Betty Neuman - System Model Peer Reviewed Article

Introduction

Cardiovascular affliction, already the about common noncommunicable affliction in the Middle Eastward, is continuing to increase in prevalence in the region, with Islamic republic of iran among those countries with the highest prevalence rates (^{Moazzeni et al., 2021}). Despite advances in medical science and equipment, coronary artery bypass graft (CABG) surgery remains the standard strategy for the handling of advanced coronary artery disease (^{Palmerini et al., 2017}), bookkeeping for 78.eight% of all cardiac surgeries in Islamic republic of iran (^{Akhlaghi et al., 2020}).

Anxiety is a major problem in patients scheduled for heart surgery and is more prevalent in middle surgery than other surgeries because proper heart functioning is disquisitional to the continuance of an individual's life (^{Hinkle & Cheever, 2013}). The results of a meta-assay by ^{Takagi et al. (2017)} signal that prolonged anxiety in patients scheduled for cardiac surgery may be associated with a higher adventure of postoperative mortality. Preoperative anxiety may increment the risk of postsurgical lesions, including atrial fibrillation, acute myocardial infarction, increased disease and bloodshed, and increased use of healthcare. In addition to beingness a sad country, anxiety is a common denominator of many physical and mental disorders. In fact, for most illnesses and physical and mental disorders, anxiety is considered a major discomfort. In addition, anxiety in patients experiencing chronic and prolonged disease may crusade major destructive physiological changes (^{Alipoor et al., 2014}). ^{Tully et al. (2015)} found that patients with high levels of anxiety take a higher risk of expiry earlier CABG surgery. Moreover, ^{Middel et al. (2014)} showed a positive relationship betwixt preoperative feet and postoperative anxiety after CABG surgery. In addition, they showed that identifying patients with high feet would assistance healthcare providers offer specific interventions to reduce their feet and improve their quality of life.

Helping patients adapt to anxiety is a major responsibility of nurses. Nurses play an important office in preparing patients emotionally and psychologically during the preoperative period of cardiac surgery. Therefore, nurses should e'er await for ways to amend the quality of nursing intendance (^{Ramesh, 2017}). In this regard, applying nursing theories and models in the avant-garde practice area of nursing may be beneficial for patients (^{Reed, 1993}).

1 of these models is the Neuman Systems Model (NSM), which is an open model-based perspective that provides proper function in stressful situations or at the time of the patient's response, which is recognized as a priority in nursing (^{Meleis, 2011}). The NSM is based on an individual's human relationship with and response to stress. The iii key concepts of this model are stress, homeostasis, and patient's perception. The function of the nurse is to focus on the factors influencing the individual's response to stress and protecting the patient from the relevant take chances factors (^{Heffline, 1990}). In this model, the main goal of nursing is to maximize patient well-beingness by using nursing care to reduce stress. The nurse creates a human relationship among the patient, environment, and wellness to establish a sustainable organization. It is necessary for the nurse to evaluate the patient'south perceived stressors to improve patient stability. As the relationship between the nurse and patient develops and mutual understanding improves, differences in agreement may be eliminated. The outcome of this partnership is complementary inside a joint care programme that may be implemented with a articulate objective in listen (^{Parvan et al., 2012}).

Under the NSM, nurses are considered to be active contributors (^{Smith & Parker, 2015}), and prevention is pursued as one of the most important nursing interventions to protect the patient. In this model, the goal of nursing is to strengthen a patient'due south defenses, improve their health, and, ultimately, ameliorate their ability to cope with health issues (^{Meleis, 2011}; ^{Parvan et al., 2012}). The main point is the importance of providing nursing care in the class of prevention levels. Main prevention aims to prevent tension agents from penetrating defensive lines past reducing stress and strengthening defense lines. Secondary prevention attempts to increase goodness, reduce stress, and reinforce coping by strengthening defense lines. In fact, the goal of secondary prevention is to maintain the level of coping (^{Fawcett & Garity, 2008}; ^{McEwen & Wills, 2017}).

Nursing interventions seek to reduce the stressors and situations deemed to bear on or potentially touch the patient's desirable factors. The distinction fabricated betwixt the prevention levels in nursing interventions designed to reduce stress is one of the benefits of the NSM. Another reward is its focus on prevention levels that are more socially acceptable because the community is progressively enlightened of the significant office of nurses in the healthcare organisation. A further strength of this model is its flexibility as a stimulus–response systems model that considers the basis for development of the theory and evaluates the human relationship betwixt nursing theory and clinical enquiry and practise (^{Sultan, 2018}).

