Individualized Orem-Based Nursing Intervention After Coronary Artery Bypass Grafting

This prospective, two-group, parallel randomized controlled trial evaluated an individualized self-care and nursing intervention program based on Orem's Self-Care Theory among patients following coronary artery bypass grafting (CABG).

The study was conducted in cardiology departments and cardiac intensive care units (CCUs/CICUs) of hospitals affiliated with the Jordanian Ministry of Health in Jordan. Participants were recruited from August 2025 to February 2026, and follow-up assessments continued for 6 months.

A total of 440 eligible patients were randomly allocated in a 1:1 ratio to either the intervention group or the control group. The intervention group received an individualized Nursing Intervention Program Based on Orem's Self-Care Theory in addition to usual postoperative care, whereas the control group received usual postoperative care. The intervention was designed to address patients' individual learning needs and self-care requirements during recovery following CABG.

The intervention incorporated individualized education and nursing support addressing postoperative recovery, medication management, physical activity and gradual mobilization, dietary and lifestyle recommendations, symptom monitoring, recognition of warning signs and complications, surgical wound care, self-care behaviors, cardiac self-efficacy, psychological adjustment, problem-solving, decision-making, and long-term cardiovascular self-management. Educational content was tailored according to each participant's identified learning needs, self-care difficulties, postoperative symptoms, functional limitations, and barriers to recommended self-care.

Participants were assessed at baseline and at 3- and 6-month follow-up. Study outcomes included postoperative learning needs, self-care behaviors, cardiac self-efficacy, anxiety, depression, wound-management behaviors, and health-related quality of life. The study used standardized assessment instruments, including the Postoperative Learning Needs Scale, a CABG-adapted self-care behavior measure, the Cardiac Self-Efficacy Questionnaire, the Hospital Anxiety and Depression Scale, and the EQ-5D-5L.

The primary longitudinal comparison was based on changes in outcomes over time between the intervention and control groups. Longitudinal outcome data were analyzed using linear mixed-effects models incorporating study group, assessment time, and the group-by-time interaction as fixed effects and participant as a random effect to account for repeated measurements.

Inclusion criteria

• Adults who had undergone coronary artery bypass grafting (CABG).
• Clinically stable following surgery.
• Able to communicate and complete the study questionnaires.
• Willing to provide written informed consent.
• Access to a telephone to facilitate post-discharge follow-up and communication during the recovery period.

Exclusion criteria

• Clinical or cognitive conditions that substantially interfered with participation in the individualized self-care program or completion of the outcome assessments.
• Major postoperative conditions that could independently influence recovery and self-care performance, including major postoperative complications such as stroke or severe wound infection.