Abstract
Sleep problems are a common postoperative complication among patients undergoing cardiovascular procedures, often triggered by emotional distress, surgical discomfort, and the clinical setting itself. These issues may hinder recovery and reduce life quality. A patient-oriented nursing model, known as precision or individualized nursing, delivers customized support tailored to each patient’s needs. However, the influence of this approach on sleep disturbances in the cardiovascular patient population has not been definitively established. A total of 140 patients who underwent cardiovascular interventions were retrospectively categorized into 2 groups based on the type of postoperative nursing care received: 70 in a standard care group and 70 in an enhanced care group. To reduce selection bias, propensity score matching was applied based on baseline characteristics such as age, gender, disease type, and preoperative sleep quality. The standard group received conventional nursing care, while the enhanced group received additional personalized strategies, including emotional counseling, structured sleep education, environmental adjustments, and guided relaxation. Sleep quality was assessed using the Pittsburgh sleep quality index before surgery and on postoperative days 3 and 7. Recovery outcomes and patient satisfaction were also measured and compared between groups. The enhanced care group showed a statistically significant improvement in sleep quality, with Pittsburgh sleep quality index scores on postoperative days 3 and 7 markedly lower than those of the standard care group (P < .05). This group also experienced more favorable recovery outcomes, such as reduced pain intensity and shorter hospitalization duration (P < .05), along with notably higher satisfaction scores (P < .05). Tailored nursing care contributes meaningfully to better sleep outcomes and faster recovery in patients after cardiovascular surgery, while also boosting patient satisfaction. These results highlight the clinical value of integrating individualized nursing protocols into routine postoperative care to enhance recovery trajectories and overall patient experience.
Keywords: cardiovascular interventions, Pittsburgh sleep quality index, postoperative recovery, sleep quality, targeted nursing
1. Introduction
Cardiovascular disease (CVD) is one of the leading causes of death and disability worldwide, and with the aging population, the prevalence and mortality rates of cardiovascular diseases continue to rise. According to statistics from the World Health Organization, approximately 17 million people die from cardiovascular diseases each year, accounting for 31% of global deaths.[1,2] The treatment methods for cardiovascular diseases have gradually developed, and cardiovascular interventions (PCI) have become an essential approach in the clinical treatment of coronary artery disease, myocardial infarction, and other cardiovascular conditions.[3] With its advantages of minimal invasiveness, rapid recovery, and significant efficacy, PCI has been widely applied in the treatment of various cardiovascular diseases, significantly improving patients’ quality of life and prognosis.[4]
However, despite the effectiveness of PCI in alleviating or curing the symptoms of cardiovascular diseases, postoperative patients often face a range of adverse reactions, among which sleep disturbances are one of the most common and impactful complications.[5] Studies have shown that 40% to 60% of patients experience varying degrees of sleep disturbances after cardiovascular interventions.[6] Postoperative patients often experience insomnia, sleep fragmentation, and other issues due to postoperative pain, psychological anxiety, difficulty adapting to the hospital environment, and the negative impact of chronic illness. Sleep disturbances not only affect physiological recovery but also exacerbate psychological stress, further delaying postoperative rehabilitation and even increasing readmission rates, thereby significantly reducing quality of life.[7,8]
The occurrence of sleep disturbances is closely related to both individual patient differences and the nursing interventions provided. In traditional postoperative care, the focus is often on physiological monitoring and basic treatments, with insufficient attention to the psychological and emotional states of patients. This may result in inadequate emotional support and a less comfortable recovery environment, making it difficult to effectively alleviate postoperative sleep disturbances.[9] Therefore, how to effectively mitigate sleep disturbances after cardiovascular interventions has become a major challenge in clinical nursing.
Targeted nursing, a personalized care model gradually promoted in clinical practice in recent years, is centered on the patient and involves comprehensive interventions based on the specific conditions of the patient. Unlike traditional nursing approaches, targeted nursing emphasizes a comprehensive assessment of the patient’s physiological, psychological, and social factors, developing personalized care plans to provide more accurate and comprehensive nursing services.[10] Targeted nursing has already shown some promising results in improving patients’ sleep quality, particularly during the postoperative recovery period, with significant effects in alleviating anxiety, optimizing the sleep environment, and adjusting nursing plans.[11]
Although some studies have explored the application of targeted nursing in patients with various diseases, research on its effect on sleep disturbances in patients after cardiovascular interventions is still insufficient. Whether targeted nursing can effectively improve sleep quality, shorten postoperative recovery time, and increase patient satisfaction after cardiovascular interventions requires further verification through rigorous clinical studies. Therefore, this study aims to evaluate the clinical effect of targeted nursing in improving sleep disturbances in patients after cardiovascular interventions, by comparing the outcomes of routine nursing and targeted nursing, and to provide theoretical evidence for developing more effective postoperative care plans.
