The findings of the current study on the hospital anxiety and depression showed that all of the subjects were at a low level of the psychological condition at Firoozabadi Hospital (scoring less than 8 on each of the subscales). In total, 91.6% of the subjects perceived the quality of nursing care integrated with CG desirable. The results showed that there is a significant negative correlation between hospital anxiety and quality of nursing care integrated with CG by elderly patients with CHD.
The results are consistent with the findings of other studies [Kazitani et al. , Polikandrioti et al.  and Orujlu et al. ], which mainly assessed the quality of nursing care in the teaching hospitals from the patients ‘perception. However, the current study finding is not in agreement with the results of studies of Shujaat et al.  and Moradian et al.  that showed increased hospital anxiety and depression in the patients hospitalized in cardiac wards. These differences between the results of the mentioned previous studies might be because of the settings in which they measured patients’ anxiety and depression in university hospitals with no CG process initiated. There are significant opportunities for improving the quality and safety of clinical practices through clinical governance within health organizations and teaching hospitals . It appears that clinical governance represents one of the most significant policy developments in recent years. The concept of CG concerns the corporate responsibility of all healthcare professionals to deliver high-quality standards, a better quality of life in a cost-effective manner .
Furthermore, it is important to note that anxiety and depression during hospitalization can negatively affect performance, quality of life, length of stay, and even health outcomes in cardiac patients. In general, the frequency of anxiety in cardiac patients is relatively high, investigating mental health disorders in elderly patients with CHD is significant .
The results of the present study also showed that hospital anxiety and depression were significantly higher in female elderly patients than male elderly patients. As mental health disorders have been demonstrated to be risk factors for CHD , the finding is consistent with the results of Polikandrioti et al.  study of Shujaat et al.  and Orujlu et al.  in patients with coronary artery disease. In this study, hospital anxiety and depression were at a low level in the subjects. This finding could be due to the educational and academic status of the hospital with the initiation of the CG and accreditation process to improve the quality of services and care for patients (20 and 21). In general, the prevalence of anxiety and depression is higher in women than in men (Baxter). In the UK, women are almost twice as likely as men to be diagnosed with anxiety disorders. In England, 6.8% of all women were diagnosed with general anxiety disorder compared to 4.9% of all men .
Hospital depression was not correlated with the quality of nursing care. This may be because the occurrence of depression is related to the length of hospital stay and it was different in this study.
However, to create "Elderly Friendly Hospitals" and to realize the concept of "Healthy, Active and Successful Aging" , future studies focus on qualitative approaches in the field of new health policies are needed to understand the impact of CG and accreditation on the quality of care and mental health from the elderly patients’ perception. It is recommended that Managers of healthcare services should take into account CG seriously to paradigm shift beyond routinely care program toward innovative approaches of health policy. Moreover, hospital accreditation and CG have a positive impact on improving the quality of services provided in the hospitals through improved quality of management, improved health professional workability . In the study of Azim Beik et al, 2017 in Iran, the workability of the considerable percentage of nurses in teaching hospitals of Tehran was at an appropriate level that could result in patients’ satisfaction and favorable psychological well-being .
Focusing on holistic nursing care in clinical services, it is noteworthy to note that some limitations should be taken into account when interpreting this study's results (e.g. No comparison with other units and hospitals). The study was conducted on the elderly patients with CHD at Firoozabadi Medical Center and the samples are not necessarily representative of all patients. To reach a conclusion that encompasses the whole patients’ viewpoints, it is advisable to conduct this study on a larger scale and in multiple teaching hospitals. Although this study was conducted on seniors who achieved a minimum score of 7 on the AMT test for cognitive functioning, which could be a strength of the study, the hospital anxiety and depression in seniors with cognitive impairment might have other results. Moreover, the present study was a cross-sectional (descriptive correlational) design, to fully and accurately understand the association between the variable of hospital anxiety and depression and quality care integrated with CG, it is recommended to conduct a predictive correlational design as well as trend studies over time in different stages from the time of admission until discharge from the hospital.