In this randomized clinical trial with cardiac surgical patients, the preoperative guidance intervention with the aid of audiovisual resources improved the patients' anxiety levels and increased knowledge, compared to the conventional intervention of only verbal guidance from the health professional.
The orientation investigated in this study combined with technology transforms the preoperative period into a period of concrete, continuous learning that reduces waiting time. This is beneficial for the patient, as studies show that the delay in the perioperative process increases negative feelings and physical and emotional instability4,15. The video resource was evaluated in other studies that also improved preoperative MRI guidance and decreased anxiety levels7,13.
In this research, it was possible to observe that the video was well accepted by the EG patients, increasing the feelings of confidence to perform the surgery after the intervention. Making this resource an important intervention for the patient care process, considering that the patient has a lack of knowledge and this is an obstacle in the patient's stability, making it a point to be worked on before surgery4,5.
As observed in this study, low education reflects an increase in the level of anxiety and is an obstacle for the patient to understand the orientation. This association is found in other studies associating it with increased anxiety and worsening of the prognosis of surgical patients16.
An association was found between the use of AR and an increase in the level of knowledge, as in other studies that used video as an educational tool7. It is possible to conclude that the experimental group obtained better knowledge in relation to topics such as immediate preoperative, postoperative and surgical recovery. These themes are pointed out in studies as unknown by patients, suggesting that they are the focus to improve patient learning5,16.
In addition, preoperative guidance also reduces anxiety, improves physical and psychological recovery and reduces care costs16-19. A randomized clinical trial4 showed that individualized health education reduces the incidence of postoperative delirium.
A better understanding of the health situation and the surgical procedure for the patient provides a feeling of comfort and improves the interpersonal relationship between professional and patient, considering preoperative nursing guidance as an efficient non-pharmacological measure in anxiety and postoperative recovery. in the form of health education7,16,18.
An association was found between preoperative guidelines and reduced anxiety levels in both groups (p < 0.05). Anxiety, before with moderate levels, reached low levels. This evidence is observed in many studies that associate this decrease with fewer surgical complications, hemodynamic stability, lower pain rates and analgesic consumption16,18,19.
An association was also found between the use of AR and a greater reduction in anxiety, where the EG obtained a complete decrease in STAI-state, an increase in the rate of responses to positive feelings and a decrease in negative feelings, which suggests that the explanation by the video increases knowledge and demonstrates positive effects in this scenario to help nurses.
Levels classified as high in STAI were not identified in any patient in this sample, which may be related to the fact that the sample is predominantly male and the high levels of anxiety are related to females, as demonstrated by some studies that show risk factors prone to high levels of anxiety and depression in the preoperative period of cardiac surgery in women3,19.
There is also a difference between the STAI averages in the studied groups, in which the CG had higher STAI-state and STAI-trace than the EG both in the pre and post-mortem periods, which demonstrates the effectiveness of the AR used in the research. In addition, this mean value may also be related to the age of the patients, according to the literature19.
These instruments facilitate patient approach and ensure safe care, which reduces risks and improves patient confidence in the team, in order to contribute to a safe and uncomplicated recovery.
It is noteworthy that the nursing visit focused on the patient, with an emphasis on knowledge about the surgical period, has long-term beneficial effects7,18. Knowing this, this study contributes significantly by bringing a technological tool that can serve as an alternative non-pharmacological intervention instrument in the care process for surgical patients.
Clinical trials like this one have small samples in an attempt to evaluate a homogeneous population, therefore, the generalization of the results is limited to the population of this study, corresponding to adults undergoing myocardial revascularization surgery.
Studies in different populations and with larger samples are necessary and should be carried out to evaluate the research question, encouraging multicenter studies to improve the evidence and design interventions that help the patient during surgery.
It was concluded that this study contributes significantly by bringing a technological tool that can serve as an alternative tool for non-pharmacological intervention in the process of caring for surgical patients. In which video as an AR has a positive effect on increasing knowledge and reducing the level of anxiety of patients in the preoperative period of CRM.
It also demonstrates the importance of nurses in the preoperative period and in health education for patients with heart disease, resulting in reduced anxiety and increased knowledge. This builds the improvement of the nursing care process through educational technologies and the reduction of surgical complications due to lack of knowledge about the surgical process and recovery. Without causing further damage or complications to the patient.