of the patient and to reduce the level of stress and negative feelings in relation to surgery.

Coronary Artery Bypass Graft (CABG) and patient fear. One of the numerous diseases in worldwide groups is heart disease and diseases of the circulatory system [5, 10]. Cardiovascular diseases are considered the leading cause of death worldwide [11]. Although drug treatment and recent advances in new treatments have been effective in fighting coronary artery disease, surgery remains the only treatment option for many of these patients [12]. Cardiac surgery is the most effective way of treating ischemic heart disease, which helps to prevent the development of myocardial infarction. Such an operation is called aorto - coronary bypass surgery.

Coronary artery bypass surgery (hereinafter CABG) is not only the first, but also one of the best options for patients [13, 14]. This operation is complex and extensive and according to the literature, most of the patients experience depression and anxiety both before and after the operation [15, 16, 5, 17]. CABG is a very stressful operation [18], and according to many studies, the expectation of cardiac surgery causes more stress than other types of surgical interventions [15, 16, 5, 17]. Depression is noted in 14% to 47% [19] and anxiety in 15% to 52% of patients who had the CABG operation [20].

The Tully et al. [21] research suggests that depression and anxiety are associated with post-surgical complications, such as heart complications, function level and quality of life [21]. Furthermore, increased preoperative anxiety can delay the postoperative recovery period [22]. Similarly, a high level of anxiety before surgery determines a high incidence of postoperative pain [23], a negative effect on the mood of the patient, and delayed hospitalization [24].

Moreover, a systematic review of Stenman et al. [25] demonstrates an increase in all causes of death due to preoperative depression in four of the seven studies analyzed [25]. In addition, the Blumenthal et al. [19] study showed that among the 817 patients who underwent CABG, the increased symptoms of depression before and after surgery were associated with an increase in the causes of death.

Elevated anxiety symptoms prior to surgery were associated with increased mortality after surgery [26, 27].

Preoperative nursing care. In connection with the reasons described above, the question arises about the qualified preparation for the operation not only from the mechanical side (shave before the operation, to give soothing overnight, etc.), but also from the emotional side. Particularly, it is a confidential conversation, the manifestation of empathy towards the patient in order to reduce fear and anxiety before surgery.

In terms of the development of medical care as well as optimization, hospitalization periods have changed, and patients now spend less time in the hospital. In Kazakhstan, patients often go to the hospital just one day before surgery and are discharged as soon as their vital functions are restored from a medical point of view. Therefore, preparation for the operation is an important step, but there is only one day to prepare.

In general, perioperative care is a term used to describe the various functions of nursing related to the surgical experience. It consists of three stages: preoperative, intraoperative and postoperative [28, 29].

All phases play a big role in patient care, but the preoperative phase is the most important, as patients during this period are most vulnerable both physiologically and psychologically [29, 30]. During the preoperative phase, patients undergo various situations that cause psychological anxiety, and this can lead to stress during and after the surgical procedure [1]. According to many studies, the expectation of cardiac surgery causes more stress than other types of surgical interventions [5, 15, 17].

Preoperative education helps the patient understand what the operation will be like and mentally prepare for surgery as well as improve recovery in the postoperative period [31]. Preoperative patient education implies the intervention of nurses, which includes providing information to patients about the forthcoming operation and includes answers to questions about what they can expect after the operation, the possible outcomes and results, and providing psychological and emotional support. To put it more simply, nurses help patients reduce their anxiety and fear before the operation, which reduces the level of postoperative complications and leads to a more rapid recovery after surgery [1, 2, 3, 4]. Therefore, and according to a systematic review [1], it can be concluded that preoperative activities reduce preoperative anxiety in patients scheduled for surgical procedures.

Situation in Kazakhstan. According to previous studies [1, 4, 5], nurses turn out to be an important source of emotional support for patients and an integral part of their life during hospitalization. Unfortunately, very few scientific articles have been written in Kazakhstan or Russia about the emotional or psychological support to patients before surgery and they are all written from the perspective of doctors or psychologists, not nurses.

According to the Ministry of health of the Republic of Kazakhstan in the 1990s, after Kazakhstan separated from the USSRand became an independent state in medicine, there was a period of acute shortage of medical personnel, especially nurses. Therefore, many of the functions and responsibilities of nurses were taken over by doctors and since then, it has remained unchanged. At present, the health sector in Kazakhstan has moved forward in development, but the foundations and some guidelines remain the same. Delegating these duties from doctors to nurses would help improve the patients' postoperative outcome.

Since doctors do not always have enough time for pre-operative conversation, the care is selective. If these conversations could be carried out by a nurse, the care would be the same to all patients. Moreover, all this would develop the counseling skills of nurses and enhance their confidential relations with patients, further their basic knowledge of cardiac surgery, and overall, expand the professional role of nurses. Reforms are necessary for further growth and development of nursing as an independent unit of health care.



