Anxiety, Coronary Artery Disease, Discharge Education, Nursing, Pain, Patient Discharge, Postoperative Care, Recovery of Function, Stress, Physiological, Surgical Nursing
Conditions
Keywords
Coronary Artery Disease, Postoperative Care, Patient Discharge, discharge education, Surgical Nursing
Brief summary
This randomized controlled trial will evaluate the effectiveness of artificial intelligence-supported individualized discharge education for patients undergoing coronary artery bypass graft (CABG) surgery. Participants will be assigned to either the intervention group, which will receive personalized AI-generated discharge education delivered through a nurse-avatar video in addition to standard verbal education, or the control group, which will receive standard discharge education only. The study will compare postoperative pain, anxiety, physiological stress response, recovery, and satisfaction with discharge education between the two groups. Outcomes will be measured during hospitalization and at the routine postoperative follow-up visit. The findings may help improve patient education methods and postoperative recovery in cardiac surgery patients.
Detailed description
Coronary artery bypass graft (CABG) surgery is a major cardiac procedure that requires structured discharge education to support patients' physical, psychological, and behavioral recovery after hospitalization. Traditional discharge teaching provided by nurses is often limited by time constraints, varying patient needs, and inconsistent information delivery. Recent advances in artificial intelligence (AI) offer new opportunities to provide individualized, understandable, and repetitive patient education that may enhance postoperative recovery. This randomized controlled trial aims to evaluate the effectiveness of AI-supported individualized discharge education for patients undergoing CABG surgery. The intervention consists of a personalized discharge education script generated by an advanced large-language-model system (ChatGPT), structured according to 6 main topics and 24 sub-domains, and then converted into a nurse-avatar video. Patients in the intervention group will receive this AI-supported education in addition to the standard verbal discharge education provided by cardiovascular surgery nurses. Patients in the control group will receive only the standard discharge education based on current hospital protocols. The study will assess multiple postoperative outcomes, including pain intensity, anxiety levels, physiological stress response (cortisol, adrenaline, noradrenaline, ACTH, glucose, and insulin), recovery after discharge using a validated surgical recovery scale, and satisfaction with discharge education. Measurements will be collected at four time points: the day before discharge, the morning of discharge before education, immediately after the completion of discharge education, and at the routine postoperative follow-up visit. A total of 128 participants will be randomized into two groups using block randomization stratified by sex. All data will be collected using validated scales and standardized laboratory procedures. This study is expected to provide evidence on whether AI-supported discharge education can improve postoperative recovery, reduce stress and anxiety, and increase satisfaction among CABG patients. The results may contribute to the development of innovative, technology-enhanced education models for surgical patients and support the integration of AI tools into nursing practice.
Interventions
BEHAVIORALAI-Supported Individualized Discharge Education
This intervention consists of personalized discharge education generated by an advanced artificial intelligence system (ChatGPT) based on the patient's clinical, social, and psychosocial characteristics. The content is structured into 6 main topics and 24 sub-sections. The script is converted into a nurse-avatar video and delivered to the patient via a mobile device. This intervention is provided in addition to the standard verbal discharge education routinely given by cardiovascular surgery nurses.
BEHAVIORALStandard Discharge Education
This intervention consists of routine verbal discharge education provided by cardiovascular surgery nurses according to standard hospital protocols. It includes essential postoperative instructions, medication guidance, wound care instructions, activity recommendations, and follow-up information. No AI-generated or video-based educational materials are provided in this intervention.
Sponsors
Hasan Kalyoncu University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
No masking was used. This is an open-label trial, and no parties were blinded to group assignment.
Intervention model description
Participants will be randomly assigned to one of two parallel groups. The intervention group will receive AI-supported individualized discharge education delivered through a nurse-avatar video in addition to standard verbal education. The control group will receive standard discharge education only. Each participant will remain in the group to which they were originally assigned throughout the study.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients who have undergone coronary artery bypass graft (CABG) surgery. * Age 18 years or older. * Hemodynamically stable at the time of enrollment. * Able to understand and communicate in Turkish. * Able to use or have access to a mobile phone capable of viewing the educational video. * Able to provide informed consent. * Scheduled for routine postoperative follow-up at the study hospital.
Exclusion criteria
* Patients undergoing emergency CABG surgery. * Presence of severe cognitive impairment that prevents understanding or following instructions. * Diagnosed psychiatric disorders (e.g., schizophrenia, severe depression) that interfere with study participation. * Severe vision or hearing impairment that prevents receiving the education. * Presence of postoperative complications requiring intensive care readmission. * Patients with endocrine disorders affecting stress biomarkers (e.g., Cushing's syndrome, Addison's disease). * Chronic use of corticosteroids or medications that significantly alter cortisol levels. * Patients who decline to participate or withdraw consent. * Patients who are unable to complete follow-up assessments.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Anxiety will be measured using a 10-cm Visual Analog Scale (VAS). Participants will indicate their perceived level of anxiety on a horizontal line ranging from 0 to 10, where 0 represents "no anxiety" and 10 represents "the highest possible level of anxiety." The score is obtained by measuring the distance in centimeters from the left end of the scale to the participant's mark, producing a continuous value between 0 and 10. Higher scores indicate higher levels of anxiety. This measure allows for sensitive detection of changes in anxiety over time. No threshold or categorical classification is used; all results are reported as continuous VAS scores. |
| Anxiety Level | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Anxiety will be assessed using the Visual Analog Scale (VAS). The scale ranges from 0 to 10, where higher scores indicate greater anxiety levels. |
| Serum Cortisol Level | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Physiological stress will be evaluated by measuring serum cortisol levels obtained from venous blood samples. Higher cortisol levels indicate increased physiological stress response. |
| Postoperative Recovery | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Postoperative recovery will be evaluated using a validated postoperative recovery scale assessing physical, emotional, and functional recovery. Higher scores indicate better postoperative recovery. |
| Satisfaction with Discharge Education | Pre-discharge (within 24 hours before discharge) and 4 weeks (±3 days) post-discharge | Satisfaction with discharge education will be measured using a validated satisfaction scale assessing patients' satisfaction with the information received before discharge. Higher scores indicate greater satisfaction. |
| Blood Pressure - Systolic | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Systolic blood pressure will be measured using a calibrated clinical blood pressure monitor and recorded in mmHg. Higher values indicate higher arterial pressure during cardiac contraction. |
| Blood Pressure - Diastolic | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Diastolic blood pressure will be measured using a calibrated clinical blood pressure monitor and recorded in mmHg. Higher values indicate arterial pressure during cardiac relaxation. |
| Respiratory Rate | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Respiratory rate will be measured by counting the number of chest rises over one minute and recorded as breaths per minute (breaths/min). Higher values indicate increased respiratory effort or possible respiratory distress. |
| Oxygen Saturation (SpO₂) | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Oxygen saturation will be measured using pulse oximetry and recorded as the percentage of oxygen-saturated hemoglobin in arterial blood. Lower values indicate impaired oxygenation. |
| Body Temperature | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Body temperature will be measured using a digital thermometer and recorded in degrees Celsius (°C). Deviations from normal temperature may indicate infection or inflammatory response. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart Rate | Baseline (1 day before discharge), pre-discharge (within 24 hours before discharge), and 4 weeks (±3 days) post-discharge | Heart rate will be measured using a clinical monitor and recorded in beats per minute (bpm). Higher values indicate increased cardiac activity. |
Contacts
CONTACTUğur Akman, RN, MSc
Outcome results
None listed