Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome.

OBJECTIVE: To identify the predictive factors of anxiety and depression in patients with acute coronary syndrome. METHODS: Cross-sectional and retrospective study conducted with 120 patients hospitalized with acute coronary syndrome. Factors interfering with anxiety and depression were assessed. RESULTS: Anxiety was related to sex, stress, years of education, and depression, while depression was related to sex, diabetes mellitus, obesity, years of education, and trait-anxiety. CONCLUSIONS: Obesity and anxiety were considered predictive factors for depression, while depression and fewer years of education were considered predictive factors for anxiety.

[Burnout in nursing residents]. / Burnout em residentes de enfermagem.

Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An investigative, descriptive, analytical, longitudinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, translated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonalization; 18.8% showed impaired commitment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric Intensive Care. Age and specialty area were positively correlated with Personal Accomplishment. One of the Residents was identified with changes in three subscales of the Maslach Burnout Inventory, thus characterized as a Burnout Syndrome patient. Nursing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers.

Comparing levels of anxiety during bed and shower baths in patients with acute myocardial infarction.

This study compared the levels of anxiety presented by patients with acute myocardial infarction in bed and shower baths and the influence of antecedent variables: age, gender, medications, previous hospitalization and/or bed bath, patients' preference regarding the professional's gender, risk factors and anxiety-traits. This crossover study was conducted between February and August 2007 in coronary units. The sample was composed of 71 patients with acute myocardial infarction. The State-Trait Anxiety Inventory (STAI) was applied before the baths (bed and shower baths), immediately after the baths and twenty minutes after the second evaluation. Results revealed that patients were more anxious in the bed bath than in the shower in the three assessments (p <0.0001) and the only variable that interfered with state-anxiety was high blood pressure.

Preliminary study about occupational stress of physicians and nurses in pediatric and neonatal intensive care units: the balance between effort and reward.

This study compared the balance between effort (E) and reward (R) among physicians and nurses working in pediatric (PED) and neonatal (NEO) Intensive Care Units. This descriptive cross-sectional study was carried out with 37 physicians and 20 nurses. The Effort-Reward Imbalance Questionnaire was used. Statistically significant differences were not found among physicians (p>0.05) or nurses from PED and NEO in relation to E and R (p>0.05). No statistically significant differences were found between physicians and nurses in PED in the several studied variables. Comparison between the professionals working in NEO revealed that physicians presented more over-commitment than nurses (p=0.01). The organizational setting of NEO proved to be more demanding for physicians, exacting a greater commitment to their work, while demands presented in both units seemed to be the same for nurses.

[Preliminary study about qualify of life of physicians and nurses working in pediatric and neonatal intensive care units]. / Estudo preliminar sobre a qualidade de vida de médicos e enfermeiros intensivistas pediátricos e neonatais.

Compare the Quality of Life (QL) of doctors and nurses who work in Pediatric (PED) and Neonatal (NEO) Intensive Care Units, and to evaluate whether there are differences between the QL in the same job category, but differing according to the work unit. This descriptive study was performed with 37 physicians and 20 nurses. The WHOQOL100 was used. Physicians from the PED differ statistically in the field VI (p = 0.003) compared with physicians from the NEO. Physicians and nurses from the PED showed a statistically significant difference in field V (p < 0.01), while physicians and nurses from the NEO showed a statistically significant difference in field VI (p = 0.05). The QL assessment of physicians and nurses working in pediatric and neonatal intensive care units was below the scores found in scientific literature, compared to studies that evaluated patients with chronic pain and mental health disorders, indicating the occurrence of occupational stress.

[Demands and control of work: implications in pediatric and neonatal intensive care units]. / Demandas do trabalho e controle: implicações em unidades de terapia intensiva pediátrica e neonatal.