Through this study, we hope to explore a new nursing model applicable to patients after cardiovascular interventions, with the aim of optimizing nursing interventions, improving sleep quality, promoting postoperative recovery, enhancing overall nursing quality, and ultimately providing better treatment outcomes and quality of life for patients with cardiovascular diseases.
2. Research methods
2.1. Study subjects and grouping
This study was approved by the Ethics Committee of the Department of Internal Medicine, Enshi Central Hospital (Approval No. 2023-001). Since this was a retrospective study, informed consent was waived by the Ethics Committee, as it involved the use of existing patient records without direct interaction. This study selected patients who underwent cardiovascular interventions at our hospital between January 2023 and January 2024. Based on the different postoperative nursing approaches, the patients were divided into 2 groups: the experimental group (targeted nursing group) and the control group (routine nursing group). The researchers retrospectively reviewed the patients’ nursing records to assign them to the respective groups. According to the inclusion and exclusion criteria, the experimental group consisted of 79 patients and the control group consisted of 73 patients. Patient allocation was based on the nursing records in the electronic medical record system, ensuring objectivity and randomness. The retrospective data collection ensured sample representativeness, and no selection bias was introduced due to differing nursing approaches. After propensity score matching (PSM) based on basic information, the final sample size consisted of 70 patients in each group.
The grouping method was as follows: patients were assigned to groups based on the type of nursing care they received. The experimental group received additional targeted nursing interventions, while the control group received only routine nursing care. Baseline characteristics (such as age, gender, disease type, and preoperative sleep quality) were compared between the 2 groups to ensure comparability before the intervention.
2.1.1. Inclusion criteria
Aged 18 to 75 years, regardless of gender;
Diagnosed with coronary heart disease, myocardial infarction, or other indications, and eligible for cardiovascular intervention, having received coronary artery intervention (PCI) or other related cardiovascular procedures;
No severe mental illness, sleep disorders, or other underlying diseases (e.g., diabetes, chronic lung disease) affecting sleep quality before surgery;
Patients received either routine nursing care or targeted nursing care during postoperative recovery, with complete nursing data and follow-up records available for retrospective analysis.
2.1.2. Exclusion criteria
Severe postoperative complications (e.g., heart failure, extensive bleeding);
Patients who could not be effectively followed up or were lost to follow-up after surgery;
Patients for whom complete data could not be obtained for any other reason.
2.2. Intervention measures
In this study, the nursing interventions for the experimental and control groups were different. The control group received routine care, which included basic vital signs monitoring (such as routine monitoring of body temperature, pulse, blood pressure, respiration, etc), wound care and medication (wound treatment and medication management as instructed by the doctor, including antibiotics and pain management), health education (postoperative health education explaining the prevention of common postoperative complications and related precautions), and daily care (routine management of the ward environment, personal hygiene care, dietary guidance, etc).
The experimental group received targeted nursing in addition to the routine care. The targeted interventions aimed to improve the patients’ sleep quality and psychological state, including psychological counseling (which provided emotional support during the postoperative recovery period, explanations about possible symptoms, helping patients understand their condition correctly, and alleviating anxiety, fear, and depression), sleep hygiene education (where nursing staff educated patients on basic sleep hygiene principles such as maintaining a regular sleep schedule, avoiding excessive eating or stimulating substances like caffeine, and ensuring a quiet and comfortable sleep environment), environmental optimization (where nursing staff personalized the hospital room by minimizing noise and light interference, ensuring a quiet, comfortable environment for sleep, and adjusting bed positions and bedding based on individual needs), and relaxation training (where the experimental group patients engaged in daily relaxation exercises under the guidance of nursing staff, including deep breathing exercises and progressive muscle relaxation to reduce postoperative stress and improve sleep quality).
2.3. Data collection
2.3.1. Sleep quality assessment
The Pittsburgh sleep quality index (PSQI) was used to assess the patients’ sleep quality. The PSQI scale evaluates sleep quality across 7 dimensions, with a total score range from 0 to 21, where a higher score indicates poorer sleep quality. Both groups of patients were assessed using the PSQI before surgery, as well as on postoperative days 3 and 7.
