Effect of Stress Ball During Chest Tube Removal After Open Heart Surgery

Chest tubes are routinely removed on the second or third postoperative day in patients in the Cardiovascular Surgery Intensive Care Unit, and patients with stable hemodynamic variables are discharged to the clinic. Morphine (0.01 mg) and paracetamol (if necessary) are used for routine analgesic treatment during the intensive care unit. Data will be collected between September 1, 2025, and September 1, 2026. Before the stress ball application after open heart surgery, participants in the control and study groups will be asked to complete the Descriptive Characteristics Form, VAS, VAS-A, and Hemodynamic Variables Monitoring Form. The Hemodynamic Variables Monitoring Form will be completed by the researcher (F.E.Ö) while monitoring the patient on the bedside monitor (Nihon Kohden, Tokyo). Participants who complete the Descriptive Characteristics Form, VAS, and VAS-A, and whose hemodynamic parameters are recorded, will be administered the stress ball application by Firdevs Ebru Özdemir and Nesrin Temiz.In addition to the clinic's routine treatment and care, patients in the study group will receive a stress ball during chest tube removal. 15 minutes before the procedure, nurses (FEÖ and NT) will explain and demonstrate how to use the stress ball. The stress ball will be applied for approximately five minutes, including the chest tube removal procedure. A round, medium-hard, high-quality silicone ball, approximately 6 cm in diameter, will be used. Patients will be asked to hold the ball in their palms, count to three, squeeze, and release once. Patients will be instructed to continue this exercise until the chest tube removal procedure is completed, and then, under the supervision of the researcher, for approximately five minutes, focusing their attention on the stress ball. The ball will be washed and cleaned after each use and wiped with disposable asepsis wipes before being administered to the patient. The control group will not receive any other treatment beyond routine treatment and will be assessed at the same time as the study group.

The chest tube will be removed by a physician during the stress ball application. Procedural pain level, anxiety level and hemodynamic variables of all patients in the study and control groups will be re-evaluated immediately after chest tube removal and 15 and 30 minutes after chest tube removal.

Inclusion criteria

Patients will be included : have only one chest tube after open heart surgery,

• are 18 years of age or older,
• are conscious and cooperative,
• speak and understand Turkish,
• have a stable general condition and hemodynamic variables,
• have a planned surgical procedure,
• have no previous chest tube experience,
• have no psychiatric diagnosis,
• are not using psychiatric and/or local neuromuscular blocking medications,
• agree to participate in the study (sign the Informed Consent Form).

Exclusion criteria

Patients who do not have a chest tube or have multiple chest tubes after open heart surgery,

• Are under 18 years of age,
• Are conscious and uncooperative,
• Do not speak or understand Turkish,
• Are in an unstable general condition or hemodynamic variables,
• Have undergone emergency surgery,
• Have previous chest tube placement experience,
• Have a current psychiatric diagnosis,
• Are taking psychiatric and/or local neuromuscular blocking medications,
• Do not agree to participate in the study (do not sign the Informed Consent Form) will not be included in the study.