ANALISA ATAU MENTALAAH JURNAL

DENGAN MENGGUNAKAN PICOT

Disusun Dalam Rangka Memenuhi Tugas

Mata Kuliah EBN

DOSEN PENGAMPU MATA KULIAH

“Dr. Ns. RAHMIWATI, S.Kep, M Kep”

DISUSUN :
DINALIZA UTAMI
(2014201100)

UNIVERSITAS FORT DE KOCK

PRODI S-1 KEPERAWATAN
TH 2020/20121
Volume 1, No. 3
Desember 2018

REAL in Nursing
Journal (RNJ)
Research of Education and Art Link in Nursing
Journal

https://ojs.fdk.ac.id/index.php/Nursing/index

Terapi Komplementer Guna Menurunkan

Nyeri
Pasien Gastritis: Literatur Review

Andinna Dwi Utami & Imelda Rahmayunia Kartika

 Program Studi Pendidikan Ners
STIKes Fort de Kock Bukittinggi, Indonesia
 REAL in Nursing Journal (RNJ), Vol. 1, No. 3
Utami, A.D. & Kartika, I.R. (2018). RNJ. 1(3) : 123-132

Terapi Komplementer Guna Menurunkan Nyeri Pasien Gastritis:

Literatur Review
REAL in Nursing Andinna Dwi Utami & Imelda Rahmayunia Kartika
Journal (RNJ)
https://ojs.fdk.ac.id/inde ABSTRACT
x.php/Nursing/index
Gastritis is inflammation that affects the gastric mucosa. This
inflammation can cause swelling of the gastric mucosa until
the release of the superficial mucosal epithelium is the most
important cause of disorders in the digestive system. Pain is
Keywords:
an unpleasant sensory and emotional experience due to actual
pain,
and potential tissue damage. Pain Management using
gastritis patients,
distraction, relaxation (Using deep breath) techniques,
complementary therapy
efflurage massage, guided imaginary, warm water
compresses, progressive deep muscle relaxation techniques,
Korespondensi:
hand held finger relaxation. The method used is used in review
Andinna Dwi Utami
Literature review begins with the selection of topics, then the
andinnadwiutami9@gmail
keyword is determined for searching journals using Indonesian
.com and English through several databases including Google
Scholar, Ebsco, and Pro Quest. This search is limited to
Stikes Fort De Kock journals from 2009 to 2019. Based on several explanations
Bukittinggi that have been stated, that the most commonly used
complementary therapy is deep breath relaxation, because
deep breath relaxation used for the therapeutic process greatly
helps alleviate the pain experienced by patients because it
facilitates the healing process and can be carried out
independently by patients.

ABSTRAK

Gastritis merupakan peradangan yang mengenai mukosa lambung. Peradangan ini dapat mengakibatkan
pembengkakan mukosa lambung sampai terlepasnya epitel mukosa superfisial yang menjadi
penyebab terpenting gangguan dalam sistem pencernaan. Nyeri adalah pengalaman sensori dan
emosional yang tidak menyenangkan akibat kerusakan jaringan yang aktual dan potensial.
Manajemen Nyeri yang menggunakan teknik distraksi, relaksasi (Menggunakan napas dalam), pijat
efflurage, guided imaginary, kompres air hangat, teknik relaksasi otot progresif dalam, relaksasi
genggam jari. Metode yang digunakan digunakan dalam ‘Literatur review diawali dengan pemilihan
topik, kemudian ditentukan keyword untuk pencarian jurnal menggunakan bahasa Indonesia dan
Bahasa Inggris melalui beberapa database antara lain Google Scholar, Ebscho, dan Pro Quest.
Pencarian ini dibatasi untuk jurnal mulai tahun 2009 sampai 2019. Berdasarkan beberapa
penjelasan yang telah dikemukakan, bahwa terapi komplementer yang paling sering digunakan
adalah relaksasi nafas dalam, karena relaksasi nafas dalam yang digunakan untuk proses terapi
tersebut sangat membantu meringankan nyeri yang dialami pasien oleh karena itu memudahkan
dalam proses penyembuhan dan dapat dilakukan secara mandiri oleh pasien.