Nursing theories should be developed with the goal of promoting practical applications in clinical practise. Developing and reviewing theories have the potential to open up new approaches to quality intendance that may challenge the current care organization (^{Wadensten & Carlsson, 2003}). Nursing is not only a practical discipline only also a knowledge-based profession. Therefore, to create new applied approaches, having the foundation of knowledge is one of the requirements in this field (^{Aghebati et al., 2012}). In that location is a gap between theory and do in the nursing profession, and nurses focus more than on the applied aspects of nursing than on nursing science and art (^{Mrayyan, 2006}). Moreover, the demand to reduce anxiety using holistic intendance models in patients undergoing CABG is addressed in this commodity. This is an issue that has been comparatively addressed in the scientific literature, especially in non-Western countries. Therefore, the existing gaps encouraged the evolution of a research projection aimed at evaluating the result of applying the NSM for anxiety in patients scheduled for CABG surgery.

Methods

Design

This written report was a single-heart, unmarried-blinded, 2-armed, randomized controlled trial conducted in an urban area of Islamic republic of iran from October 2017 to August 2018.

Participants and Sampling

Participants' inclusion criteria for this written report were every bit follows: existence a candidate for CABG surgery, having full consciousness, admitted at least 1 day before surgery, willing to participate in the written report, able to communicate in the Western farsi linguistic communication, and aged 30–70 years. This age range was selected based on the rare number of candidates below 30 years former and in accord with the literature, which has shown a significantly negative correlation between age and anxiety, equally patients older than 70 years have been found to report the lowest level of anxiety before and later CABG surgery (^{Krannich et al., 2007}). The exclusion criteria were as follows: discontinuing the patient'due south participation at whatever phase of the study, an emergency status that required giving medical intendance to the patient during the intervention, and whatsoever delay in surgery (e.grand., considering of financial problems, not providing consent for surgery, deteriorating health status). The minimum sample size required was 32 participants in each group based on ^{Nasiry Zarrin Ghabaee et al. (2015)}, which applied the NSM to reduce the level of anxiety in orthopedic patients before surgery. In this report, the required sample size was determined with a 95% confidence and eighty% test power, and the mean standard difference of anxiety score was estimated in both groups. The final, target sample size was determined to be 35 people in each group in this study, considering a potential dropout rate of 10%.

$n=\mathrm{ii}{S}^2{\frac{\left(Z_{\mathrm{one}}+Z_2\right)}{d^2}}^2=2s^2{\frac{\left(1.96+0.84\right)}{0.49{\mathrm{southward}}^{\mathrm{two}}}}^{\mathrm{two}}=32$

Patients who were referred to the cardiology center and were waiting for surgery enrolled in the study using a convenience sampling method based on eligibility criteria. Of the 75 total potential participants, 70 were randomly assigned to either the intervention group (n = 35) or the control group (n = 35) using the following cards/envelope shuffling method (^{Kim & Shin, 2014}). Kickoff, code "A" was assigned to the intervention group, and lawmaking "B" was assigned to the control group. So, the researcher (first writer) wrote messages A and B on cards and placed them in an envelope. Adjacent, each of the enrolled participants was asked to have one of the envelopes. Those who took an envelope containing Card A were included in the intervention group, and those who took an envelope containing Card B were included in the control group (Effigy 1). The researcher (first writer) implemented the intervention and collected the data.

Figure 1.:

The Study Process Based on the CONSORT Flow Diagram

Data Collection

A sociodemographic data questionnaire, the Revised Cardiac Surgery Stressors Scale (RCSSS), and the Country Anxiety Inventory were used for data collection.

The sociodemographic data questionnaire was designed by researchers using a review of the literature and either self-completed past the participants who were literate or completed during the interview by the researcher for participants who were illiterate.

The Country Anxiety Inventory questionnaire contains 20 questions scored on a iv-point Likert scale. Reverse ratings were applied for negative items, and a total score was calculated, ranging from 20 to 80, with score ranges categorized as low anxiety (20–37), moderate anxiety (38–44), and loftier anxiety (45–fourscore). This questionnaire has been translated into xxx languages and has been adjusted to suit the Iranian cultural setting. In this report, Cronbach'southward alpha (α) was calculated to appraise the internal consistency reliability of the translated instrument, with the event of .97 indicating sufficient internal consistency based on a recommended level of > .70 (^{Spielberger, 2010}). This questionnaire was completed by/for all of the participants at three points in time: earlier the intervention, immediately afterwards the intervention, and at discharge time.

