---

Aim

The aim of this study was to evaluate the effect of planned breathing exercises on oxygenation in patients undergoing coronary artery bypass surgery.

Background

Pulmonary complications and impaired oxygenation are common after coronary artery bypass graft surgery and cause increased hospitalization and health care costs. Breathing exercises are applied commonly in managing coronary artery bypass graft (CABG) patients in many hospitals, but scientific evidence is not sufficient about the efficacy of this treatment.

Method

In a clinical trial , 100 patients undergoing CABG were randomly allocated to planned breathing exercises (n=50) and control group (n=50). The patients in experimental group received breathing exercises protocol (deep breathing, incentive spirometry and directed cough maneuvers) and the patients in control group received daily routine hospital physiotherapy. Other therapies were similar in two groups. Arterial blood gases were compared between groups before operation and the first, second and third postoperative day. The data were analyzed by SPSS Version 17 software using chi square, T test and analysis of variance.

Findings

The study findings showed no statistically significant difference between groups in terms of demographic data, history of chronic diseases, Pao2 and Sao2 before surgery and on the first and second day after surgery. On the third postoperative day, the mean score of SaO2 (95, SD=2.47 vs. 93.24, SD=16.3, p=0.003) and PaO2 (83.19, SD=16.23 vs. 72.66, SD=13.20, P≤0.001) were higher in the experimental group.

Conclusion

The patients receiving planned breathing exercises including deep-breathing exercises, incentive spirometry and directed cough maneuvers have better oxygenation after coronary artery bypass surgery.

---

Aim

 This study was conducted to assess the degree of relationship between peripheral venous pressure and central venous pressure in patients undergoing CABG. 

Background

 Although, cannulation of a large central vein is the standard method for monitoring central vein pressure and providing secure vascular access, this method has serious complications. Moreover, previous studies in adults have demonstrated a clinically useful correlation between central and peripheral venous pressure. 

Method

 In this cross-sectional study, 100 adult patients with the mean age of 61 years that underwent coronary artery bypass graft surgery in Shahid Rajaei Heart Center were enrolled. Peripheral venous pressure through a short 16-18 G catheter and central venous pressure through central line (inserted in right-internal jugular or subclavian vein) were monitored simultaneously in 5 stages: following the induction of anesthesia before, after and during cardiopulmonary bypass and after sternum closure. The results were analyzed by SPSS.  

Findings

 Findings indicated that the mean value of peripheral venous pressure was 11 mmHg and the mean value of central venous pressure was 9.5 mmHg, therefore the mean difference was 2±0.5 mmHg. The correlation of peripheral venous pressure and central venous pressure was 0.95 (P≤0.001) in all 5 evaluating times. Changes in other parameters did not affect the relationship between these two parameters. 

Conclusion

 We concluded that peripheral venous pressure can be used as a predictor of central venous pressure in patients with coronary artery bypass graft surgery.

---

Aim. The aim of this study was to compare the quality of life (QOL) in patients after coronary artery bypass graft surgery (CABG) and percutaneous transluminal coronary angioplasty(PTCA), before surgery and three, six and twelvemonths after surgery.

Background.CABG and PTCA are common treatments in coronary artery disease(CAD). After PTCA the patient is hospitalized only for one day and pays less than CABG,but it is not obviouswhether there is any difference between the quality of life in these two groups.

Method.This prospective cohort study was conducted on 241 patients (115 PTCA and 126 CABG patients) who were hospitalized in Tehran University of Medical Sciences hospitals between 2004-2006. The data were collected by questionnaire including 40 questions regarding demographic data, disease information and quality of life. The data were analyzed by statistical tests including T- test, Fisher's exact test, Wilcoxon and Friedman.

Findings.The findings showed that both groups hadreduction in the quality of life(P≤0.001), but the QOL had statistically significant difference in both groups three, six and twelve months after surgery (P≤0.001).

Conclusion.Patients and their families need to be supported and trained by health care team after performing each of these surgeries and encouraged to follow up their disease status.

---

Aim. The aim of this study was to assess the effect of anti-embolism stocking in preventing lower limb edema following saphenous vein harvesting in patients undergoing coronary artery bypass graft surgery (CABG).

Background. Saphenous vein harvesting in the CABG may cause leg edema and compression therapy commonly used for the prevention of this problem.