To compare the demand and control over work of physicians and nurses working in pediatric and neonatal critical care units. Cross-sectional study with 37 doctors and 20 nurses. We used the Job Content Questionnarie. Physicians from the ICU Neonatal differ in social support received from the supervisor (p= 0.01) compared to the ICU Pediatric. ICU nurses of the Neonatal present job insecurity (p= 0.05). Physicians and nurses from the ICU Pediatric differ in control over the work, psychological demands of work, physical effort and support of the supervisor (p <0.05). Physicians and nurses from the ICU Neonatal show statistical differences in control over the work, physical effort and support of the supervisor (p<0.05). The work environment in the ICU'S presents high demand and low control over the work.

Health-related quality of life predictors during medical residency in a random, stratified sample of residents.

OBJECTIVE: To evaluate the quality of life during the first three years of training and identify its association with sociodemographicoccupational characteristics, leisure time and health habits. METHOD: A cross-sectional study with a random sample of 128 residents stratified by year of training was conducted. The Medical Outcome Study -short form 36 was administered. Mann-Whitney tests were carried out to compare percentile distributions of the eight quality of life domains, according to sociodemographic variables, and a multiple linear regression analysis was performed, followed by a validity checking for the resulting models. RESULTS: The physical component presented higher quality of life medians than the mental component. Comparisons between the three years showed that in almost all domains the quality of life scores of the second year residents were higher than the first year residents (p < 0.01). The mental component scores remained high for third year residents (p < 0.01). Predictors of higher quality of life were: second or third year of residency, satisfaction with the training program, sufficient time for leisure, and care of critical patients for less than 30 hours per week. CONCLUSION: The mental component of quality of life was the most impaired component, indicating the importance of caring for residents' mental health, especially during their first year and when they are overloaded with critical patients.

The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study.

BACKGROUND: Medical education and training can contribute to the development of depressive symptoms that might lead to possible academic and professional consequences. We aimed to investigate the characteristics of depressive symptoms among 481 medical students (79.8% of the total who matriculated). METHODS: The Beck Depression Inventory (BDI) and cluster analyses were used in order to better describe the characteristics of depressive symptoms. Medical education and training in Brazil is divided into basic (1st and 2nd years), intermediate (3rd and 4th years), and internship (5th and 6th years) periods. The study organized each item from the BDI into the following three clusters: affective, cognitive, and somatic. Statistical analyses were performed using analysis of variance (ANOVA) with post-hoc Tukey corrected for multiple comparisons. RESULTS: There were 184 (38.2%) students with depressive symptoms (BDI > 9). The internship period resulted in the highest BDI scores in comparison to both the basic (p < .001) and intermediate (p < .001) periods. Affective, cognitive, and somatic clusters were significantly higher in the internship period. An exploratory analysis of possible risk factors showed that females (p = .020) not having a parent who practiced medicine (p = .016), and the internship period (p = .001) were factors for the development of depressive symptoms. CONCLUSION: There is a high prevalence towards depressive symptoms among medical students, particularly females, in the internship level, mainly involving the somatic and affective clusters, and not having a parent who practiced medicine. The active assessment of these students in evaluating their depressive symptoms is important in order to prevent the development of co-morbidities and suicide risk.

The needs of members of the families of general hospital inpatients.

CONTEXT AND OBJECTIVE: The needs of members of the families of intensive care unit patients have been studied, but little is known about the needs of members of the families of general hospital inpatients, especially patients with chronic diseases. The aim of this study was to identify the needs of members of the families of general hospital inpatients and investigate associations between these needs and the patients' clinical and psychiatric profiles. DESIGN AND SETTING: Descriptive study, in a public teaching hospital. METHODS: A random sample of 47 patients and members of their families was studied. Family members' needs were investigated using the critical care family needs inventory and the patients' clinical profiles were investigated using the hospital anxiety and depression scale, confusion assessment method and Karnofsky performance status. The frequencies of family members' needs were described and the patients' clinical and psychiatric characteristics were correlated with the needs using the chi-squared test. RESULTS: Chronic patients predominated and the needs for reassurance and information were indicated as the most important by all members of their families. No associations were found between the patients' characteristics and the needs of members of their families during the hospitalization. CONCLUSIONS: The needs indicated by members of the families of general hospital inpatients were similar to those of members of the families of patients in intensive care units: they considered it very important to be reassured and kept informed throughout the hospitalization.