The RCSSS includes 37 questions, and the second part includes RCSSS cases in iii subgroups: intrapersonal stressors, including 11 phrases; interpersonal stressors, including nine phrases; and extrapersonal stressors, including 17 phrases. The items were ranked co-ordinate to the level of business organization of the participants on a Likert calibration from 0 to 4, with 0 = no worries, ane = very low worries, 2 = low worries, iii = moderate worries, and 4 = worries. The lowest scale score of 0 indicates the absenteeism of stressors, whereas the maximum score of 148 indicates the highest stressor factor, with ranges of 0–37 indicating very low stressors, 38–74 indicating depression stressors, 75–110 indicating the presence of relatively stressful factors, and 111–148 indicating stressful factors. The reliability of this questionnaire was calculated using Cronbach'due south blastoff coefficient (patient = .81; nurse = .93) in previous research in the Iranian context (^{Parvan et al., 2013}). In this study, the reliability of the RCSSS calculated using Cronbach's alpha was shown to be adequate (patient = .82; nurse = .91). This scale was only used to categorize patients based on level of prevention.

Intervention

First, the potential and actual stressor factors for each patient, including intrapersonal, interpersonal, and extrapersonal, were evaluated using the RCSSS (patient part; ^{Parvan et al., 2013}). 2d, appropriate goals and strategies for action were determined. If no bodily stressors were institute, interventions at the get-go level of prevention were carried out, and the influence of the stressors on the natural defense line was prevented by reducing the probability of exposure to stressors and strengthening the defense line. If stressors were identified based on the patient function of RCSSS, these factors were known as actual stressors, and the patient was placed in the 2d level of prevention. If unlike levels of stressors were identified, the RCSSS (nurse part; ^{Parvan et al., 2012}) was too completed by the responsible shift nurse to decide the patient stressor. The nurse'southward perception is considered equally one of the steps of the NSM in relation to the patient's stress factors. On the basis of the written report of the second level of prevention, the intervention was identified to reduce the stressors that caused impairment to the natural and flexible defence force line. The intervention was aimed at strengthening internal defense lines to reduce the reaction. In the presence of the stressors, the intervention continued at the third level of prevention after surgery using Benson's relaxation method. The main goal of the tertiary prevention component of the NSM is adaptability (^{Fawcett & Desanto-Madeya, 2012}; ^{Sahrakhil et al., 2017}). To implement the Benson'due south relaxation procedure, patients were placed in a relaxed environment and in the nearly comfortable position. Then, they were asked to choose a calming discussion and have comfy, deep breaths. They were asked to inhale through their olfactory organ and repeat their calming words during exhalation through their mouth. During this procedure, patients were asked to relax all of the muscles in their body from head to anxiety (^{Sahrakhil et al., 2017}).

Prevention of the first and second levels was done in one or two 45- to 60-minute consecutive sessions before surgery. The first session was implemented on the day of admission in the morning or evening shift. The 2d session was implemented during the evening or night shift. The conversations were held individually at patient bedsides nether weather considered favorable by both patient and researcher. The contents of these conversations included a self-introduction, the purpose of the research, and a simple explanation almost coronary avenue beefcake, preoperative cardiac surgery, the operating room and intensive intendance unit, and postintensive care unit cardiac and postoperative orders and care (Table 1). At the terminate of the first session, an educational booklet on the issues discussed was given to the intervention group. Moreover, the patient'south companion in the intervention group received the care programme from the researcher one 24-hour interval before the surgery based on the NSM. Of the 32 participants in the intervention group, 28 were assigned to the showtime and second levels of prevention and received the preoperative intervention. Only four received the third level of prevention. Preventive level assignments were determined based on the presence of stressors identified through the questionnaire on the revised cardiac surgery stressors (patient part). The participants assigned to the control group received usual care only.

Table 1. - Contents of Sessions, past Prevention Level

Session	Content
Commencement	• In patients in the outset prevention and at the time of admission • Introduce yourself and limited the purpose of the inquiry • An caption of coronary anatomy, preoperative cardiac surgery, the operating room and ICU, postal service-ICU cardiac surgery, postoperative care and instructions (bathing, at home, nutrition, taking medication, and medicine intake), the role of proper nutrition in relieving stress and anxiety, and reassurance in the infirmary environment and the operating room
Second	• In patients in the secondary prevention and in the second shift later on admission • Discussion and clarification of issues • Intervention according to the needs and actual stressors detected by the patient and the nurse based on Neuman stressors • Intrapersonal (awareness of the rehabilitation phase, habitation care, routine care in the intensive intendance unit and other areas, surgery sensation, time back to section, duration of exercise, awareness of nutritional therapy) • Interpersonal (clarification of hospital therapy procedures, psychological back up, relation with patients, and providing information nearly medications) • Extrapersonal (providing information on insurance and paying for expenses, talking to the healthcare sector and referring patients to charities, creating a serenity surround and reducing dissonance, staying in the ICU, injection instruction, grooming in connection with tubes and the patient's breast tube, and a tutorial on catheters showing the patient the connections)
Third	• In patients with the third prevention and in the postoperative stage • Promote relaxation responses by implementing Benson's relaxation method

Notation. ICU = intensive care unit.

