Effect of Box Breathing Before Chest Tube Removal After Open-Heart Surgery

This randomized controlled trial aims to evaluate the effects of box breathing performed before chest tube removal on pain, anxiety, dyspnea, and hemodynamic parameters in patients undergoing open-heart surgery. A total of 86 patients will be randomly assigned in a 1:1 ratio to either the box breathing group or the control group. Participants in the intervention group will perform the 4-4-4-4 box breathing technique for approximately five minutes before chest tube removal in addition to routine care, while participants in the control group will receive routine care only. Pain, anxiety, dyspnea, and hemodynamic parameters will be assessed before and at specified time points after chest tube removal.

Inclusion Criteria: * Patients who have undergone open-heart surgery and have a chest tube * Aged 18 years or older * Willing to participate in the study and providing written informed consent * Conscious, oriented, and cooperative * Able to read and understand Turkish * Clinically and hemodynamically stable * Having no more than three chest tubes (up to two mediastinal and one thoracic chest tube) * No diagnosed psychiatric disorder * Not receiving psychiatric medications and/or local neuromuscular blocking agents Exclusion Criteria: * Patients who have not undergone open-heart surgery * Unconscious, disoriented, or uncooperative patients * Unable to read and understand Turkish * Intubated patients * Receiving additional analgesic medication other than routine analgesia * Receiving local anesthesia at the chest tube insertion site * Having four chest tubes (two mediastinal and two thoracic) * Unwilling to participate in the study * Having a diagnosed psychiatric disorder or mental health condition