Вы находитесь на странице: 1из 8

Journal of Psychiatry, 2018

Volume 3 No 1: 1-8

The Influence of Deep Breath Relaxation Techniques and Five-Finger


Hypnotic Therapy on Preoperative Patient Anxiety

Jek Amidos Pardede*


Selamat Febry Andrea Sitepu
Masri Saragih

Nursing Study Program, Sari Mutiara Indonesia University


Correspondence: *jekpardedemi@rocketmail.com

ABSTRACT
Pre operative is an early stage to prepare patients everything possible to be in operation, more than two
thirds of patients waiting for surgery experience anxiety. The result of the anxiety the patient pre surgery
which was great then there is a possibility the operation could not be carried out. One way to overcome
anxiety is by way deep breathing relaxation techniques with five finger hypnosis. This study aims to
determine the effect of deep breathing relaxation technique with five finger hypnosis therapy on the
patient’s pre operative anxiety at RSUD. Dr. H. Kumpulan Pane Tebing Tinggi. This study uses quasy
experiment with the design of the one group pre and post test design. Number of samples in this study
were 31 respondents. The sampling technique used was purposive sampling. Collecting data in this study
using a questionnaire. Based on the result of study respondents anxiety level prior to deep breathing
relaxation techniques with hypnosis therapy five finger, mild anxiety (16,1 % ), moderate anxiety (61,3%),
and severe anxiety (22,6 %). After deep breathing relaxation techniques with hypnosis therapy five
fingers, mild anxiety (83, 9%), and moderate anxiety (16, 1 % ). The test used in this study by using the
wilcoxon test. Wilcoxon test result with a value of z = -4. 107. There is a significant influence in breath
relaxation techniques with hypnotic therapy five fingers against anxiety patients pre operative in RSUD Dr.
H. Kumpulan Pane Tebing Tinggi p value = 0.000 ( p < 0,1 ). This research can be used by the patient pre
operative in overcoming anxiety is experienced.

Keywords: Deep breathing relaxation techniques, five finger hypnosis therapy, anxiety, preoperative

INTRODUCTION
Preoperative is the initial stage to prepare the patient as much as possible so that they can be
operated on properly, recover quickly, and be free from postoperative complications. The overall
success of the surgery depends on this phase. Surgery is a potential or actual threat to a
person's integrity that can generate physiological and psychological stress reactions. Surgery is
loaded with tension. Patients who are going to undergo surgery are generally accompanied.
According to Hulu & Pardede (2016). Anxiety in the preoperative period because they think
surgery is a scary thing.

According to Efendy (2008, in Gea 2014) in an anxious state, the body will overproduce the
hormone cortisol which will result in an increase in blood pressure, chest tightness, and unstable
emotions. The result of preoperative patient anxiety is very great, there is the possibility that the
operation cannot be carried out, because in patients who experience anxiety before surgery,
abnormalities such as increased blood pressure will appear so that if the operation is still carried
out it will result in difficulty in stopping bleeding, and even after surgery it will interfere with the
healing process. In 2011 there were 50 out of 700 patients who canceled surgery due to
psychological factors, namely anxiety at the Central Surgical Installation, BLU Prof. Dr. R. D.
Kandou Manado (Budikasi et al, 2015).

Correspondence: *jekpardedemi@rocketmail.com
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

More than two-thirds of patients awaiting surgery experience anxiety. The level of anxiety in each
patient depends on the experience which is influenced by several factors. Some levels of anxiety
occur as a natural reaction that cannot be predicted, especially in preoperative patients,
especially in patients who are experiencing surgery for the first time. Excessive preoperative
anxiety can cause a pathophysiological response which includes tachycardia, hypertension,
arrhythmias, and severe pain that can persist until the postoperative period (Ariati, 2012).

The results of research conducted by Apriansyah, et al (2014) at Muhammadiyah Palembang


Hospital regarding the relationship between pre-operative patient anxiety levels and
postoperative pain levels showed that pre-operative respondents who experienced moderate and
severe anxiety categories were 23 respondents (50%) of the total. 46 respondents studied while
respondents who experienced mild category anxiety with pain complaints totaled 10 respondents
(21.7%).