2.3.2. Postoperative recovery indicators
These include pain scores and length of hospital stay. Pain intensity was measured using the visual analog scale (VAS), where patients rated their pain level on a scale from 0 (no pain) to 10 (worst pain imaginable). The length of hospital stay was defined as the number of days from admission after surgery to discharge.
2.3.3. Patient satisfaction
Patient care experiences were assessed using a nursing satisfaction questionnaire, which included dimensions such as nursing attitude, nursing skills, and nursing environment. Each item was scored on a 5-point scale. The overall nursing satisfaction score was calculated as the average score across all items.
2.4. Data analysis
All data were analyzed using SPSS 26.0 statistical software (Chicago). Continuous variables were expressed as mean ± standard deviation (x̄ ± s), and between-group comparisons were performed using independent sample t-tests. Categorical variables were presented as frequency and percentage, and group comparisons were conducted using chi-square tests (χ² test). For the changes in PSQI scores over time, repeated measures analysis of variance (RM-ANOVA) was used. A P-value of <.05 was considered statistically significant. PSM was used to control for confounding variables and ensure comparability between the experimental and control groups. Propensity scores were calculated based on key factors such as age, gender, disease type, and preoperative sleep quality. The matching process used a 1:1 nearest-neighbor method with a caliper of 0.2. After matching, 70 patients were included in each group, with no significant differences in baseline characteristics, ensuring balance between groups. We performed sensitivity analyses and calculated standardized mean differences to assess balance, with SMD values <0.1 indicating adequate matching.
3. Results
After applying the inclusion and exclusion criteria, a total of 79 patients in the experimental group and 73 patients in the control group were selected. To exclude the effects of confounding factors and ensure a single variable, PSM was performed, resulting in 70 patients in each group. The patients’ preoperative and postoperative sleep quality, pain scores, length of hospital stay, and nursing satisfaction were compared and analyzed to assess the effect of targeted nursing on improving sleep quality in patients after cardiovascular interventions. The detailed results are as follows.
3.1. Baseline characteristics comparison
In this study, there were no significant differences in the baseline characteristics between the experimental group and the control group (P > .05), indicating that the baseline characteristics of both groups were comparable prior to the intervention. The specific baseline characteristics include patients’ age, gender, disease type, and preoperative sleep quality. Table 1 shows that there were no significant differences between the 2 groups in terms of age, gender, disease type, or preoperative PSQI scores, ensuring comparability between the 2 groups before the intervention.
Table 1.
Baseline characteristics.
| Variables | Experimental group | Control group | t/χ²-value | P-value |
|---|---|---|---|---|
| Age (year) | 62.3 ± 9.4 | 61.9 ± 9.1 | 0.328 | .743 |
| Male (n, %) | 40 (57.1%) | 38 (54.3%) | 0.174 | .675 |
| Female (n, %) | 30 (42.9%) | 32 (45.7%) | 0.174 | .675 |
| Coronary artery disease (n, %) | 50 (71.4%) | 48 (68.6%) | 0.274 | .601 |
| Myocardial infarction (n, %) | 20 (28.6%) | 22 (31.4%) | 0.274 | .601 |
| Preoperative PSQI score | 12.3 ± 3.1 | 12.4 ± 3.3 | 0.089 | .930 |
3.2. Changes in sleep quality
To assess the effect of targeted nursing on improving sleep quality, the PSQI was used for evaluation. On postoperative days 3 and 7, the PSQI scores of the experimental group were significantly lower than those of the control group, indicating that targeted nursing had a significant effect on improving patients’ sleep quality. Table 2 shows the changes in PSQI scores before surgery, as well as on postoperative days 3 and 7. The experimental group showed a marked improvement in sleep quality, particularly on postoperative days 3 and 7, with their PSQI scores significantly lower than those of the control group (P < .001). In contrast, the control group showed slower improvement in sleep quality, with the PSQI score on day 7 still significantly higher than that of the experimental group.
Table 2.
Pittsburgh sleep quality index score.
| Preoperative PSQI score | PSQI score on postoperative day 3 | PSQI score on postoperative day 7 | F-value | P-value | |
|---|---|---|---|---|---|
| Experimental group (n = 70) | 12.3 ± 3.1 | 9.4 ± 2.7 | 6.5 ± 2.4 | 42.31 | <.001 |
| Control group (n = 70) | 12.4 ± 3.3 | 11.2 ± 2.9 | 10.4 ± 2.8 | 5.25 | <.001 |
PSQI = Pittsburgh sleep quality index.