Method. This prospective cohort study was conducted on 106 patients underwent elective CABG in Tehran Shahid Rajaei cardiovascular center from June 2011 to March 2011. Following the surgery, at the end of the fourth week, the patients were divided into two study groups according to the method of anti-embolism stocking usage. The first group regularly and consistently used the anti-embolism stocking following surgery (anti-embolism stocking group), whereas the second group did not use anti-embolism stocking, or irregularly used it (control group). The severity of the lower limb edema and changes in the circumference of the legs and thigh were analyzed following the surgery between two groups.

Findings. The findings showed that four weeks after the surgery, the incidence and the severity of the lower limb edema were significantly lower in the anti-embolism stocking group (P≤0.001). Also, the postoperative increase in leg circumference was significantly lower in anti-embolism stocking group, but there was no statistically significant difference between two groups in terms of thigh measurements (P≤0.05). The findings showed that weight and daily activity significantly correlated (P = 0.035 and 0.002 respectively) with the occurrence of lower limb edema, but there was no statistically significant correlation of occurrence of lower limb edema with age, gender, height, the use of diuretic, diabetes, low-salt diet, cardiac postoperative complication, donor leg ulcer complication and method of saphenous vein use.

Conclusion. This study showed that the regular use of anti-embolism stocking has a significant effect for the prevention of the lower limb edema and reduction of its grade, following the saphenous vein harvesting in CABG patients.

---

Aim. This study aimed to evaluate the effect of cardiac rehabilitation on the quality of life in patients undergoing coronary artery bypass graft surgery (CABG).

Background. Nowadays, CABG is common in many patients to treat complications of the cardiovascular disease.

Method. This quasi-experimental study was conducted on 100 patients after coronary artery bypass graft surgery procedure (CABG). Based on objective and with regard to the inclusion criteria, the subjects were randomly divided into two groups of experimental and control groups. Cardiac rehabilitation program was conducted 24 sessions for the experimental group and the control group followed the usual program. Data were collected by demographic and SF-36 quality of life questionnaires at discharge (at the beginning of rehabilitation), the fourth week (after twelfth session) and the eighth week (after twenty fourth session) of cardiac rehabilitation. The data were analyzed by using Chi-square, independent T and RMANOVA tests.

Findings. The findings showed that the experimental and control groups were not significantly different with each other in terms of demographic variables. Comparison of experimental and control groups by using independent T-test showed that approximately there was statistically significant difference in all quality of life components after 12 sessions of cardiac rehabilitation in experimental group (4 weeks after control group discharge). Also, the comparison of both groups showed that after 24 sessions of cardiac rehabilitation in experimental group (8 weeks after control group discharge), there was statistically significant difference in variables such as physical functioning, general health, vitality, emotional role (emotional limitations), mental health, physical and mental health component and quality of life.

Conclusion. The results indicate a significant improvement on quality of life with cardiac rehabilitation intervention therefore, it is necessary to emphasize and encourage cardiac rehabilitation.

---

Aim. The aim of this study was to evaluate the impact of cardiac rehabilitation on hemodynamic parameters

in patients undergoing coronary artery bypass graft surgery (CABG).

Background. Nowadays, CABG is common to treat complications of cardiovascular disease in many

patients.

Method. This clinical trial study was conducted on 50 patients after CABG. The patients were selected

based on objective and with regard to the inclusion criteria. Rehabilitation program was conducted for 24

sessions. Data were collected by demographic questionnaire and hemodynamic parameters checklist at the

beginning of rehabilitation, 12th session and 24th session of cardiac rehabilitation. The data were analyzed

by using Chi-square, RMANOVA tests and SPSS software.

Findings. The groups in terms of demographic variables were not significantly different with each other.

The findings showed statistically significant differences in variables such as systolic blood pressure, pulse

rate and arterial hemoglobin saturation. There were significant differences in these variables between the

first and the last sessions (session 24), also between the first session and during the rehabilitation (session

12). There was a significant difference between the 12th and the end of rehabilitation (session 24) in the

diastolic blood pressure (p=0.045), but no significant differences in other hemodynamic parameters were

seen.

Conclusion. The results indicate a relative improvement in some hemodynamic parameters with cardiac

rehabilitation intervention therefore, it is necessary to pay more attention to the cardiac rehabilitation.

---

Abstract

Aim. The aim of this review study was to describe psychosocial problems in patients with coronary artery disease and determine strategies to prevent and deal with.