  1. Alanazi А. 2014. Reducing anxiety in preoperative patients: a systematic review. British Journal of Nursing. 23 (7).
  2. 2.Kruzik N. 2009. Benefits of preoperative education for adult elective surgery patients. AORN Journal. 90(3), p. 381-387.
  3. 3.O'Brien L., Mckeough C., Abbasi R. 2013. Pre-surgery education for elective cardiac surgery patients: A survey from the patient's perspective. Australian Occupational Therapy Journal .60(6), p. 404-409.
  4. Ping, G. 2015. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials. Journal of Clinical Nursing. 24, (1-2), p. 34–46.
  5. Rosiek A., Kornatowski T., Rosiek-Kryszewska A., Leksowski A. and Leksowski K. 2016. Evaluation of Stress Intensity and Anxiety Level in Preoperative Period of Cardiac Patients. BioMed Research International.
  6. Nugent Pam, M.S. 2013. EMOTIONAL SUPPORT in Psychology Dictionary.org
  7. Mosby's Medical Dictionary, 9th edition. 2009. Elsevier.
  8. Bulechek G., Butcher H., & Dochterman J. 2008. Nursing interventions classification (5th ed.). Mosby Elsevier.
  9. Ascari R.A., Neiss M., Sartori A.A. et al. 2013. Perceptions of surgical patient during preoperative period concerning nursing care. Journal of Nursing UFPE. 7 (4), p1136-1144.
  10. Dulega A., Slusarsk B. and Koziej D. 2013. The scope of diagnosis of the condition of patients with cardiovascular diseases for nursing care. Problems of Nursing. 21, (4), pp. 452–461.
  11. 11) Go A.S., Mozaffarian D., Roger V., Benjamin E., Lloyd-Jones D., Berry J., Borden W., Bravata D., Dai S., Ford E., Fox, C. 2013. Heart disease and stroke statistics – 2012 update a report from the American Heart Association. Circulation. 127 (1), chapters e6 – e245.
  12. Acton, Q. 2013. Coronary Heart Disease: New Insights for the Health- care Professional. Scholarly Editions.
  13. Kulick D.L. 2016. Coronary Artery Bypass Graft Surgery (CABG) Medical review in MedicineNet.com.
  14. Woods S.L., Froelicher ESS. Motzer S.A., Bridges E.J. 2010. Cardiac Nursing. Wolters Kluwer Health/Lippincott Williams & Wilkins.
  15. Krzych J., Pawlak A., Woznica А. et al. 2009. Conditions of severity of anxiety and depression in the perioperative period in the economically active men undergoing coronary artery and cardiopulmonary bypass. Journal of Cardio-Thoracic Surgery.6 (3), p. 238–243
  16. 16) McKinley S., Fien M., Riegel B., Meischke H., Aburuz M.E., Lennie T.A. Moser, DK. 2012. Complications after acute coronary syndrome are reduced by perceived control of cardiac illness. Journal of Advanced Nursing; 68 (10), p 2320-2330.
  17. Rymaszewska J. Kiejna A. and Hadry ́s, T. 2003. Depression and anxiety in coronary artery bypass grafting patients. European Psychiatry, 18 (4), pp. 155-160;
  18. Leegaard M., Fagermoen M.S. 2008. Patients' key experiences after coronary artery bypass grafting: a synthesis of qualitative studies. Scandinavian Journal of Caring Sciences. 22(4), p 616–628.
  19. Blumenthal J.A., Lett H.S., Babyak M.A, White W., Smith P.K., Mark D.B., Jones R., Mathew J.P., Newman M.F., N.O.R.G. Investigators. 2003. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet. 362, p 604-609.
  20. Tully P.J., Cosh S.M., Baumeister H. 2014. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. Journal of Psychosomatic Research. 77(6), p 439-448.
  21. Tully P.J., Baker R.A. 2012. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. Journal of Geriatric Cardiology. 9 (2), p 197–208.
  22. Priority Medicines for Europe and the World .2013. “A Public Health Approach to Innovation” Update on 2004, Background Paper, BP 6.24 Low Back Pain. Author: Duthey B.
  23. Laufenberg-Feldmann R., Kappis B., Schuster M., Ferner M. 2016. Relevance of preoperative anxiety for postoperative outcome in urological surgery patients: A prospective observational study Schmerz. 30(2), p 166–73
  24. 24) Rasouli M.R., Menendez M.E., Sayadipour A. 2016. Direct cost and complications associated with total joint arthroplasty in patients with preoperative anxiety and depression. Journal of Arthroplasty. 31(2), p 533–36
  25. 25.Stenman, M., Holzmann, M.J., Sartipy, U. 2016. Association between preoperative depression and long-term survival following coronary artery bypass surgery - a systematic review and meta-analysis, International Journal of Cardiology. 222, p 462-466
  26. 26) Tully, P.J., Baker, R.A., Knight, J.L. 2008. Anxiety and depression as risk factors for mortality after coronary artery bypass surgery. Journal of Psychosomatic Research. 64, p 285- 290.
  27. Cserep Z., Losoncz E., Balog P., Szili-Torok T., Husz A., Juhasz B., Kertai M.D., Gal J., Szekely A. 2012. The impact of preoperative anxiety and education level on longterm mortality after cardiac surgery. Journal of Cardiothoracic Surgery. 7, 86.
  28. AORN. 2005. Standards, recommended practices, and guidelines. Association of periOperative Registered Nurses.
  29. Goncalves M. A. R.; Cerejo M.N. R. & Martins J. C. A. 2017. The influence of the information provided by nurses on preoperative anxiety. Revista de Enfermagem Referкncia .4 (14), p17-25.
  30. Rief W., Shedden-Mora Meike C.J., Laferton A.C., Auer C., Petrie K.J., Salzmann S., Schedlowski M. & Moosdorf R. 2017. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Medicine. 15(4), p 1-13.
  31. Ramesh C., Nayak S., Pai V. B., Patil N. T., George A., George L.S., Devi E.S. 2016. Effect of Preoperative Education on Postoperative Outcomes Among Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. 32 (6), р 518-529.
Year: 2019
City: Almaty
Category: Medicine