From Variability to Value: A Standardized Nurse–led Preoperative Protocol in Cardiac Surgery

Background Recent studies have highlighted the effectiveness of in–depth shared preoperative assessment in improving clinical outcomes, patient safety, and quality of care. Although the importance of a comprehensive assessment that also includes nursing assessment has been known for several years, there are a variety of approaches and standards in clinical practice, with a clear lack of consensus on the most effective methodology. Objective The proposed study explores the feasibility of a standardized protocol to improve the quality of care in cardiac surgery and reduce anxiety in patients with the main objective of reducing preoperative anxiety by reorganizing the preoperative evaluation by the anesthesia nurse. The secondary objective is to improve user satisfaction and reduce preoperative fear levels. Methods This is an ongoing pre–post comparative study in patients undergoing cardiac surgery. In the pre–phase, we measured pre–operative anxiety and fear using the APAIS scale and the Surgical Fear Questionnaire. In the post–operative period, user satisfaction indicators were collected related to the quality of nursing care. The intervention and the post–phase will start in January 2026. Results Sixty–five patients have been enrolled for the pre–phase since September 2025. The 33.8% of the sample was anxious according to the APAIS cut–off. The overall need for information was moderate, with a distribution centered around the mean value of the scale and a clinically relevant variability(SD › 2). Pre–operative fear was reported by 40% of patients in the short term, 23.1% in the long term, and 26.2% considering the total value. Patients, regardless of pathology, showed similar levels of anxiety and fear; however, the need for information was different in relation to the type of intervention planned (p=0.004). Due to global variability of responses, it was not possible to localize with statistical certainty which intervention impacted more in the individual subgroups analyzes. In the post–operative period, the satisfaction indicators showed an overall positive assessment of the care aspects, with consistent results also for reception, and staff preparation despite the limited interaction with family members. Conclusion In this first exploratory phase we were able to map the actual situation which will constitute our benchmarking in the post–phase and confirm the need of a nursing intervention to reduce information anxiety and surgical fear.