Background. The prevalence of cardiovascular diseases is rising in industrial and developing countries. According to the report of World Health Organization, cardiovascular diseases are accounted for a large percentage of mortalities. The most common cardiovascular disease is coronary artery disease that produces problems for people and worries in community.

Method. A systematic search was conducted on studies published in the last 20 years by using databases such as OVID, PROQUEST, SCIENCE DIRECT, GOOGLE SCHOLAR, EBSCO, SID, MAGIRAN and IRAN MEDEX with keywords such as problems, patients, coronary artery disease and related keywords. Because the aim of this study was describing the psychosocial problems of patients after coronary artery disease, physical problems was excluded.

Findings. About 70 article in English and 20 articles in Persian were found about psychosocial problems after coronary artery disease. Patients' problems were categorized in three categories: educational needs of patients with coronary artery disease, consequences of psychosocial outcomes of coronary artery disease, and different consequences for men and women with coronary artery disease.

Conclusion. Because the heart is a sensitive organ, any heart disease can jeopardize patient identity, and psychosocial effects of heart disease is more prominent than physical effects. So, it is necessary to inform patients about the nature of disease and its causes, and how to implement secondary prevention and rehabilitation to return to work and normal life. Accordingly, continuous care for self-care is of great importance. This can be established by community-based clinics for secondary prevention. Especial attention to issues of women with coronary artery disease is essential.

---

Abstract

Aim.  This study was done to assess coronary artery angiography results in ACS patients referred to KashanShahidBeheshti hospital.

Background.Coronary artery disease is one of the most common diseases with the highest mortality rates in developed and developing countries.

Method. This is a cross-sectional study, which was conducted using existent data through convenience sampling of 435 patients. The data were gathered using patient's records using tools including questionnaires and checklist. Variables include age, sex, diagnosis, physician name, left ventricle ejection fraction, dominant side of perfusion of cardiac muscle, type of physician recommendation and involved vessels. Finally, data was statistically analyzed using SPSS software, 16.0.

Findings. The results of this study  showed 56.1% of cases had mild (non-pathological) disorder and others (43.9%) had a severe stenosis in their coronary arteries. Also, 21% of cases had three vessel disease. Also, left anterior descending artery (LAD) was more stenoticthan  the other arteries.

Conclusion.According to the results of this study and high frequencies of non pathologic cases, it is recommended that cheaper diagnostic methods such as accurate clinical examination get used for patient selection

---

Abstract

Aim. The aim of this study was to examine the effect of massage therapy on sleep quality of patients after coronary artery bypass surgery (CABG).

Background. Poor sleep quality is common among patients following CABG and has been noticeable for more than 30 years.

Method. In this quasi-experimental study, 72 patients, who had undergone CABG in Isfahan Chamran Hospital were were recruited. The patients were randomly assigned to the two experimental and control groups. The patients of the experimental group received light pressure stroking massage for 20 minutes in four sessions after the surgery. The patients in control group received only the routine care. The patients› sleep quality was measured before and after the intervention with St Mary›s Hospital Sleep Questionnaire. Data were analyzed by SPSS software, version 18 and descriptive and inferential statistical methods were used for data analysis.

Findings. Mean scores for sleep quality before the intervention in the experimental and control groups were 22.5±3.6 and 22±3.8, respectively, and no statistically significant difference seen between them. After the intervention, there was a statistically significant difference between mean scores for sleep quality of the experimental and control groups (11.8±2.8 vs 15.5±4.7) (P<0.001).

Conclusion. The use of massage therapy can promote sleep quality of patients after CABG and due to low cost and simplicity it can be used as a complement to drug therapy and postoperative interventions implemented in these patients.

---

Abstract

Aim. This study was conducted with the aim of evaluating the effect of spritual care based on «GHALBE SALIM» model on spritual experiences of the patients who have undergone coronaryartery bypass surgery.

Background. Patients undergoing open heart surgery, experience a crisis in their life. Every crisis is considered as a spiritual crisis and creates a unique experience that is rooted in culture and religion. Spiritual intervention which considers the spiritual mutual experience of the therapist and client is called spiritual care based on «GHALBE SALIM» model.