Interns' depressive symptoms evolution and training aspects: a prospective cohort study.

OBJECTIVE: To study depression symptoms' incidence of medical interns (first year of medical residency) and its correlation with occupational characteristics, satisfaction and stress about their training program. METHODS: Prospective Cohort Study conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo. First year residents, N = 166, from a teaching hospital were invited to answer the Beck Depression Inventory (BDI) and an occupational questionnaire in a prospective longitudinal study. BDI score variation was related with socio-demographic aspects and occupational characteristics using linear regression models. RESULTS: 111 subjects participated (67%); the BDI-score increased in 8 months (mean = 2.75 ± 3.29 vs. 7.00 ± 5.66; p<0.0001). The depressive symptoms' incidence was 9.01% (score>15). BDI-score variation had mean = 4.25 ± 4.93, ranging from -8 to 28. Residents not satisfied with professional training acquired (ß = 3.44; p = 0.004), with their personal life (ß = 2.97; p = 0.001), or who felt stressed in the relationship with senior residents (ß = 2.91; p = 0.015) presented 3 more points of BDI-score after 8 months comparing to those without these perceptions; and being unsatisfied with the nursing team increased BDI-score after 8 months in 2 more points (ß = 1.95; p = 0.025). CONCLUSION: Among the factors that interfere with depression in interns is the occupational characteristics, which might be enhanced by the training facility. Addressing these dissatisfaction and stressful issues should help the university provide better care of interns' mental health.

Impact of anxiety and depression on morbidity and mortality of patients with coronary syndrome.

OBJECTIVE: Evaluate the impact of anxiety and depression on morbidity and mortality of patients with acute coronary syndrome. METHOD: Retrospective cohort study, with follow-up of two years, conducted with 94 patients. The morbidity and mortality (readmission, myocardial revascularization, and death) was evaluated immediately after discharge and after one and two years. Anxiety and depression were evaluated by the State-Trait Anxiety Inventory and by Beck's Depression Inventory. The Kaplan-Meier estimator and the Logrank test were used. The significance level adopted was 0.05. RESULTS: We observed that 76.6% of the patients did not present symptoms of depression or had mild signs, while 78.8% had low to moderate anxiety. The symptoms of depression and anxiety were not related to morbidity (need for MR p=0.098 and 0.56, respectively; readmission p=0.962 and 0.369, respectively) and mortality (p=0.434 and 0.077, respectively). CONCLUSION: No relationship was found between levels of anxiety and depression with the morbidity and mortality of patients.

A pioneering experience in Brazil: the creation of a support network for alcohol and drug dependent physicians. A preliminary report.

OBJECTIVE: The objectives of this study are to present the creation and operation of a support network to help physicians in Brazil, describe the socio-demographic profile, and investigate the prevalence of mental disorders and chemical dependence among physicians seeking treatment. METHOD: Semi-structured interviews using ICD-10 criteria were conducted to obtain data regarding alcohol/drug dependence, and psychiatric comorbidity. Socio-demographic and occupational characteristics were obtained. RESULTS: 247 patients made contact and 192 attended the first evaluation visit. Of those, 158 were male, and most (55%) were married. The mean age was 42.4+/-11.1 years. The reasons for seeking treatment were: comorbidity between mental disorders and chemical dependence (67.7%); chemical dependence (20.8%); mental disorders (7.8%); and burnout (4.2%). The mean interval between the detection of the problem and seeking treatment was 7.5 years. Factors associated with the severity of the problem included unemployment (21.6%), difficulties of practicing professional activities (63.5%), problems with the Regional Council of Medicine (13%), psychiatric hospital admission (31.2%), and self-medication (71.8%). In our sample, 9.3% of the physicians had changed their area of specialization. CONCLUSIONS: A high prevalence of psychiatric disorders was found in this sample as well as psychosocial and professional problems. Treatment networks focusing on the physicians' mental health could catalyze cultural changes in treatment-seeking behavior, thereby improving early detection and treatment.

