This study aims to evaluate the effectiveness of culturally tailored nurse-led holistic spiritual care in improving hemodynamic stability and psychological well-being among patients undergoing preoperative cardiac surgery in South Sumatra, Indonesia.

Preoperative anxiety is common among cardiac surgery patients and can lead to increased blood pressure, heart rate, and overall physiological instability. In addition, psychological distress may negatively affect patient recovery and well-being.

This multi-center randomized controlled trial involves adult patients scheduled for elective cardiac surgery. Participants are randomly assigned to either an intervention group or a control group. The intervention group receives a 20-minute session of culturally tailored holistic spiritual care, including therapeutic communication, deep breathing, progressive muscle relaxation, spiritual reflection, and culturally appropriate prayer. The control group receives standard preoperative care.

Primary outcomes include changes in hemodynamic parameters such as blood pressure, heart rate, and mean arterial pressure. Psychological well-being is assessed using the WHO-5 Well-Being Index.

The results of this study are expected to provide evidence on the effectiveness of integrating culturally responsive spiritual care into routine preoperative nursing practice to improve both physiological and psychological outcomes.

Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide, with an increasing number of patients requiring cardiac surgical procedures such as coronary artery bypass grafting and valve surgery. Preoperative anxiety is highly prevalent among cardiac surgery patients and is associated with adverse physiological responses, including increased blood pressure, elevated heart rate, and hemodynamic instability, which may negatively affect perioperative outcomes.

Holistic nursing care, particularly spiritual care, has been recognized as an important approach to address both physiological and psychological needs of patients. Spiritual care interventions, including relaxation techniques, therapeutic communication, and prayer, have demonstrated potential in reducing anxiety and promoting emotional well-being. However, existing evidence remains limited, particularly in multi-center randomized controlled trials and in culturally diverse populations.

This study is a multi-center randomized controlled trial conducted in two tertiary hospitals in South Sumatra, Indonesia. The study aims to evaluate the effectiveness of culturally tailored nurse-led holistic spiritual care in improving hemodynamic stability and psychological well-being among patients undergoing preoperative cardiac surgery.

Participants are randomly assigned to either an intervention group or a control group. The intervention consists of a structured 20-minute session delivered by trained nurses prior to surgery, incorporating therapeutic communication, guided deep breathing, progressive muscle relaxation, spiritual reflection, and culturally adapted prayer based on patients' beliefs and cultural background. The control group receives standard preoperative care without structured spiritual intervention.

The study evaluates both physiological and psychological outcomes. Hemodynamic parameters, including systolic and diastolic blood pressure, heart rate, and mean arterial pressure, are measured before and after the intervention. Psychological well-being is assessed using a validated instrument.

This study addresses important gaps in the integration of culturally responsive spiritual care into perioperative nursing practice. The findings are expected to provide evidence for a feasible, non-pharmacological, and culturally appropriate intervention to improve patient outcomes in cardiac surgical settings.

Inclusion Criteria:

• Patients scheduled for elective cardiac surgery
• Age 18-65 years
• Conscious and able to communicate effectively
• Able to understand and provide informed consent
• Hemodynamically stable prior to intervention
• Willing to participate in the study

Exclusion Criteria:

• Patients scheduled for elective cardiac surgery
• Age 18-65 years
• Conscious and able to communicate effectively
• Able to understand and provide informed consent
• Hemodynamically stable prior to intervention
• Willing to participate in the study

Individual participant data (IPD) will not be publicly shared due to ethical and confidentiality considerations. However, de-identified data may be made available from the corresponding author upon reasonable request, subject to approval by the institutional ethics committee.