Method. In this clinical trial, 60 patients, candidated for elective coronary artery bypass graft surgery, were randomly assigned to experimental and control groups. Experimental group received spiritual care based on»GHALBE SALIM» model during hospital stay. The questionnaire Daily Spiritual Experience Scale (DSES) was completed by patients at the time of admission and discharge.

Findings. The level of spritual experiences at the time of hospitalization was not statristically significant between groups. On discharge, after implementing «GHALBE SALIM» model, the level of spritual experiences in experimental group was significantly higher in comparison with control group (P<0.001).

Conclusion. Spiritual care based on «GHALB SALIM» model increases the level of spiritual experiences and could be performed for meeting spiritual needs of patients.

---

Abstract

Aim. This study examines the effect of mindfulness-based cognitive therapy on depression in male patients with coronary artery disease.

Background. After heart events such as acute myocardial infarction, the patient experiences psychological distress. Approximately 65 percent of anxiety symptoms predict poor quality of life reduce return to work and increase risk of mortality.

Method.This is an experimental study with two groups and three stages. Forty male patients with coronary artery disease were randomly allocated to either control or trial group after they had been detected as having a "Beck depression inventory" score of one standard deviation higher than the mean score. The mean score of depression was also evaluated in both groups, immediately and two months after the intervention experimental group. The data were analyzed by SPSS Version 19 and covariance analysis.

Findings.The results showed a statistically significant difference between groups in terms of depression score, immediately and two months after intervention in experimental group (P<0.0001).

Conclusion.Based on the effect of mindfulness-based cognitive therapy on reducing depression in patients with coronary artery disease, it is suggested to implement this method for these patients.

---

Abstract  

Background. One of the most important aspects of care and follow-up after coronary artery bypass graft surgery is treatment adherence program. As the long term success of the surgery depends on the treatment of adherence plan.

Aim. The purpose of this study was to evaluate the efficacy of phone and SMS follow-up care on patients' treatment adherence after coronary artery bypass graft.

Method. This clinical trial was performed on patients undergoing coronary artery bypass graft surgery in the heart surgery unit in Tehran hospitals in 2014. In this study, 90 patients were selected purposively and allocated into telephone follow-up group (n=30), SMS follow-up group (n=30) and control group (n=30). Demographic and treatment adherence questionnaire were completed twice (before intervention and two months after the intervention). The telephone follow-up and SMS follow-up groups were given training and booklet before discharge. In telephone follow-up intervention, three calls a week was made for two months and the SMS follow-up group received text messages daily for two months. To analyze the data, Chi-square test, Fisher exact test, t-test and ANOVA, ANCOVA, and Bonferroni test were used.

Findings. There was no statistically significant difference between the telephone follow-up and SMS follow-up groups in terms of treatment adherence scores, before and after intervention. A statistically significant difference was seen between telephone follow-up and control groups (p<0.0001), and SMS follow-up and control groups (p<0.0001) in terms of treatment adherence scores, before and after the intervention.  

Conclusion. Both SMS and telephone follow-up are effective to improve treatment adherence in patients after coronary artery bypass graft. It is suggested to use these interventions for patient following coronary artery bypass graft.

---

Abstract

Aim.The purpose of this study was to examine the effect of patient education on postoperative pain perception in patient undergoing Coronary Artery Bypass Graft (CABG).

Background.Pain is a common complication after CABG surgery. Non-pharmacological methods are more favorable than pharmacological agents. 

Method.In this quasi-experimental study, 72 patients who were scheduled for elective CABG surgery  were randomized to experimental (n=36) and control group (n=36). Experimental group received educational intervention about pain control, one day before surgery (20-30 minutes duration), while control group received no intervention. Following transferring to the ICU and 2 hours after extubation, patients’ pain intensity wasmeasured by Johnson’s numerical scale. The measurements wererepeated twice withanintervalof threehours. The type and dosage of pain medication administered during ICU stay were recorded. To analyse the data, descriptive(mean and standard deviation, frequency distribution and percentage) and analytical statistics (Chi-square and Mann-Whitneytest) were used.

Findings.There was no statistically significant difference between two groups in terms of demographic characteristics. Two hours after extubation, there were no statistically significant difference between experimental and control group in the intensity of pain (P=0.313). Pain intensity was significantly lower in experimental group than control group, 5 hours (P=0.015) and 8 hours (P=0.006) after surgery. The results also showedthat the amount ofanalgesics used to relieve post-operativepain was significantly lower in experimental group than control group (P=0.046).