Ethical Considerations

Ethical approval for this study was obtained from the Vice-Chancellor of Ideals of Research and Technology of Isfahan University of Medical Sciences (reference no: IR.MUI.REC.1396.iii.838) and the Iranian Clinical Trial Center (reference no: IRCT2018011603897N1). The managers of the research settings were notified of the aim of this study and that participation would non issue in any harm or difficulty. The participants were informed about the aim and procedure of this study and that data would exist kept confidential. Finally, an informed consent form was signed past those who consented to participate.

Information Analysis

SPSS software Version 22 (IBM, Inc., Armonk, NY, USA) was used for data analysis. Frequency and per centum for qualitative variables and mean and standard deviation for quantitative variables were practical using descriptive statistics to describe these variables. In add-on, the chi-square test, Fisher's exact test, and an independent sample t test were conducted to detect differences in sociodemographic variables between the two study groups. In addition, an independent sample t examination was used to compare the mean anxiety scores between the intervention and control groups earlier the intervention, immediately after the intervention, and at discharge time. This test was besides used to compare the mean RCSSS scores of patients and nurses. Moreover, the one-style repeated measures analysis of variance (ANOVA) exam was applied to evaluate changes in hateful anxiety scores over fourth dimension in the 2 report groups and to compare mean feet over time in the intervention group. A p value < .05 was regarded as significant.

Results

Equally shown in Effigy 1, of the seventy participants, 3 from each group were excluded from the final analysis because of exclusion criteria (north = 64). The mean historic period of participants in the intervention and control groups was 60.72 and 57.23 years, respectively. Well-nigh participants in the intervention (68.8%) and control (59.4%) groups were male. Other sociodemographic variables are listed in Tabular array ii. In that location were no significant differences in sociodemographic variables between the 2 groups (Table 2).

Table 2. - Demographic Characteristics and Patient Information by Group

Variable	Intervention Group		Control Group		t	p
	Mean	SD	Hateful	SD
Age (years)	sixty.72	8.fourteen	57.23	11.fourteen	1.40	.17
Number of previous hospitalizations	3.62	iii.17	ii.61	1.52	1.55	.thirteen
Duration of the nearly contempo hospitalization (days)	v.23	4.49	v.70	3.71	0.43	.67
Number of previous surgeries	1.68	ane.06	1.53	0.72	0.51	.61
Variable	n	%	n	%	z/χii	p
Gender					χtwo = 0.61	.43
Female	10	31.ii	13	xl.6
Male	22	68.eight	19	59.four
Religion					–	.fifty
Shiite	31	96.nine	32	100.0
Sunni	1	3.1	0	0
Marital status					χtwo = 0.56	.76
Single	one	3.ane	two	6.two
Married	28	87.5	26	81.3
Widowed	3	ix.4	4	12.v
Past cardiac catheterization in this infirmary					χii = 0.87	.35
Aye	24	75.0	27	84.4
No	viii	25.0	5	15.6
Family unit history of cardiovascular disease surgery					–	.98
Aye	8	25.0	8	25.0
No	24	75.0	24	75.0
Family income					z = 0.77	.44
Less than living expenses	22	68.8	19	59.4
More living expenses	10	31.2	13	40.6
Level of education					z = 0.62	.54
Illiterate	11	34.iv	14	43.7
Elementary school	9	28.1	8	25.0
Secondary schoolhouse	4	12.5	3	9.four
High school	vi	18.8	iv	12.5
University	2	six.2	3	9.4
Date of previous hospitalization					z = 0.13	.89
Last 4 months	16	50.0	16	50.0
Last 5–6 months	4	12.5	three	ix.iv
Terminal 7–12 months	two	6.2	2	six.2
More the last 12 months	10	31.3	xi	34.4

Equally shown in Table iii, the results of RCSSS showed that no significant differences were present betwixt the hateful scores of the intervention and command groups (p = .59, t = 0.54). Regarding patients' and nurses' perspectives on RCSSS, the mean scores of the nurses were significantly college than those of the participants (p < .001, t = seven.lx; Table 3).

Table 3. - Comparison of RCSSS Scores Between the Intervention and Control Groups and Between Patient and Nurse Perspectives

Subgroup/Score	Intervention Group (north = 32)		Command Group (n = 32)		p	t
	Mean	SD	Mean	SD
Intrapersonal	sixteen.14	8.84	fifteen.28	8.18	.73	0.34
Interpersonal	8.00	3.81	viii.57	iv.39	.77	0.30
Extrapersonal	23.08	9.fifty	22.93	12.95	.96	0.05
Total score	45.23	21.64	49.05	18.81	.59	0.54
Subgroup/Score	Nurse		Patient		p	t
	Mean	SD	Mean	SD
Intrapersonal	26.04	4.58	16.fourteen	8.84	< .001	five.63
Interpersonal	16.30	6.40	eight.00	3.81	< .001	5.03
Extrapersonal	38.16	6.72	23.08	nine.50	< .001	7.33
Total score	fourscore.57	xiv.93	45.23	21.64	< .001	7.60

Note. RCSSS = Revised Cardiac Surgery Stressors Scale.

