Intervention: The intervention group, listened to holy Quran recitation for 10 minutes twice a day 4 hours a part (10 am and 2 pm) for 2 consecutive days (usually the 2nd and the 3rd day post-operative) after extubation and gaining alertness. We have chosen Surah Al-Rehman because it is considered as the most rhythmic surah of the Quran and the recitation of Qari Abdul Basit is very soothing and effective as he has recited from the deep of the heart. The listing will be by a disposable head phones for an I pad for each hospital. The control group received usual care by their nurses.
Measurement of variables: Sociodemographic and clinical characteristics will be measured either by patient interview (age, gender, pain level, marital status, educational level, smoking status, and working status) or by medical records review (history of hypertension, history of diabetes mellites, history of acute myocardial infarction, left ventricular ejection fraction, and body mass index, and length of stay at the hospital). Depression, anxiety and Stress will be measured using the Depression Anxiety Stress Scale (DASS21). DASS 21 is a set of self-reported items used to measure the intensity of DAS over the week prior to administration. DASS21 is the short version of the basic 42-item questionnaire DAS S-42, developed by Lovibond and Lovibond. It consists of three seven-item scales (a total of 21 items): depression scale (DS), anxiety scale (AS), and stress scale (SS). Items are measured through a four point Likert scale from 0 (did not apply to me at all) to 3 (applied to me very much, or most of the time). Items in each scale are summed whereby higher scores indicate higher levels of DAS. A score between 0 and 4, 0 and 3, 0-7 are considered normal DAS, respectively. A score between 5 and 6, 4 and 4, 8 and 9 are considered mild DAS, respectively. A score between 7 and 10, 6 and 7, 10 and 12 are considered moderate DAS, respectively. A score between 11 and 13, 8 and 9, 13 and 16 are considered severe DAS, respectively. A score above 13, 9, 19 are considered extremely severe DAS, respectively. The reliability of DASS21 was measured using Cronbach's alpha and was reported to be good; it was 0.91 for the depression subscale, and 0.80 for the anxiety subscale. The reliability of the Arabic version of DASS21 was measured using Cronbach's alpha coefficients and was found to be 0.76 for depression, 0.75 for anxiety.