Rorschach e residência médica: estudo prospectivo com residentes de ortopedia e traumatologia / Rorschach and medical residency: prospective study with orthopedic and traumatology residents / Rorschach y residencia médica: estudio prospectivo con los residentes de ortopedia y traumatología

Identificar e comparar ao longo do período de residência de ortopedia a presença de dificuldades emocionais nos profissionais em treinamento. MÉTODO: estudo prospectivo composto por 13 residentes homens, média de idade de 26 anos. Foi utilizado o Método de Rorschach (SC) aplicado no 1º mês do R1 (T0), no 12º mês do R1 (T2) e no 9º mês do R3 (T3) RESULTADOS: elevada quantidade de respostas MOR em T0, que diminuiu acentuadamente ao longo do tempo (T3). Com relação as variáveis FD S, ambas apresentaram mínima diminuição de T0 para T3, contudo, mostraram-se aumentadas expressivamente em T2. Os residentes iniciam o R1 apresentando componentes autodepreciativos, que se dissipam ao longo do tempo e mantêm as características de autocobrança e autoinspeção. CONCLUSÃO: a residência médica não se apresenta deletéria, contudo, pode ser fonte potencializadora de vulnerabilidades emocionais principalmente durante o primeiro ano devido à inexperiência, ritmo e intensidade da tarefa médica. (AU)

The aim was to identify and compare the presence of emotional difficulties during the orthopedic residency period of professional medical training. This prospective study included 13 male residents, with a mean age of 26 years. The Rorschach (SC) instrument was applied in the 1st month of R1 (T0), after 12 months of R1 (T2) and after 9 months of R3 (T3). There were high amounts of MOR responses at T0, which decreased markedly over time (T3). The FD and S variables showed a minimal decrease from T0 to T3, however, increased significantly at T2. The residents began R1 presenting self-deprecating components, which dissipated over time, with the maintenance of self-inspection and self-burdening as traits. The medical residency program does not appear to be harmful, however, it may be a source of emotional vulnerability, especially during the first year due to the inexperience and the pace and intensity of the medical tasks. (AU)

Identificar y comparar durante el período de residencia en ortopedia la presencia de dificultades emocionales en la formación profesional. MÉTODO: estudio prospectivo compuesto por 13 varones residentes, con una edad media de 26 años. Se utilizó el método Rorschach (SC) se aplicó en el 1.er mes del R1 (T0), en el 12º mes del R1 (T2) y en el 9º mes del R3 (T3). RESULTADOS: elevada cantidad de respuestas MOR en T0, que disminuyó notablemente a lo largo del tiempo (T3). Acerca de las variables FD S, ambas presentaron disminución mínima de T0 a T3, aunque se incrementaron significativamente en T2. Los residentes comienzan el R1 presentando componentes autodestructivos que se disipan con el tiempo y mantienen las características de autoexigencia y autoinspección. CONCLUSIÓN: La residencia médica no se presenta perjudicial, sin embargo, se puede potencializar la fuente de vulnerabilidades emocionales, especialmente durante el primer año por inexperiencia, ritmo e intensidad de la tarea médica. (AU)

Positive Effects of a Stress Reduction Program Based on Mindfulness Meditation in Brazilian Nursing Professionals: Qualitative and Quantitative Evaluation.