Kata Kunci : nyeri, pasien gastritis, terapi komplementer

 123|RNJ

Gastritis merupakan peradangan yang

PENDAHULUAN mengenai mukosa lambung. (Chen, et
Penyakit pada sistem pencernaan adalah al. 2010) Peradangan ini dapat
mengakibatkan pembengkakan
penyebab paling umum terjadinya
nyeri. Salah satunya penyakit mukosa lambung sampai terlepasnya
epitel mukosa superfisial yang menjadi
gastritis atau yang biasanya di
kenal dengan maag. Gastritis penyebab terpenting gangguan dalam
sistem pencernaan. Pelepasan sel
merupakan peradangan yang
mengenai mukosa lambung epitel akan merangsang timbulnya
proses inflamasi pada lambung
(Nurhanifah, Afni, & Rahmawati,
2018). Banyaknya faktor yang (Sukarmin, 2012 dalam Wijayanti dan
Dirdjo 2015). Gastritis yang
dapat menyebabkan gastritis yang
membuat angka kejadian gastritis
juga meningkat menurut World Health
Organization (WHO) angka
kematian di dunia akibat kejadian
gastritis di rawat inap yaitu 17-21%
dari kasus yang ada pada tahun
2012. Di Indonesia menurut WHO
(2012) adalah 40,8%. Angka
kejadian gastritis pada beberapa
daerah di Indonesia cukup tinggi
dengan prevalensi 274.396 kasus
dari 238.452.952 jiwa penduduk
(Waluyo & Suminar 2017).