3.3. Changes in pain scores
Pain is one of the key factors affecting sleep quality in patients. We assessed postoperative pain levels using the VAS. The results showed that on postoperative days 3 and 7, the VAS scores of the experimental group were significantly lower than those of the control group, indicating that targeted nursing effectively alleviated postoperative pain. Table 3 shows the changes in VAS scores on postoperative days 3 and 7. The VAS scores of the experimental group were significantly lower than those of the control group (P < .001), particularly on postoperative day 3, when pain was noticeably reduced in the experimental group. By postoperative day 7, the VAS scores of the experimental group had further decreased, while changes in the control group were relatively small.
Table 3.
Visual analog scale score.
| VAS score on postoperative day 3 | VAS score on postoperative day 7 | t-value | P-value | |
|---|---|---|---|---|
| Experimental group (n = 70) | 3.4 ± 1.2 | 2.1 ± 1.0 | 21.53 | <.001 |
| Control group (n = 70) | 4.6 ± 1.5 | 4.0 ± 1.3 | 5.67 | <.001 |
3.4. Length of hospital stay
The length of hospital stay is one of the important indicators of postoperative recovery. The results showed that the experimental group had a significantly shorter length of hospital stay compared to the control group, suggesting that targeted nursing may help accelerate postoperative recovery. Table 4 shows the differences in hospital stay between the experimental and control groups. The length of hospital stay in the experimental group was significantly shorter than that in the control group (P < .001), which may be related to the faster recovery, improved sleep quality, and reduced pain experienced by the experimental group.
Table 4.
Hospital stay duration.
| Hospital stay duration (days) | t-value | P-value | |
|---|---|---|---|
| Experimental group (n = 70) | 7.2 ± 1.6 | 3.85 | <.001 |
| Control group (n = 70) | 8.5 ± 1.8 | 3.85 | <.001 |
3.5. Patient nursing satisfaction
Patient satisfaction with nursing services is one of the key indicators of nursing quality. In this study, a self-designed nursing satisfaction questionnaire was used to assess the patients’ nursing experiences. The results showed that the overall nursing satisfaction in the experimental group was significantly higher than that in the control group. Table 5 shows the differences in nursing satisfaction between the 2 groups. The nursing satisfaction score in the experimental group was significantly higher than in the control group (P < .001), indicating that targeted nursing not only improved the patients’ sleep quality but also enhanced their overall satisfaction with nursing services.
Table 5.
Overall nursing satisfaction score.
| Overall nursing satisfaction score | t-value | P-value | |
|---|---|---|---|
| Experimental group (n = 70) | 4.5 ± 0.5 | 10.24 | <.001 |
| Control group (n = 70) | 3.8 ± 0.7 | 10.24 | <.001 |
4. Discussion
Cardiovascular disease patients often face various recovery challenges after undergoing interventional treatments, among which sleep disorders are a significant and often overlooked issue. A decline in sleep quality not only affects patients’ physical recovery but may also have negative effects on their mental health.[12,13] This study explores the effect of targeted nursing interventions on improving sleep quality and the recovery process in patients after cardiovascular interventions. The results indicate that targeted nursing significantly improves patients’ sleep quality, shortens postoperative recovery time, and enhances overall patient satisfaction, providing new insights for postoperative nursing management in cardiovascular interventions.
Cardiovascular interventional surgeries, including coronary artery intervention (PCI) and coronary artery bypass grafting, often result in varying degrees of physiological and psychological stress in patients. Postoperative pain, medication side effects, discomfort with the hospital environment, and psychological trauma due to surgery are factors that may contribute to sleep disturbances. Specifically, pain is one of the most common sleep disruptors, especially in the early postoperative stages, where pain often prevents patients from falling or staying asleep.[14,15] In addition, unfamiliar hospital environments, noise, lighting, and frequent examinations and nursing procedures may also contribute to deteriorating sleep quality.[16,17] Long-term sleep disturbances not only affect postoperative recovery but may increase the risk of anxiety and depression. Insufficient sleep weakens immune function, prolongs recovery, and even leads to complications.[18–20] Thus, improving the sleep quality of patients after cardiovascular interventions is a key factor in promoting overall recovery.