One way to overcome anxiety is by means of deep breath relaxation techniques and five finger
hypnosis. Some of the benefits of deep breathing techniques are the psychological benefits of
reducing stress, which is one way to relax the body by concentrating on breathing. Deep
breathing can help reduce the severity and frequency of tension headaches associated with
stress, slow heart rate, lower blood pressure, and reduce fatigue. From the data obtained from
medical records, patients who underwent major surgery from January to December 2015 totaled
483 patients with the most 5 operated diseases such as uterine neoplasms, urinary tract stones,
caesarian, appendicitis, and hernias. From the results of interviews conducted by the author on
10, The patient said that 6 patients said they were anxious and afraid when they faced surgery
and the results of the observation of 4 patients had trembling hands, difficulty thinking and cold
acral of the patient, this affected the patient who was going to face surgery. From the background
description above, the authors are interested in conducting a study to determine whether there
was an effect of deep breath relaxation techniques with five-finger hypnosis therapy on pre-
operative patient anxiety.

The general objective of this study was to determine the effect of deep breath relaxation
techniques with five finger hypnosis therapy on preoperative patient anxiety. The benefit of this
research is expected that nurses in the surgical ward can provide deep breath relaxation
techniques with five finger hypnosis therapy in pre-operative patients who experience anxiety.

RESEARCH METHODS
The design of this research is a quasi-experiment with pre-test and post-test with one group
which aims to determine the effect of deep breath relaxation techniques and five-finger hypnosis
on changes in preoperative patient anxiety. The population in this study were major preoperative
patients at RSUD Dr. H. The Tebing Tinggi City Pane Collection, which is estimated to be 40
patients per month with the top 5 diseases being operated on, such as uterine neoplasms,
urinary tract stones, cesarean, appendicitis, and hernias. The samples in this study were major
preoperative patients. From the average number of patients who undergo surgery per month as
many as 40 people, the sampling technique used in this study was purposive sampling, which is
a sampling method by selecting certain samples that are judged according to the research
objectives in a population.

The sample criteria in this study were all pre-operative patients who met the following inclusion
criteria: Patients who have never had the previous surgical experience, Patients who will undergo

Correspondence: *jekpardedemi@rocketmail.com
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

major type surgery. Patients were able to communicate well the day before surgery. In many
circumstances, investigators had anticipated the possibility of selected subjects dropping out,
losing to follow-up, or being disobedient. If from the beginning it has been determined that the
subject group will not be analyzed, it is necessary to correct the calculated sample size by adding
the number of subjects so that the sample size is still met. The statistical test used was the
Wilxocon test with a value of p <0.1 = p <0.1.

RESULT

Table 1
Distribution of Frequency and Percentage of Respondent Characteristics

Characteristics of n %
Respondent

Age
18 – 32 years old 13 6,5
33 – 47 years old 10 32,3
48 – 60 years old 8 61,3
Gender
Male 11 61,3
Female 20 38,7
Education
Primary school 6 19,4
Junior High 11 35,5
High school 10 32,3
4 12,9
Bachelor
Profession
Housewife 3 9,7
Farmer 9 29,0
Entrepreneur 9 29,0
Civil servants 3 9,7
7 22,6
and others
Marital status
Single 9 22,6
Married 17 67,7
Widow widower 5 9,7
Financing
Insurance 15 48,4
General 16 51,6

Correspondence: *jekpardedemi@rocketmail.com
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

Based on Table 1, it can be seen that based on the age group of respondents the majority are in the
age range 18 - 32 years as much as 61.3%, in the gender of the majority of respondents are women
as much as 64.5%, at the education level the majority of respondents are at the junior high school
level as much as 35.5% The majority of respondents' occupations are farmers, namely 35.5%
respectively, the majority of respondents' marital status is married, amounting to 54.8% and the
majority of respondents' financing status is insurance, namely 54.8%.

Table 2
Preoperative Patient Anxiety Before Given Intervention

Preoperative Patient n %
Anxiety
Light 5 16,1
Moderate 19 61,3
Weight 7 22,6

Based on Table 2, it can be seen that the majority of preoperative patient anxiety is moderate,
namely 61.3%.