Conclusion.Patient education about pain control may have positive effects on postoperative pain in patients undergoing CABG surgery. This intervention could serve as an effective strategy for nurses to improve pain management among these patients. 

---

Abstract

Aim.This  review study was done with the purpose of exploring the role of diabetes role in the development of atherosclerosis.

Background.The process of accumulation of fat in the blood vessels is called atherosclerosis. The most important risk factors and aggravating condition of atherosclerosis are the accumulation of carbohydrates and diabetes.

Method.In this study, we reviewed the electronic and manual searches of databases such as Medline, Embase, Springer, Blackwell Synergy, Elsevier, Scopus, Cochran Library and the databases SID, Iran Medex and Magiran within the time period of 2005 -2015.

Findings.The most common cause of death in patients with diabetes is coronary artery disease. Because nitric oxide production is higher in diabetic patients, the process of atherosclerosis occurs more rapidly and coagulation cascade disorder leads to the platelet adhesion, so, diabetic people, especially women, are more prone to atherosclerosis and coronary artery disease.

Conclusion.Nurses can modify several risk factors for atherosclerosis in these patients through education and follow-up, thereby, improving quality of life in these patients.

---

Aim. The aim of this study was to examine the effect of preferred music on sleep quality of patients after coronary artery bypass surgery (CABG). Background. Sleep disorder is common among patients undergoing coronary artery bypass surgery that can also affect other postoperative outcomes. Method. This study was a quasi-experimental trial in which 70 patients who were undergoing coronary artery bypass surgery were recruited using convenience sampling method and assigned into the experimental and control group. Patients in experimental group listened to their preferred music by MP3 player for 20 minutes during 4 consecutive days, while patients in control group received only routine care. The patients’ sleep quality was measured before and after the intervention by means of Pittsburgh sleep quality inventory. Data were analyzed by SPSS, version 16, and descriptive and inferential statistical were used to report the findings. Findings. There was no statistically significant difference in sleep quality, before and after intervention in experimental and control groups. Conclusion. Music did not have effect on sleep quality among patients undergoing coronary artery bypass surgery, but the study can be reproduced with some modifications (change in intervention time and period and targeted selection of patients) in future studies.

---

Aim. The purpose of this study was to review the effectiveness of new cardiac biomarkers.

Background. Cardiovascular diseases have been a heavy burden on the health system’s shoulders and caused about 30 percent of human's deaths annually. Irreversible myocardial injury occurs within around 15-20 minutes following the coronary artery occlusion. Therefore, early diagnosis of this problem is very important for the health care professionals to save patients’ lives. Nowadays, thanks to recognition of new biomarkers and using their characteristics, evaluating the short-term and long-term prognosis is possible.

Method. In this study, papers published within the time period 1980 to 2014, were considered. The papers  were searched out by the keywords “cardiac biomarker”, “new cardiac markers”, “coronary diseases”, and “cardiovascular diseases” in Elsevier, Google Scholar, JAMA, Science Direct, Wiley, PubMed, and Iran Medex databases.

Findings. The results indicate that characteristic of each biomarker can play an important role to advance the goals of medicine and harm reduction in the cardiovascular patients. However, despite the high efficiency, routine usage of them is still unclear which indicates the need for further research in this field.

Conclusion. New biomarkers provide new insight about recognition of the causes of cardiovascular diseases, also their easy and rapid application with high sensitivity and predictive value will develop a dramatic change in the diagnosis and treatment of patients with cardiovascular diseases.

---

Aim. This study was conducted to examine the effect of family-centered education on the quality of life patients after coronary artery bypass graft surgery.

Background. Following coronary artery bypass graft surgery, the patients face many physical, mental and social problems, which reduce their quality of life. Teaching the patient's family provides an opportunity for family members to cooperate actively in taking care and supporting patient, thereby, improve patients' quality of life.

Method. This was an experimental study in which 96 patients with their active family members were recruited according to inclusion criteria and randomly allocated to experimental (n=48) and control group (n=48). Before intervention, SF-12 Quality of Life Questionnaire (QOL) was completed by participants in both groups. Then, experimental group received family-centered education in three sessions and control group received only hospital routine educational program. Quality of life was again measured one month later. The data were analyzed by SPSS version 22.