As shown in Table 4, no significant departure was plant in preintervention mean feet scores between the two groups (p = .48, t = 0.71). The level of anxiety was moderate in the control group (42.40) and in the intervention group (44.27) earlier the intervention. However, the mean anxiety score in the intervention group was significantly lower immediately after the intervention (p = .008, t = 2.73) and at belch time (p = .007, t = 2.77) than in the control group. Moreover, the one-way repeated measures ANOVA for each group revealed that the mean anxiety scores statistically significantly reduced over time in the intervention group (p = .001, F = 11.34) just not in the control group (p = .18, F = i.79).

Table 4. - Comparing of Feet Scores Between the Intervention and Control Groups

Time	Intervention Group (n = 32)		Command Grouping (n = 32)		Contained t Test
	Mean	SD	Mean	SD	t	p
Before intervention	44.27	11.04	42.40	9.83	0.71	.480
After intervention	37.66	8.28	43.75	9.53	two.73	.008
At discharge	36.46	eight.60	42.69	9.36	ii.77	.007
1-fashion repeated measures ANOVA
F	11.34		1.79
p	.001		.180

Note. ANOVA = analysis of variance.

In the intervention group, the outcome of Fisher's to the lowest degree significant test later one-mode repeated measures ANOVA showed that the mean anxiety score in the intervention group was significantly lower immediately after the intervention (mean difference [MD] = −6.61, p = .001) and at discharge fourth dimension (Physician = −7.81, p < .001) than before the intervention, with no pregnant difference institute between immediately after the intervention and at discharge time (MD = i.21, p = .33). On the basis of the results of the contained sample t exam, at discharge time, no significant difference was identified in terms of feet scores between participants who received the first and second levels of prevention and those who received all three levels of prevention (p = .34, t = 0.95).

Discussion

The aim of this study was to investigate the effect of applying the NSM on anxiety in patients scheduled for CABG surgery. The findings revealed that using this care program based on this model had a significant effect on reducing anxiety in these patients.

Although there have been some discussions regarding the effect of nursing theories in practice, the value of using nursing theories for the advancement of the nursing profession has been supported in the literature (^{Bourdeanu & Dee, 2013}). Theories and models of nursing provide a coherent and systematic framework to guide nursing assessments, planning, and interventions. In improver, theories and models tin help generate more cognition and differentiate what should be the footing of nursing practice (^{Polit & Beck, 2004}). Furthermore, models tin help nurses provide better care to patients (^{Huang et al., 2015}). In this study, the NSM was used to provide care to patients.

The results of a previous study conducted on candidate patients for orthopedic surgery showed that using the NSM reduced the anxiety level in patients waiting for surgery (^{Nasiry Zarrin Ghabaee et al., 2015}). Moreover, the finding of some other study indicated that applying this model may reduce the level of stressors in patients scheduled for CABG surgery. In addition, providing care based on this model can effectively diminish the incidence of anxiety in patients with gastrointestinal malignancy, endometrial carcinoma, and lung cancer (^{Wang et al., 2019}). The results of the reviewed studies are consistent with the results of this report.

In this study, patients reported a lower perception of stressors than nurses. This finding is consistent with the results of a previous study (^{Parvan et al., 2012}). The misunderstanding of nurses may take an adverse event on nursing intendance and induce stressful symptoms in patients during nurse–patient communication. Nurses should avoid applying their preconceptions in determining the severity of patient stressors (^{Parvan et al., 2012}).

Studies take shown that the functional and psychological status of patients worsens when they are placed on the cardiac waiting listing because they do not know what to expect (^{Guo, 2015}; ^{Rosenfeldt et al., 2011}). At the aforementioned time, many nurses responsible for the care of candidate patients for heart surgery are not enlightened of the benefits to patients of preoperative interventions. Thus, they focus on postoperative interventions only (^{Alshvang, 2018}). A substantial part of the NSM revolves around internal and external stressors, with an emphasis on patient education (^{Neuman & Fawcett, 2002}). In this written report, the intervention plan was designed based on the NSM in the first and second levels of prevention. Information technology was delivered to patients individually later identifying patient stressors during teaching sessions. Providing an educational booklet was also found to reduce anxiety level. In agreement with this study, a randomized controlled report by ^{Guo et al. (2012)} establish that a preoperative educational intervention was effective in reducing anxiety in cardiac surgery patients. The results of another study showed nurse-initiated preoperational pedagogy and counseling to be associated with a reduced level of feet after CABG surgery (^{Zhang et al., 2012}). Still, according to the results of a recent systematic review, further research is required to investigate preoperative educational intervention furnishings in cardiac patients, specially in non-Western countries (^{Guo, 2015}).