Table 3
Preoperative Patient Anxiety After Given Intervention

Preoperative Patient n %
Anxiety
Light 26 83,9
Moderate 5 16,1

Based on Table 3, it can be seen that the pre-operative patient anxiety after being given a deep breath
technique with five finger hypnosis is mostly mild, namely 83.9%.

Table 4
Anxiety of Pre Operative Patients Before and After Given The Deep Breath Relaxation Technique with
Five Finger Hypnosis Therapy

Preoperative
Patient Anxiety Light Moderate Weight P value Z

n % n % n % 0,000 -4,107
Before 5 16,1 19 61,3 7 22,6
After 26 83,9 5 16,1 0 0
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

Based on Table 4, it can be seen that after being given a deep breath technique with five finger
hypnosis therapy, 22.6% of respondents with severe anxiety turned into moderate anxiety 16.1%, 61.3%
of respondents with moderate anxiety turned into mild anxiety 83.9 %. Wilcoxon test results, there is a
significant effect of deep breath relaxation techniques with five-finger hypnotic therapy on preoperative
patient anxiety in Dr. H. Group of Pane Kota Tebing Tinggi with p-value = 0.000 (p <0.1).

DISCUSSION
Anxiety Before Being Given Deep Breath Relaxation Techniques With Five Finger Hypnosis
Therapy
The results showed that the results of measuring respondents' anxiety before being given deep breath
relaxation techniques with five fingers hypnotic therapy using a questionnaire, the majority of moderate
anxiety was 61.3%. One of the most common responses in pre-operative patients is a psychological
response (anxiety), mentally patients who are going to face surgery must be prepared because there is
always a sense of anxiety and fear of injections, wound pain, anesthesia, and even the possibility of
disability or death (Apriansyah, Romadani, and Andrianovita, 2014).

Anxiety is a subjective experience of restless mental tension as a general reaction and the inability to
deal with problems or insecurities. The unpleasant feelings generally produce physiological symptoms
(such as shaking, sweating, increased heart rate, etc.) and psychological symptoms (such as panic,
tension, confusion, inability to concentrate, etc.). According to Smeltzer (2006, in Maryunani, 2014)
added, there are several things that cause anxiety, namely those that come from external factors
(environment, fear of surgery, fear of anesthesia) and internal factors (age, gender, knowledge,
education, and profession). Based on the characteristics of the respondents in this study, the majority of
respondents were> 31 years old (61.3%). Respondent's age is a factor that affects the level of anxiety.
According to Kaplan and Sadock (2007, in Fetty, 2013), anxiety can occur at any age, more often in
adulthood. Most of the anxiety occurs at the age of 21 - 45 years. The gender of respondents is the
majority of women, 64.5%.

According to Prasetyo (2010), anxiety can be experienced by every individual, and women who
experience anxiety twice as much as men. The majority of respondents' education level in this study is
SMP 35.5%. So, on average the respondents in this study were able to understand and easily respond
to the information conveyed by researchers. According to Stuart & Sundeen (2006, in Fetty, 2013), a
person's education will affect the ability to think, the higher the level of education, the easier it will be to
think rationally and the easier it will be to capture the information conveyed.

According to the researchers' assumptions, the average individual who will undergo surgery or surgery
experiences anxiety, both mild anxiety, moderate anxiety, to severe anxiety depending on the
individual's own response. The majority of pre-operative patients experienced moderate anxiety, the
anxiety experienced by preoperative patients was in accordance with the existing statements, where
most respondents felt excessive worry, accompanied by fear, and looked anxious because they would
be operated on. This is something that often happens to every individual who is going to undergo
surgery because they have the perception that surgery is a threatening and frightening thing.
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

Anxiety after being given a deep breath relaxation technique with five finger hypnosis therapy
The results showed that the results of measuring respondents' anxiety after being given deep breath
relaxation techniques with five fingers hypnotic therapy using a questionnaire, the majority of mild
anxiety was 83.9%. Deep breathing relaxation is mental and physical freedom from tension and stress
because it can change the patient's cognitive perception and affective motivation. Relaxation techniques
allow patients to control themselves when there is discomfort or pain, physical stress, and emotion in
pain. Several studies have shown that deep breath relaxation is very effective in reducing postoperative
anxiety and pain (Brunner & Suddart, 2001 in Gea, 2014).

