Nurse-Led Integrative Spiritual Care and Pandanus Amaryllifolius Aromatherapy for Psychophysiological Stress and Quality of Recovery After Cardiac Surgery: A Controlled Quasi-Experimental Study

Abstract

Objective: To evaluate the effects of a nurse-led integrative intervention combining spiritual care and Pandanus amaryllifolius aromatherapy on psychophysiological stress and postoperative quality of recovery among patients undergoing elective cardiac surgery.
Methods: This prospective controlled quasi-experimental study was conducted at RSUD Siti Fatimah (Siti Fatimah Regional General Hospital), South Sumatra Province, Indonesia, from March to June 2026. Eighty-four adults undergoing elective cardiac surgery were consecutively recruited and assigned to an intervention group receiving nurse-led spiritual care plus P. amaryllifolius aromatherapy in addition to standard perioperative care (n=42) or a control group receiving standard care alone (n=42). Anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), physiological stress using heart rate, blood pressure, mean arterial pressure, respiratory rate, and SpO₂, and postoperative recovery using the Quality of Recovery-15 (QoR-15). Baseline-adjusted analyses were performed.
Results: APAIS scores decreased from 14.2 ± 3.1 to 8.3 ± 2.7 in the intervention group and from 14.5 ± 3.3 to 12.7 ± 3.1 in controls, with an adjusted mean difference of −4.0 points (95% CI −5.1 to −2.9; p<0.001). Significant intervention effects were also observed for heart rate, systolic blood pressure, and mean arterial pressure. QoR-15 scores were higher in the intervention group than controls (122.6 ± 12.4 vs 111.3 ± 13.7), with an adjusted difference of 10.8 points (95% CI 5.3–16.3; p<0.001).
Conclusion: Nurse-led spiritual care combined with P. amaryllifolius aromatherapy was associated with lower perioperative psychophysiological stress and better postoperative recovery after cardiac surgery.