The NSM applies a holistic vision to discover the effects of stress on patients as well every bit to improve patient capabilities to adjust and rebalance (^{Verberk & Fawcett, 2017}; ^{Wang et al., 2019}). Although the effect of this model has not been investigated in patients undergoing CABG surgery, the application of this model has been documented in the care of patients with diverse diseases. ^{Ahmadi and Sadeghi (2017)} suggested that this model exist applied as a framework to assist nurses in the care of patients with multiple sclerosis. In improver, Wang et al. reported that the NSM is applicative to the care of patients with cirrhosis, patients with cancer, patients with hypertension, and patients with stroke.

The findings of this report bear witness no difference in the intervention group at the time of discharge in terms of the level of anxiety between those who received the first and second levels of prevention and those who received all iii levels of prevention. The aim of the get-go and second levels of prevention in the NSM is removing stressors, whereas the aim of the third level of the intervention is adapting to the stressors. Therefore, it should be considered that the stressors were still present in the participants who received the third level of prevention. This may be attributed to individual differences in terms of psychological or family status (^{Sedaghat et al., 2019}). Co-ordinate to the findings in this study, adaptation using a relaxation method as the 3rd level of prevention may exist an constructive intervention to reduce anxiety in patients scheduled for CABG surgery. However, the use and estimation of our findings should exist washed with caution because these results may be owing to the small number of participants who received all three levels of prevention.

Limitations

There were a number of limitations in this study. First, this study was performed at a single center using a small sample size. Second, although participants filled out the questionnaires in a depression-stress environs, issues such as boredom and financial or family conflicts may still take occupied the thoughts of the participants and influenced their responses. Third, although the researchers tried to keep the participants in the two groups unaware of the identity of the intervention, participant ascertainment and observer bias may have all the same biased the results. Finally, private cultural, social, religious, and spiritual factors may have influenced the participants' anxiety levels, which would decrease the generalizability of the results of this study to other countries.

Conclusions

The results of this study support that the NSM has the potential to significantly and positively reduce anxiety in patients scheduled for CABG surgery. This model may be easily used in do every bit a guide for nurses to provide quality care to patients awaiting surgery. Therefore, the NSM may exist a suitable theory to apply in reducing anxiety in patients scheduled for CABG surgery. The results of this report are applicable for nurses, nursing managers, and hospital managers to provide holistic intendance to patients in hospital and community settings.

Acknowledgments

The results of this research are part of a principal's thesis in nursing that was canonical past the Isfahan Academy of Medical Sciences (Grant No. 396838). We limited our appreciation to the research deputy, patients, and nursing staff for their cooperation during this report.

Author Contributions

Study formulation and design: EA, SB

Data drove: EA

Data assay and interpretation: EA, SB, AM

Drafting of the article: All authors

Critical revision of the article: Atomic number 26, AM

References

Aghebati N., Mohammadi Due east., Ahmadi F. (2012). The concept of nursing in holistic theories: An integrative review. Show Based Care, 2(two), 67–84. (Original work published in Persian).

• Cited Here

Ahmadi Z., Sadeghi T. (2017). Application of the Betty Neuman Systems Model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Periodical—Experimental, Translational and Clinical, 3(3), 1–8. https://doi.org/ten.1177/2055217317726798

• Cited Hither

Akhlaghi E., Babaei S., Abolhassani S. (2020). Modifying stressors using Betty Neuman arrangement modeling in coronary artery bypass graft: A randomized clinical trial. Periodical of Caring Sciences, ix(one), xiii–19. https://doi.org/10.34172/jcs.2020.003

• Cited Here

Alipoor A., Oraki M., Yazdian Sabet Thousand. (2014). Efficiency of brainwave entrainment by binaural beats in reducing feet. Journal of Kermanshah Academy of Medical Sciences, xviii(1), Article e74271. https://doi.org/ten.22110/jkums.v18i1.1385 (Original piece of work published in Persian)

• Cited Here

Alshvang S. (2018). Preoperative nurses' teaching for open heart surgery patients [Doctorol dissertation]. Walden Dissertations and Doctoral Studies. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=5867&context=dissertations

• Cited Here

Bourdeanu Fifty., Dee V. (2013). Assessment of chemotherapy-induced nausea and airsickness in women with chest cancer: A Neuman Systems Model framework. Enquiry and Theory for Nursing Practice, 27(four), 296–304. https://doi.org/10.1891/1541-6577.27.4.296

• Cited Here

Fawcett J., Desanto-Madeya Due south. (2012). Gimmicky nursing knowledge: Analysis and evaluation of nursing models and theories. F. A. Davis.