CONTEXT: Mindfulness meditation has been shown to effectively mitigate the negative effects of stress among nursing professionals, but in countries like Brazil, these practices are relatively unexplored. OBJECTIVE: To evaluate the effects of a Stress Reduction Program (SRP) including mindfulness and loving kindness meditation among nursing professionals working in a Brazilian hospital setting. DESIGN: Pilot study with a mixed model using quantitative and qualitative methods was used to evaluate a group of participants. The quantitative data were analyzed at three different time points: pre-intervention, post-intervention, and follow-up. The qualitative data were analyzed at post-intervention. SETTING: Hospital São Paulo (Brazil). PARTICIPANTS: Sample 13 nursing professionals, including nurses, technicians, and nursing assistants working in a hospital. INTERVENTION: Participants underwent mindfulness and loving kindness meditation during a period of six weeks. INSTRUMENTS: Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Satisfaction With Life Scale (SWLS), Self-Compassion Scale (SCS), WHOQOL-BREF quality of life assessment, and Work Stress Scale (WSS). Qualitative data were collected via a group interview following six weeks participation in the SRP. RESULTS: The quantitative analyses revealed a significant reduction (P < .05) between pre-intervention and post-intervention scores for perceived stress, burnout, depression, and anxiety (trait). These variables showed no significant differences between post-intervention and follow-up scores. The WHOQOL-BREF revealed significant increase (P < .05) just in the physical and psychological domains at post-intervention scores, which remained at the follow-up. Qualitative results showed improvement in the reactivity to inner experience; a more attentive perception of internal and external experiences; greater attention and awareness of actions and attitudes at every moment; and a positive influence of the SRP in nursing activities.

[Quality of life and depressive symptoms in nursing residents]. / Qualidade de vida e sintomas depressivos em residentes de enfermagem.

This study aimed to evaluate quality of life and prevalence of dysphoria/depressive symptoms in nursing residents at a medical school in São Paulo, Brazil. An exploratory, descriptive and cross-sectional study was carried out, involving 68 nursing residents from the first and second year of residency from all specialty areas, by applying the Brazilian version of the quality of life questionnaire SF-36 (Medical Outcomes Study 36--Item Short-Form Health Survey) and the Brazilian Version of the Beck Depression Inventory (BDI). Aspects related to quality of life were at risk in the mental component of SF-36: emotional aspects, vitality and mental health. Dysphoria/depression were found in 27.9% of the nursing residents.

[Clinical and demographical aspects of alcohol and drug dependent physicians]. / Perfil clínico e demográfico de médicos com dependência química.

UNLABELLED: The misuse of alcohol and drugs among physicians is a common cause of malpractice, absenteeism and complaints to the Medical Councils. This problem demands more attention, because it entails risks to the population and to the physicians themselves. AIMS: To describe the clinical and demographic profile of a sample of physicians in treatment for alcohol and drug dependence also to evaluate psychiatric comorbidity and consumption-related consequences. METHODS: Data was collected from a sample of 198 physicians attending outpatient treatment by a questionnaire specifically designed for this study. RESULTS: Most of the subjects were men (87.8%), married (60.1%), with a mean age of 39.4 years (S.D. =10.7). Sixty-six per cent had already been in inpatient treatment for alcohol and drug misuse. Sixty-nine per cent were specialists practicing mainly: internal medicine, anaesthesiology and surgery. Psychiatric comorbidity was diagnosed in 27.7% for DSM-IV Axis I and in 6% for DSM-V Axis II. With regard to drugs the most frequent pattern was use of alcohol and drugs (36.8%), followed by exclusive use of alcohol (34.3%) and exclusive use of drugs (28.3%). It was observed that the mean interval between the identification of misuse of substances and the seeking of treatment was of 3.7 years. Thirty per cent tried to achieve treatment by themselves. The social and legal problems observed were: unemployment in the previous year (1/3 of the sample), marital problems and divorce (52%), car accidents (42%), legal problems (19%). 84.8% presented professional problems and 8.5% had problems within the Medical Councils. CONCLUSION: The researchers suggest supportive and preventive attitudes for this matter.