Gea's research (2014) shows that before giving deep breath relaxation, the average anxiety level of
respondents was in the medium anxious category with a percentage of 70%, after giving deep breath
relaxation the average respondent's anxiety level was in the mild anxiety category with a percentage of
70%. The results of statistical tests showed that the p-value in the study was 0. 000 which was smaller
than the alpha value (0.05), meaning that there was a significant effect between giving deep breath
relaxation to reducing the anxiety level of preoperative patients.

Imaginary stimuli in the form of things you like will make you relax, then these stimuli are carried to the
brain stem to the thalamus sensor to be formatted. A small portion of these stimuli are transmitted to the
amygdala and the surrounding hippocampus and most of them are sent to the cerebral cortex. In the
cerebral cortex, there is a process of sensory association, in the hypothalamus things that are liked are
considered as important signals by the hippocampus so that they are processed into memory. When
there is stimulation in the form of images about the things that are liked, the memory that has been
stored will appear again and give rise to perception. From the hippocampus, stimuli that have meaning
are sent to the amygdala which will form a pattern of behavioral responses in accordance with the
meaning of stimuli received (Guyton and Hall, 2007 in Ariati 2012).

Loriana's research (2009, in Ariati 2012), shows that the anxiety level of pre Appendectomy surgery
patients is at a mild to moderate level of anxiety. Preoperative anxiety level with mild anxiety was 50%
and moderate anxiety was 50% and after five finger hypnosis therapy, the level of anxiety with mild
anxiety was 70% and moderate anxiety was 10%. According to the researchers 'assumptions, after
being given a deep breath relaxation technique with five finger hypnosis, the respondents' anxiety
experienced a change from the majority of moderate anxiety to the majority of mild anxiety. Deep breath
relaxation techniques with five finger hypnosis therapy can relieve tension in the muscles of the body
and mind with pleasant and enjoyable images so as to provide the respondent with a sense of comfort.
Thus, deep breath relaxation techniques with five finger hypnosis therapy can reduce respondents'
anxiety

Anxiety Before And After Given Deep Breath Relaxation Techniques With Five Finger Hypnosis
Therapy Against Anxiety in Pre Operative Patients
Wilcoxon test results, there is a significant effect of deep breath relaxation techniques with five-finger
hypnotic therapy on preoperative patient anxiety in Dr. H. Group of Pane Kota Tebing Tinggi with p-
value = 0.000 (p <0.1). From the results of this study that after being given a deep breath relaxation
technique with five finger hypnosis therapy, 22.6% of respondents with severe anxiety turned into
moderate anxiety 16.1%, 61.3% of respondents with moderate anxiety turned into mild anxiety 83.9%.
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

By taking a deep breath slowly, the body will become more relaxed. The feeling of relaxation will be
transmitted to the hypothalamus to produce Corticotropin-Releasing Factor (CRF) and then stimulate
the pituitary gland to increase the production of Proopioidmelanocortin (POMC) so that the production of
enkephalin by the adrenal medulla increases and also produces endorphin neurotransmitters that make
relaxes (Guyton and Hall, 2007 in Ariati 2012 ). Gea's research (2014) shows that before giving deep
breath relaxation, the average anxiety level of respondents was in the medium anxious category with a
percentage of 70%, after giving deep breath relaxation the average respondent's anxiety level was in the
mild anxiety category with a percentage of 70%. The results of statistical tests showed that the p-value
in the study was 0.000 smaller than the alpha value (0.05), meaning that there was a significant effect
between giving deep breath relaxation to the decrease in the level of anxiety in preoperative patients.

Five finger hypnosis therapy is a method of relaxation that uses the power of the mind. This technique
begins with a general relaxation process, which is asking the client to slowly close his eyes and take a
deep, slow breath to induce relaxation. Then the patient is encouraged to relax to empty the mind so
that the thoughts that are being thought are temporarily eliminated and the patient can focus on the
image they are thinking about, and the patient begins to fill the mind with images that are pleasant and
enjoyable (Smeltzer and Bare, 2002 in Ariati 2012 ). The results of this study are in line with research
conducted by Banon, Dalami, and Noorkasiani (2014), regarding the effect of five-finger hypnosis
therapy on reducing anxiety in hypertensive patients, who found that there was an effect of five-finger
hypnosis therapy on changes in anxiety in hypertensive patients with a p-value of 0, 019 (<0.05). Ariati's
research (2012) shows the same results regarding the effect of the five-finger hypnosis technique on
reducing the anxiety level of patients pre appendectomy surgery at Sawerigading Palopo Hospital which
found that there is an effect of the five-finger hypnosis technique on reducing anxiety levels with a p-
value of 0.001 (<0, 05).