• Cited Here

Fawcett J., Garity J. (2008). Evaluating research for evidence-based nursing practise. F. A. Davis.

• Cited Here

Guo P. (2015). Preoperative education interventions to reduce anxiety and amend recovery among cardiac surgery patients: A review of randomised controlled trials. Journal of Clinical Nursing, 24(1–2), 34–46. https://doi.org/ten.1111/jocn.12618

• Cited Here

Guo P., E 50., Arthur A. (2012). A preoperative education intervention to reduce feet and amend recovery among Chinese cardiac patients: A randomized controlled trial. International Periodical of Nursing Studies, 49(2), 129–137. https://doi.org/10.1016/j.ijnurstu.2011.08.008

• Cited Here

Heffline M. Due south. (1990). Exploring nursing interventions for acute pain in the postanesthesia care unit. Journal of Post Anesthesia Nursing, 5(5), 321–328.

• Cited Here

Hinkle J. Fifty., Cheever Thousand. H. (2013). Study guide for Brunner & Suddarth'south textbook of medical-surgical nursing (13th ed.). Lippincott Williams & Wilkins.

• Cited Here

Huang Southward., Xie X., Wu Due south. (2015). Applying Roy Adaptation Model (RAM) in assessing wellness of patient with post-operative coronary artery bypass graft (CABG) surgery. Hougner Protocols in Biomedical Sciences, one(2), 10–xviii.

• Cited Here

Kim J., Shin W. (2014). How to do random allocation (randomization). Clinics in Orthopedic Surgery, 6(one), 103–109. https://doi.org/10.4055/cios.2014.vi.one.103

• Cited Here

Krannich J.-H. A., Weyers P., Lueger S., Herzog M., Bohrer T., Elert O. (2007). Presence of depression and anxiety before and afterward coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry, vii(1), Article No. 47. https://doi.org/10.1186/1471-244X-7-47

• Cited Here

McEwen M., Wills Eastward. M. (2017). Theoretical basis for nursing (fifth ed.). Lippincott Williams & Wilkins.

• Cited Here

Meleis A. I. (2011). Theoretical nursing: Development and progress (5th ed.). Lippincott Williams & Wilkins.

• Cited Hither

Middel B., El Baz North., Pedersen S. S., van Dijk J. P., Wynia K., Reijneveld S. A. (2014). Reject in health-related quality of life 6 months afterwards coronary artery bypass graft surgery: The influence of anxiety, depression, and personality traits. Periodical of Cardiovascular Nursing, 29(six), 544–554. https://doi.org/10.1097/JCN.0b013e3182a102ae

• Cited Hither

Moazzeni S. S., Toreyhi H., Asgari S., Azizi F., Tehrani F. R., Hadaegh F. R., Hadaegh F. (2021). Number of parity/live nascency (s) and cardiovascular disease among Iranian women and men: Results of over 15 years of follow-up. BMC Pregnancy and Childbirth, 21, Article No. 28. https://doi.org/10.1186/s12884-020-03499-ii

• Cited Here

Mrayyan M. (2006). Jordanian nurses' job satisfaction, patients' satisfaction and quality of nursing care. International Nursing Review, 53(3), 224–230. https://doi.org/ten.1111/j.1466-7657.2006.00439.10

• Cited Here

Nasiry Zarrin Ghabaee D., Bagheri-Nesami M., Abbaspour H. (2015). Application of Neuman Systems Model in nurse anesthetists to reduce patients' feet level: A randomized clinical trial. Periodical of Mazandaran University of Medical Sciences, 25(126), 122–131.

• Cited Here

Neuman B. M., Fawcett J. (2002). The Neuman Systems Model (fourth ed.). Prentice Hall.

• Cited Here

Palmerini T., Serruys P., Kappetein A. P., Genereux P., Riva D. D., Reggiani L. B., Christiansen E. H., Holm N. R., Thuesen L., Makikallio T., Morice One thousand. C., Ahn J. Chiliad., Park S. J., Thiele H., Boudriot East., Sabatino K., Romanello One thousand., Biondi-Zoccai M., Cavalcante R., Stone Thou. W. (2017). Clinical outcomes with percutaneous coronary revascularization vs coronary avenue bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients. American Heart Journal, 190, 54–63. https://doi.org/x.1016/j.ahj.2017.05.005

• Cited Here

Parvan Thousand., Zamanzadeh 5., Dizaji S. L., Shabestari M. M., Safaie Northward. (2013). Patient's perception of stressors associated with coronary avenue bypass surgery. Journal of Cardiovascular and Thoracic Research, 5(3), 113–117. https://doi.org/10.5681/jcvtr.2013.024

• Cited Here

Parvan K., Zamanzadeh V., Lakdizaji S., Shabestari G. M. (2012). Nurse's perception of stressors associated with coronary artery bypass surgery. Periodical of Caring Sciences, four(4), 237–243. https://doi.org/x.5681/jcs.2012.033

• Cited Here

Polit D. F., Beck C. T. (2004). Nursing research: Principles and methods (7th ed.). Lippincott Williams & Wilkins.

