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Nurse practitioner-led bundled care reduces postoperative delirium, pain, and sleep disturbances, and shortens hospital stay in cardiac surgery patients.

In a randomized controlled trial of 100 cardiac surgery patients, nurse practitioner-led bundled care significantly reduced postoperative delirium on Day 2 (6% vs 32%, p=0.001), improved pain scores across Days 1-3 (F=72.18, p<0.001), and improved sleep quality across Days 2-4 (F=233.35, p<0.001). Total hospital stay was shorter (median 8 vs 10 days, p<0.001).

Last updated: Aug 11, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Effect of a Nurse Practitioner-Led Bundled Care on Postoperative Recovery in Cardiac Surgery Patients: A Randomized Controlled Trial.

observational

Paul D, Kanagaraj P, Pappaiya P · Research in nursing &amp; health (2026)

Participants: N/A
Duration: Not specified (likely perioperative period until discharge)
Intervention: Nurse practitioner-led bundled care including preoperative orientation, early mobilization, cognitive reorientation, family engagement, relaxation, and sleep promotion.
Outcome: Postoperative delirium (CAM-ICU), pain (VAS), sleep quality (RCSQ), ICU stay, ward stay, total hospital stay.
Effect Size: N/A (reported as p-values and F-statistics)
Population: Adults undergoing elective coronary artery bypass graft, mitral valve replacement, or aortic valve replacement at a tertiary cardiac hospital in India.

Result:

PubMed: 42565486DOI: 10.1002/nur.70117

Mechanism Graph

Preoperative orientation and cognitive reorientation reduce delirium risk factors
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Early mobilization and family engagement enhance recovery and reduce complications
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Relaxation and sleep promotion improve sleep quality and reduce pain perception
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Result: Lower delirium, pain, and shorter hospital stay

Limitations

  • ⚠Single-blinded design (outcome assessors blinded, but participants not blinded)
  • ⚠Post-test only design without baseline sleep or pain measures
  • ⚠Single-center study in a resource-constrained setting, limiting generalizability

Frequently Asked Questions

What is nurse practitioner-led bundled care?▼

It is a multicomponent intervention delivered by nurse practitioners, including preoperative orientation, early mobilization, cognitive reorientation, family engagement, relaxation, and sleep promotion.

How does this intervention affect postoperative delirium?▼

It significantly reduces delirium incidence on Day 2 (6% vs 32% in control, p=0.001).

Does this intervention improve sleep quality?▼

Yes, sleep quality measured by RCSQ was significantly better across Days 2-4 (p<0.001).

What is the impact on hospital length of stay?▼

Total hospital stay was reduced from median 10 days to 8 days (p<0.001).

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References

  1. 1.Paul D, Kanagaraj P, Pappaiya P. "Effect of a Nurse Practitioner-Led Bundled Care on Postoperative Recovery in Cardiac Surgery Patients: A Randomized Controlled Trial.." Research in nursing &amp; health, 2026. PMID: 42565486 DOI: 10.1002/nur.70117
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.