The Effect Addition Deep Breathing

In Slow Stroke Back Massage For

Decreased Blood Pressure In Eldery
Hypertension

Name : Unik Tri Hartati

Nim : 201410301117
 MAGNITUDE

For Bantul District the prevalence of hypertension based on blood

pressure measurement was 23.9%, based on diagnosis by health
personnel was 6.1%, while based on diagnosis and or history of
taking hypertension medication was 6.2% . Based on note on
Integrated Disease Surveillance (STP ) based on outpatient
Puskesmas (new case) of the top ten diseases in all age groups in
Bantul Regency in 2009 hypertension was ranked third with 9,189
cases (Elvyrah F 2011).

From the preliminary study of researchers at the

elderly posyandu “Seger Waras” in Bantul, 63
people who followed the routine examination aged
55-90 years consisting of 31 with systolic blood
pressure 110-130 and 32 people with systolic blood
pressure > 130mmhg
 SERIOUSNESS THE PROBLEM

Hypertension for a long time if not detected

early and received adequate treatment can
cause damage to the kidney (kidney failure),
heart (coronary heart disease) and brain (cause
stroke). Many hypertension patients with
uncontrolled blood pressure and the number
continues to increase. (Dika P, 2016).
 COMMUNITY
CONCERT

Mean: “And whosoever We prolong his days will

We give him back to Him. So do they not think?
"(Yasin 68).
FORMULATION OF THE
PROBLEM
1. Is there any effect of slow stroke
back massage for decreased blood
pressure in elderly hypertension?
2. Is there any effect of addition
deep breathing in slow stroke
back massage for decreased blood
pressure in elderly hypertension?
• General purpose
To determine the effect of the
addition of deep breathing in
slow stroke back massage for
decrease blood pressure for
elderly hypertension.
• Special purpose
To determine the effect of
slow stroke back massage for
decrease blood pressure for
elderly hypertension.
Benefits of research :
1. For science
2. For researchers
3. For the elderly
The scope of research:
1. The scope of the material
2. The scope of the environment
3. The scope of the respondent
4. The scope of time
 AUTHENTICITY OF RESEARCH
1. In the study of Nopri Afrila, Ari Pristiana Dewi, Erwin, the
independent variable is slow stroke back massage and
acupressure, the dependent variable is hypertension. This
research design uses quasy experiment with non-equivalent
control group approach involving two groups, that is experiment
group and control group. Sampling technique that is used using
area sampling technique. The difference with my research is
independent variable and sampling technique.
2. In Anastasi Widyo Retno and Dian Prawesti research the
independen variable is slow stroke back massage and the
dependent variable is hypertension. His research design was pre-
experiment (One Group Pre-test-posttest Design). Sampling
technique used in this research is Purposive Sampling that is
included in Nonprobability Sampling. The difference with my
research is the independent variable and the research design
 DEFINITION OF
ELDERLY

Elderly is not a disease but an advanced stage of a

life process characterized by a decline in the body's
ability to adapt to environmental stress (Pudjiastuti
& Utomo 2003). The aging process affects physical
and mental changes that lead to decreased
endurance resulting in the emergence of various
diseases, and most often found in the elderly are
hypertensive diseases (Tamher & Noorkasiani
2009)
 CLASSIFICATION
OF ELDERLY

According to WHO the elderly is

divided into:
middle age: 45 – 59 years old
elderly: 60 – 74 years old
old: 75 – 90 years old
Very old age : >90 years old
 DEFINITION OF
HYPERTENSION

Hypertension is a non-contagious disease is still a

global health problem. Hypertension is a condition in
which systolic blood pressure ≥ 140 mmHg and
diastolic pressure ≥ 90 mmHg at two times
measurements with an interval of five minutes in a
resting state. In general, hypertension does not provide
typical complaints and symptoms that many people
who do not realize it. Therefore hypertension is said to
be the silent killer (Hafiz 2016)
 CLASSIFICATION OF
HYPERTENSION

1. Pre hypertension: systolic 120-

139mmHg, dyastolic 80-90mmHg
2. Hypertension stadium 1: systolic 140-
159mmHg, dyastolic 90-99mmHg
3. Hypertension stadium 2: systolic
>160mmHg, dyastolic >100mmHg
4. Isolated systolic hypertension: systolic
>140mmHg, dyastolic <90mmHg
(Bestari 2012).
 THE INFLUENCE FACTOR OF
HYPERTENSION
 Genetic: the presence of genetic factors in certain families will
cause the family has a risk of suffering from hypertension. This is
associated with increased levels of intracellular sodium and low
ratio of potassium to sodium. Individuals with elderly people with
hypertension have twice the risk of hypertension than non-familial
people with a history of hypertension. In addition, 70-80% of cases
of essential hypertension with a family history of hypertension
were found.
 Stress: stress can increase blood pressure at a time. The hormone
adrenaline will increase as we stress, and it can cause the heart to
pump blood faster so that blood pressure increases.
 Smoking: smoking causes increased blood pressure. Heavy
smokers can be associated with an increased incidence of
malignant hypertension and the risk of renal artery stenosis with
atherosclerosis.
 INTERVENTION

1. Deep braething with diaphragm tekhnique

is very good to be done every day by people
with high blood pressure, to help relax the
muscles of the body, especially blood vessel
muscle so as to maintain the elasticity of
arterial blood vessels that can help lower
blood pressure (Heryanto, 2004).