• Cited Here

Ramesh C. (2017). Effectiveness of comprehensive nursing intervention programme (CNIP) on anxiety, fatigue, self-efficacy and quality of life amid patients undergoing coronary artery bypass graft surgery in a tertiary care hospital—A randomized controlled trial [Doctoral dissertation, Manipal College of Nursing, Manipal Academy]. http://hdl.handle.internet/10603/180729

• Cited Here

Reed Thousand. S. (1993). Adapting the Neuman Systems Model for family nursing. Nursing Science Quarterly, 6(2), 93–97. https://doi.org/10.1177/089431849300600209.

• Cited Here

Rosenfeldt F., Braun L., Spitzer O., Bradley S., Shepherd J., Bailey M., van der Merwe J., Leong J.-Y., Esmore D. (2011). Concrete conditioning and mental stress reduction—A randomised trial in patients undergoing cardiac surgery. BMC Complementary and Alternative Medicine, xi(ane), Article No. 20. https://doi.org/10.1186/1472-6882-xi-twenty

• Cited Here

Sahrakhil M., Nasrabadi T., Ebrahimi Abyaneh E. (2017). Effects of Benson's relaxation technique on comfort level of patients before coronary artery bypass grafting (a clinical trial). Medical-Surgical Nursing Journal, 5(4), 60–65.

• Cited Hither

Sedaghat S., Rostami Due south., Ebadi A., Fereidooni-Moghadam M. (2019). Stressors in open up-middle surgery patients: A qualitative report. ARYA Atherosclerosis, xv(iv), 192–200. https://doi.org/ten.22122/arya.v15i4.1840

• Cited Here

Smith G. C., Parker Thousand. E. (2015). Nursing theories and nursing practise. F. A. Davis.

• Cited Here

Spielberger C. D. (2010). State-trait feet inventory. In Weiner I. B., Crajghead Due west. E. (Eds.), The Corsini Encyclopedia of Psychology.  Wiley Online Library. https://doi.org/10.1002/9780470479216.corpsy0943

• Cited Here

Sultan B. (2018). Application of Betty Neuman theory in intendance of stroke patient. Annals of Nursing and Practice, five(one), Article1092.

• Cited Here

Takagi H., Ando T., Umemoto T.; ALICE (All-Literature Investigation of Cardiovascular Evidence) Grouping. (2017). Perioperative depression or anxiety and postoperative mortality in cardiac surgery: A systematic review and meta-assay. Centre and Vessels, 32(12), 1458–1468. https://doi.org/10.1007/s00380-017-1022-iii

• Cited Here

Tully P. J., Winefield H. R., Baker R. A., Denollet J., Pedersen S. S., Wittert G. A., Turnbull D. A. (2015). Depression, anxiety and major agin cardiovascular and cerebrovascular events in patients following coronary artery featherbed graft surgery: A five year longitudinal accomplice report. BioPsychoSocial Medicine, 9(1), Article No.14. https://doi.org/ten.1186/s13030-015-0041-v

• Cited Here

Verberk F., Fawcett J. (2017). Thoughts about created environment: A Neuman systems model concept. Nursing Science Quarterly, xxx(2), 179–181. https://doi.org/10.1177/0894318417693316

• Cited Here

Wadensten B., Carlsson G. (2003). Nursing theory views on how to back up the process of ageing. Journal of Advanced Nursing, 42(2), 118–124. https://doi.org/ten.1046/j.1365-2648.2003.02594.x

• Cited Here

Wang H.-P., Huang Y.-Q., Jin C.-D. (2019). Betty Newman'due south systematic model and its application in clinical nursing. TMR Integrative Nursing, iii(4), 113–117. https://doi.org/x.12032/TMRIN20190429

• Cited Here

Zhang C. Y., Jiang Y., Yin Q. Y., Chen F. J., Ma 50. 50., Wang L. X. (2012). Affect of nurse-initiated preoperative educational activity on postoperative anxiety symptoms and complications after coronary artery bypass grafting. Journal of Cardiovascular Nursing, 27(1), 84–88. https://doi.org/10.1097/JCN.0b013e3182189c4d

• Cited Here

Keywords:

Neuman Systems Model; anxiety; coronary artery bypass graft surgery; coronary artery illness

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.

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