The assumption of researchers, deep breath relaxation techniques with five finger hypnosis therapy
really help reduce anxiety in respondents who will undergo surgery. However, several factors that can
affect the success of this therapy are the age and readiness of the respondents to receive the
information presented.

CONCLUSION
Based on research results on the effect of deep breath relaxation techniques with five finger hypnosis
therapy on pre-operative patient anxiety, it can be concluded that: five fingers in preoperative patients
the majority of mild anxiety. And there is a significant effect of deep breath relaxation techniques with
five finger hypnosis therapy on pre-operative patient anxiety with a p-value = 0.000 (p <0.1) with a value
of z = -4.107, which means that there is a strong influence on deep breath relaxation techniques with
five hypnotic therapy. finger.

REFERENCES
Apriansyah, A., Romadoni, S., & Andrianovita, D. (2015). Hubungan Antara Tingkat Kecemasan Pre-
Operasi dengan Derajat Nyeri Pada Pasien Post Sectio Caesarea di Rumah Sakit
Muhammadiyah Palembang Tahun 2014. Jurnal Keperawatan Sriwijaya, 2(1), 1-7.

Ariati, D. (2012). Pengaruh teknik relaksasi lima jari terhadap penurunan tingkat kecemasan pada
pasien preoperasi apendiktomi di rumah sakit umum sawerigading palopo. Skripsi dipublikan.
Journal of Psychiatry, 2018
Volume 3 No 1: 1-8

Astuti, H.T. (2015). Pengaruh pemberian terapi relaksasi progresif terhadap tingkat kecemasan pasien
pre operasi di RSU pku Muhammadiyah Bantul. Skripsi dipublikan

Banon, E., & Dalami, E. (2014). Noorkasiani. Efektivitas Terapi Hipnotis Lima Jari Untuk Menurunkan
Tingkat Ansietas Pasien Hipertensi.

Budikasi, F. I. E., Mulyadi, N., & Malara, R. (2015). Hubungan Pemberian Informed Consent Dengan
Tingkat Kecemasan Pasien Preoperasi Kategori Status Fisik I-ii Emergency American Society
of Anesthesiologists (Asa) Di Instalasi Gawat Darurat Rsup Prof. Dr. RD Kandou Manado.
Jurnal Keperawatan, 3(2).

Fetty, I (2013). Hubungan Pemberian Informasi Perawat Dengan Kecemasan Pada Pasien Pre Operasi
Mastektomi Di RSUD Dr. Pirngadi Medan Tahun 2013. Skripsi. Universitas Sari Mutiara
Indonesia Medan.

Gea. N.K. (2014). Pengaruh Relaksasi Nafas Dalam Terhadap Penurunan Tingkat Kecemasan Pasien
Pre Operasi di RSUD Kota Bekasi.SkripsiJakarta: Sekolah Tinggi Ilmu Kesehatan Medistra
Indonesia

Gulo, R. S., & Pardede, J. A. (2017). Work Stress Related To Self-care Nurses. Mental Health, 2(2).

Hulu, E. K., & Pardede, J. A. (2016). Dukungan Keluarga Dengan Tingkat Kecemasan Pasien Pre
Operatif Di Rumah Sakit Sari Mutiara Medan. Jurnal Keperawatan, 2(1).

Maryunani, A. (2014). Asuhan Keperawatan Perioperatif-Pre Operasi. Jakarta. Trans Info Media.

Prasetyono. (2007). Asuhan Keperawatan Pre dan Post Operasi. Jakarta : Salemba Medika

Wau, E. T., Pardede, J. A., & Simamora, M. (2018). Levels of Stress Related to Incidence of Gastritis in
Adolescents. Mental Health, 4(2).