Nursing guidance on bed baths to reduce anxiety.

OBJECTIVE: to evaluate the effectiveness of a nursing guidance protocol to reduce the anxiety of patients with acute coronary syndrome undergoing bed bath, and the correlation of vital signs with state-anxiety. METHOD: randomized clinical trial study. The sample consisted of 120 patients. The intervention group received a nursing guidance protocol about bed bath and the control group received the unit's routine information. The STAI-State scale was used to assess anxiety, and data were collected at three times: immediately after informing the patients about the bed bath; immediately after interventions; and immediately after the bath. RESULTS: the intervention group presented significantly lower state-anxiety compared to the control group (p<0.001) after the intervention. CONCLUSION: the nursing orientation was effective to reduce anxiety in patients with acute coronary syndrome undergoing bed bath.

Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service.

CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do C ncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated patients, who deserved special attention throughout the psychiatric interventions.

Clinical and demographic profile of users of a mental health system for medical residents and other health professionals undergoing training at the Universidade Federal de São Paulo.

CONTEXT: A postgraduate and resident trainee mental health assistance center was created in September 1996 within our university. OBJECTIVE: To describe the clinical and demographic profile of its users. TYPE OF STUDY: Retrospective. SETTING: Universidade Federal de São Paulo--Escola Paulista de Medicina (Unifesp-EPM). METHODS: The study was carried between September 1996 and November 2002, when 233 semi-structured registration forms were filled out either by the psychologist or the psychiatrist during their first contact with the trainees, who were medical and nursing residents, and postgraduate students at specialization, master or doctoral levels. The registration forms included demographic, occupational and clinical data. RESULTS: The trainees were predominantly young (mean of 27 years old), single (82.0% of cases), women (79.4%), seeking help especially during the first year of training (63.1%). In 70.8% of the cases, they came to the service spontaneously. Such individuals showed greater adherence to the treatment than those who were referred by supervisors (p < 0.05). In 30% of the cases, the trainee sought psychological guidance or support at the service due to specific situational conflicts. Depression and anxiety disorders were the most frequent diagnoses; 22.3% of the trainees followed up mentioned a tendency towards suicidal thoughts. In comparison with other trainees, there was a higher prevalence of males among the medical residents (p < 0.01), with more cases of sleep disorders (p < 0.05), a smaller number of individuals refraining from the use of alcohol (p < 0.05) and a higher number of trainees requiring leave of absence (p < 0.001). DISCUSSION: The first year of training in health sciences is the most stressful, especially for women. Depression and anxiety symptoms are common, reflecting transitory self-limited deadaptation. However, the severity of the cases can also be evaluated in view of the large number of trainees who mentioned suicidal tendencies. CONCLUSIONS: This study emphasizes the need and importance of providing formal, structured and confidential mental health services for medical residents and postgraduate students from other health professions, in the training programs of academic institutions.

[Embracement and anxiety symptoms in patients before cardiac surgery]. / Acolhimento e sintomas de ansiedade em pacientes no pré-operatório de cirurgia cardíaca.

This is a randomized clinical trial, aimed to compare the frequency and intensity of symptoms of anxiety in patients of preoperative cardiac surgery who received empathic behavior from nurse or family or those who received no specific type of empathic behavior. The sample consisted of 66 patients in preoperative of cardiac surgery, which were divided in three groups: empathic behavior by nurses, without specific empathic behavior and by family. Anxiety was assessed at two points in time: before and after the intervention. The instrument used was developed and validated by Suriano, comprising 19 defining characteristics of the nursing diagnosis anxiety. It was observed that the reduction of anxiety symptoms was higher in the group receiving empathic behavior of relatives when compared to the other two groups. The results suggested that encouraging the participation of family members can contribute to the reduction of anxiety symptoms in patients in preoperative cardiac surgery.