Findings. There were no statistically significant differences between the two groups regarding demographic characteristics. Based on Mann-Whitney test, a statistically significant increase was observed in scores of QOL dimensions after intervention in the experimental group as compared with control group (P<0.0001).

Conclusion: Family-centered education in patients under coronary artery bypass graft can improve quality of life in these patients.

---

Aim. The aim of this study was to investigate the role of social capital in healthy lifestyle promotion among people with Coronary Artery Disease (CAD).

Background. Social capital, one of the social determinants of health, plays an important role in promoting healthy lifestyle among people. Due to increasing incidence of CAD, research is needed about social capital and its relationship with healthy lifestyle among people with CAD.

Method. This cross-sectional study was conducted on 412 patients with CAD, including 239 men and 173 women, in 4 different wards (i.e. men and women internal wards, Diplomat and VIP wards) in Shahid Rajaie Cardiovascular, Medical and Research Center from January 2015 to June 2015. Data were collected by demographic characteristic form, Miyamoto et al. social capital questionnaire and researcher-made questionnaire of healthy lifestyle. Validity and reliability were confirmed by content analysis and Cronbach's alpha methods. The data were analyzed using SPSS with appropriate statistical tests. 

Findings. There was a statistically significant difference between social capital in terms of gender (p=0.015). A statistically ssignificant correlation was found between social capital and healthy lifestyle (r=0.418, P<0.01). The highest correlation was observed between social capital and “health responsibility” component (r=0.384, P<0.01) and the lowest correlation was observed between social capital and “abstain from tobacco and alcohol’’ (r=0.107, P<0.01). Among social capital components, “social relationships” had the highest correlation with healthy lifestyle (r=0.511, P<0.01).

Conclusion. Social capital and its components have positive and important effects on healthy lifestyle and its subscales. It is necessary to emphasize community-based programs, such as strengthening social capital in the society to prevent and control chronic diseases, especially heart disease.

---

Aim. This study was conducted to determine the effect of Lemon Balm (Melissa Officinalis) on depression in patients after coronary artery bypass graft.

Background. Coronary artery bypass grafting (CABG) is the most common operation among patients with coronary artery disease. Many of these patients are faced with depression after cardiac surgery.

Method. In this randomized clinical trial, 80 patients undergoing coronary artery bypass graft were randomly assigned to treatment and placebo groups. Data collection tools included demographic and clinical sheet and the Hospital Anxiety and Depression Scale (HADS). Each patient randomly received either a capsule containing 500 mg lemon balm or a placebo, 3 times a day. After 7 days, depression in both groups was measured and compared. Data analysis was performed using SPSS (version 16).

Findings. After the intervention, herbal balm decreased depression more in intervention group compared with the placebo group (P=0.008).

Conclusion. According to findings , Lemon balm may reduce depression after coronary artery bypass graft.

---

Abstract

Aim. The purpose of the present study was to examine the effect of supportive educational intervention on quality of sleep before coronary artery bypass grafting surgery.

Background. Patients who are waiting for surgery, experience high levels of stress and anxiety due to invasive nature of the procedure. This experience may influence their sleep quality. Disturbed sleep could lead to worsening the disease condition and reduces the process of recovery. Using non-pharmacological methods such as Benson muscle relaxation, deep breathing and guided imagery could be safe and useful for solving patients’ sleep problems before surgery.

Method. The present study was a quasi-experimental clinical trial in which 160 patients undergoing coronary artery bypass grafting surgery who hospitalized in cardiac surgery wards and cardiac intensive care units of selected hospitals of Tehran University of Medical Science were recruited and divided into two experimental (n=80) and control (n=80) group. Demographic data questionnaire was given to the patients at the first day of hospital admission. The control group received routine care. The intervention group received routine care and supportive educational intervention for at least two days between 4 and 6 p.m. All of the patients filled Groningen sleep quality scale in the day of surgery. Data analyzed by SPSS version 16.

Findings. Before surgery, the mean score of sleep quality was 4.6±5.50 in intervention group and 10.76±1.27 in control group.  There was a statistically significant difference between the experimental and control group in terms of sleep quality as the experimental group reported higher quality sleep than control group (P<0.0001).

Conclusion. Implementation of non-pharmacological methods such as relaxation, deep breathing, and guided imagery could be a good alternative method for hypnotic and sedative drugs. This could be one of the nursing interventions before coronary artery bypass grafting surgery as a safe, available and useful method.