2. Slow stroke back massage is a technique of massage on

the back slowly and with firm hand movements.
Slow stroke back massage can provide the effect of
improving blood circulation and lymph ventilation,
releasing nerve responses, releasing body chemicals
resulting in a relaxed response (Healey, 2011).
The steps of doing deep breathing exercises (according to Smeltzer, 2008,
quoted from Immania, 2014) are as follows:
1) Set the patient with half laying position in the chair or in bed
2) Arrange the patient to put one hand on the abdomen (just under the ribs)
and the other hand in the center of the chest to feel the movement of the
chest and abdomen at the time of breathing
3) Instruct the patient to take a deep breath for 4 seconds until the chest
and abdomen feel elevated maximally, keep the mouth closed during
inspiration and hold the breath for 2 seconds
4) Instruct the patient to exhale through the closed lips and slightly open
while tightening the abdominal muscles for 2 seconds
5) Repeat for 1 minute with a 2 second pause each repetition, followed by a
2 minute break
6) This exercise is done in 5 cycles for 15 minutes.
According to Potter & Perry (2005) action slow stroke back
massage also has procedures, including:
1) Identification of factors or conditions of the patient such as,
burns in the back, redness of the skin, rib fracture or vertebrae,
or the presence of open sores that become contra indications to
make a swab on the back. In patients who have a history of
hypertension or distritma, examine the pulse and blood pressure.
2) Describe the procedure and position the patient wants.
3) Preparation of materials and instruments include olive oil
according to the rules of wear, towels, blankets and clocks.
4) Respondents are welcome to choose the desired position
during the intervention, either by sitting or lying face down.
5) Open the back, shoulders, and upper arms of the respondent
then cover the rest with a blanket.
6) The intervention provider first hand wash using antiseptic or
flowing water. Pour some oil in hand and use as needed. Explain
to the respondent that the massage procedure will be performed.
7) Place the first hand on the sacrum area, massage in a circular
motion. Massage over the scapula with gentle and firm
movements. Continue in one gentle sweep to the upper arm and
laterally along the side of the back and back down to the top of the
iliaca. Do not let your hands lifted from the skin of the respondent.
Continue the above pattern for 5 minutes.
8) Squeeze the skin by taking tissue between your thumb and
fingers. Squeeze up along one side of the spina from the sacrum
area to the shoulders and around the bottom of the neck. Squeeze
or wipe down the sacrum. Repeat along the other side of the back.
9) End the sweep with the motion of the cast and let the respondent
know that the interventionist ends the sweep.
10) Clean the excess lubricant from the respondent's back using a
bath towel. Help the elderly wear the smell again.
11) Help respondents back in a comfortable position
12) Place the dirty towels in place and wash your hands
13) Review the pulse and blood pressure
14) Record response to massage and skin conditions
 CONCEPTUAL FRAMEWORK

Elderly ≥60 years old

Cardiovascular function decreased: decreased elasticity and

permaebilitas in capillary vessels, increased vascular
pressure increase systole pressure and decreased tissue
perfusion

Hypertension

Farmakologi Non Farmakologi:

1. Deep Breathing
2. Slow stroke back massage

blood pressure decreased

 HYPOTHESIS

Hypothesis I: There is the effect of slow stroke back massage

on blood pressure decrease in elderly hypertension

Hypothesis II: There is an effect of the addition of slow deep

breathing in slow stroke back massage to decrease blood
pressure for elderly hypertension
 RESEARCH METHODS
1. Research type: experimental quasi by using pre-
post test two groups design.
2. Sampling technique: porpusive sampling, with
randomized sampling.

O1 X1 O2
P S R
O3 X2 O4
 RESEARCH
VARIABLE

Variable Dependent: blood pressure in hypertension

Variable Independent: Deep breathing and slow
stroke back massage
 DEFINISI
OPERASIONAL

Hypertension
Hypertension can result from increased cardiac output due to
increased heart rate, stroke volume and increased stretching
of heart muscle fibers. A person is said to have hypertension
if the result of blood pressure measurement using tensimeter
more than 140

Slow stroke back massage

diaphragm deep breathing
deep breathing is the
breathing of the diaphragm
with slow frequency and
slow, rhythmic, by closing
the eyes when breathing
Slow stroke back massage is a gentle, slow
massage, with a rhythmic emphasis on the
thoracic area 10 to 12 and lumbar 1 which is
the source of innervation on 29 uterus and
cervik, this technique performed as much as
60 times a swab in one minute for 3-10
minutes.
 POPULATION AND SAMPLES

Slovin:

n= 17,897 18, And to avoid

the sample drop out then the
sample added 2 people. Total
= sample 20 for two group

=
= 17,897
 Ethical Research:
Data Collection Tools and
Methods: 1. Inform consent
2. Justict
1. Personal data form 3. Annonyme
2. Tension meter 4. Confidentiality
3. Lotion
4. Towel
5. Stationary
 Data analysis
Data processing software application SPSS Data Editor
Version 16

Normality test :
Test the data normality Test of Hypotheses I and II:
use Test If the data distribution is normal using
Shapiro Wilk. Paired Test Sample T-test. If the data
(p> 0.05) normal distribution is not normal use Wilcoxon.
(p <0.05) is not normal if the p value is less than0.05 (p <0.05)
then Ha accepted and Ho rejected.
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