Targeted nursing, as a patient-centered care model, is based on providing customized interventions according to individual patient needs.[21,22] Unlike traditional routine nursing, targeted nursing emphasizes a comprehensive assessment of each patient, considering their physical condition, psychological state, and environmental factors, to design a personalized nursing plan.[23] After cardiovascular interventions, the implementation of targeted nursing includes psychological counseling, sleep hygiene education, environmental optimization, and relaxation training. These interventions help alleviate patient anxiety, improve psychological status, and thus promote better sleep quality.
The results of this study indicate that patients in the intervention group showed significant improvement in sleep quality on the 3rd and 7th postoperative days after receiving targeted nursing interventions. Compared with the control group, the PSQI (PSQI) score significantly decreased, indicating that targeted nursing effectively improved postoperative sleep quality. This finding is consistent with previous studies, which suggest that personalized nursing interventions play an active role in alleviating sleep disorders in patients after cardiovascular interventions. Moreover, the intervention group also showed better postoperative recovery indicators, including improvements in pain scores and hospital stay duration. Pain relief after surgery is one of the critical factors for enhancing sleep quality, as patients with effective pain control are more likely to achieve deep sleep. The study also found that the intervention group had significantly higher satisfaction levels, indicating that personalized nursing not only improved sleep quality but also enhanced patients’ overall treatment experience and psychological satisfaction.
These results further confirm that targeted nursing can not only improve sleep quality but also accelerate postoperative recovery and increase treatment satisfaction. Through personalized nursing interventions, postoperative complications can be minimized, and hospital stays shortened, thereby reducing medical costs for hospitals and improving overall patient prognosis.
Although this study achieved positive results, there are still some limitations. First, the sample size is relatively small, and the study was conducted in only 1 hospital, involving only patients after cardiovascular interventions. This may limit the generalizability and external validity of the results, as regional bias could have influenced the findings. To overcome these limitations, future studies should consider expanding the sample size and conducting multi-center studies across various regions. This will improve the applicability of the findings to broader populations and enhance the external validity of the results. Second, this study focused on short-term recovery post-surgery and lacked long-term follow-up. Future research should include extended follow-up periods to assess the sustained effects of targeted nursing interventions on long-term outcomes, such as quality of life and readmission rates. Additionally, while PSM was used to account for known confounders, other factors, such as the patients’ psychological state, social support, and coping mechanisms, were not fully addressed. These factors could significantly influence both sleep quality and recovery outcomes and should be explored in future research to better understand their roles in postoperative recovery. Finally, variations in the implementation of nursing interventions may influence the results. Future studies could explore how different interventions, including psychological support and social interventions, can work together to improve clinical outcomes and enhance recovery.
5. Conclusion
Targeted nursing has a significant effect on improving sleep quality, accelerating postoperative recovery, and increasing patient satisfaction in cardiovascular intervention patients. Through personalized interventions, including psychological counseling, sleep hygiene education, environmental optimization, and relaxation training, patients in the intervention group showed notable improvements in sleep quality, reduced postoperative pain, shorter hospital stays, and better recovery indicators compared to the control group. The results suggest that targeted nursing not only effectively alleviates postoperative sleep disorders but also promotes overall recovery and enhances patients’ satisfaction with treatment. Therefore, it is recommended to widely promote this nursing model in clinical practice, especially for patients after cardiovascular interventions, to optimize postoperative management and improve patients’ quality of life and treatment outcomes. Future studies can further explore the specific mechanisms and long-term effects of different nursing interventions, providing more practical guidance for clinical nursing.
Author contributions
Conceptualization: Piaopiao Tan, Dong Wang, Meng Guo.
Data curation: Piaopiao Tan, Dong Wang, Meng Guo.
Formal analysis: Piaopiao Tan, Dong Wang, Meng Guo.
Investigation: Meng Guo.
Methodology: Meng Guo.
Visualization: Piaopiao Tan, Dong Wang, Meng Guo.
Writing –original draft: Piaopiao Tan, Dong Wang, Meng Guo.
Writing –review & editing: Piaopiao Tan, Dong Wang, Meng Guo.
Abbreviations:
- CVD
- cardiovascular disease
- PCI
- percutaneous coronary intervention
- PSM
- propensity score matching
- RM-ANOVA
- repeated measures analysis of variance
- SMDs
- standardized mean differences
- VAS
- visual analog scale
- WHO
- World Health Organization
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Tan P, Wang D, Guo M. Impact of individualized nursing on postoperative sleep quality after cardiovascular interventions: A retrospective analysis. Medicine 2025;104:35(e43871).
Contributor Information
Piaopiao Tan, Email: 15549136071@163.com.
Dong Wang, Email: 543076314@qq.com.
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