Persentase dari angka kejadian gastritis di

Indonesia didapatkan mencapai
angka 40,8%. Berdasarkan profil
kesehatan Indonesia tahun 2009,
gastritis merupakan salah satu
penyakit di dalam sepuluh penyakit
terbanyak pada pasien rawat inap
di rumah sakit di Indonesia dengan
jumlah 30.154 kasus (4,9%). Angka
kejadian gastritis pada beberapa
daerah di Indonesia cukup tinggi
dengan prevalensi 274,396 kasus
dari 238,452,952 jiwa penduduk.
Didapatkan data bahwa di kota
Surabaya angka kejadian Gastritis
sebesar 31,2%, Denpasar 46%,
sedangkan di Medan angka
kejadian infeksi cukup tinggi
sebesar 91,6% (Thahir & Nurlela,
2018).
 REAL in Nursing Journal
(RNJ), Vol. 1, No. 3 Utami, A.D. &
Kartika, I.R. (2018). RNJ. 1(3) : 123-
132
dibiarkan tidak terawat akan terus menerus
mengalami kekambuhan dan memberikan
efek negatif pada kondisi kesehatan lansia
(Waluyo & Suminar 2017).
Salah satu manifestasi klinis yang terjadi pada
pasien gastritis adalah nyeri. Nyeri yang
dirasakan adalah nyeri ulu hati atau nyeri
epigastrium. (Raghavan dan Holmgren
2012) Nyeri adalah pengalaman sensori dan
emosional yang tidak menyenangkan akibat
kerusakan jaringan yang aktual dan
potensial (Ben et al. 2012) Secara umum
tanda dan gejala yang sering terjadi pada
pasien yang mengalami mengalami nyeri
dapat tercermin dari perilaku pasien
misalnya suara (menangis, merintih,
menghembuskan nafas), ekspresi wajah
(meringis, menggigit bibir), pergerakan
tubuh (gelisah, otot tegang, mondar-mandir,
dll), interaksi sosial (menghindari
komunitas pada pasien yang mengalami
nyeri pada gastritis.
METODE
Metode yang digunakan dalam penulisan
literatur review ini diawali dengan
pemilihan topik, kemudian
ditentukan keyword untuk
pencarian jurnal. Beberapa
database antara lain Google
Scholar, dan Pro Quest. Pencarian
jurnal ini dibatasi tahunnya mulai
dari tahun 2009 sampai tahun
2019. Keyword yang digunakan
adalah ‘Nyeri Gastritis, Terapi
Komplementer’. Dua puluh jurnal
Bahasa Indonesia dan jurnal
Bahasa Inggris dipilih berdasarkan
kriteria inklusi. Kriteria inklusi dalam
percakapan, disorientasi waktu) (Judha, 2012
dalam Supetran, 2018).
Salah satu terapi non-farmakologi yang dapat
diberikan pada penderita yang mengalami nyeri
pada gastritis adalah terapi komplementer
(Indayani 2018). Beberapa tindakan mandiri
yang dapat di laksanakan perawat untuk
membantu klien yaitu dengan menggunakan
Manajemen Nyeri untuk menghilangkan atau
mengurangi nyeri dan meningkatkan rasa
nyaman. Menggunakan
komunikasi terapeutik untuk mengetahui pengalaman
nyeri pasien yaitu dengan
menggunakan teknik distraksi, relaksasi
(Menggunakan napas dalam), pijat efflurage,
guided imaginary, kompres air hangat, teknik
relaksasi otot progresif dalam, relaksasi
genggam jari. Berdasarkan penjelasan yang
telah dikemukakan, maka penulis sangat
tertarik untuk mereview beberapa literatur
terkait tentang terapi komplementer terhadap
penurunan nyeri pada pasien gastritis. Sebagai
rujukan evidance based agar perawat dapat
menerapkannya dalam
124|RNJ
literatur review ini adalah terapi
komplementer terhadap nyeri gastritis.
HASIL DAN PEMBAHASAN
Literatur review ini menelaah 20 jurnal artikel
True Experiment, tentang terapi
komplementer terhadap penurunan
nyeri pada pasien gastritis dan hanya
memakai 10 jurnal yang inklusi sesuai
dengan keyword.
Relaksasi Napas Dalam
Berdasarkan 5 jurnal yang membahas
tentang Teknik Relaksasi Nafas
Dalam. Teknik relaksasi nafas dalam
merupakan suatu bentuk asuhan
keperawatan, yang dalam hal ini
perawat mengajarkan kepada klien
bagaimana cara melakukan nafas
dalam, nafas lambat (menahan
inspirasi secara maksimal) dan
bagaimana menghembuskan nafas
 secara perlahan. Selain dapat
menurunkan intensitas nyeri, teknik
relaksasi nafas dalam juga dapat
meningkatkan ventilasi paru dan
meningkatkan oksigenasi darah teknik relaksasi nafas dalam mengurangi nyeri,
(Smeltzer dan Bare, 2002 dalam
Wijayanti dan Dirdjo 2015).
Beberapa penelitian menunjukkan bahwa
perubahan nyeri setelah melakukan
relaksasi nafas dalam sangat
signifikan. Menurut penelitian
Waluyo & Suminar (2017) yang
menggunakan
Menurut (Ruhman, 2017) adanya pengaruh
Pada kasus lainnya, dilakukan intervensi selama 10-
REAL in Nursing Journal
(RNJ), Vol. 1, No. 3 Utami, A.D. &
Kartika, I.R. (2018). RNJ. 1(3) : 123-
132
diperoleh dari 19 responden, 5 Tidak nyeri, 11
responden nyeri ringan, dan 3 responden nyeri
sedang. Hasil penelitian menunjukan bahwa
penggunaan metode teknik relaksasi nafas
dalam proses penyembuhan pasien pasca
operasi fraktur femur sangat efektif dalam
menyembuhkannya dan sudah terlihat jelas
hasilnya. Karena relaksasi nafas dalam yang
digunakan untuk proses terapi tersebut sangat
membantu meringankan nyeri yang dialami
pasien oleh karena itu memudahkan dalam
proses penyembuhan. (Waluyo & Suminar
2017).
pemberian relaksasi nafas dalam terhadap
perubahan skala nyeri sebelum dan sesudah
diberikan intervensi, yaitu pada kasus seorang
pasien dilakukan intervensi selama 10- 15
menit, setelah itu peneliti meminta pasien
istrahat sekitar 30-35 menit, selanjutnya
peneliti mengkaji ulang nyeri dan hasilnya
pasien mengatakan nyerinya berkurang dan
hasil ini dibuktikan dengan observasi wajah
pasien sudah lebih nyaman dan terasa rileks,
pasien mengaatkan skala nyeri dari 6 (nyeri
sedang) menurun menjadi 3 (nyeri ringan).
15 menit, setelah itu peneliti meminta pasien
istrahat sekitar 30-35 menit, selanjutnya
peneliti mengkaji ulang nyeri dan hasilnya
pasien mengatakan nyerinya berkurang dan
kepala pasien sudah lebih nyaman dan terasa
ringan, pasien mengatakan skala nyeri dari 5-6
(nyeri sedang) menurun menjadi 2 (nyeri
ringan). Selanjutnya pada kasus seorang Ibu
dilakukan intervensi selama 10-15 menit,
setelah itu peneliti meminta pasien istrahat
sekitar 30-35 menit, selanjutnya peneliti
mengkaji ulang nyeri dan hasilnya pasien
mengatakan nyerinya berkurang dan kepala
pasien sudah lebih nyaman dan terasa ringan,
pasien mengatakan skala nyeri dari 5-6
(nyeri sedang) menurun menjadi 3 (nyeri
ringan).
 125|RNJ
pada jaringan yang dibawahnya
(Henderson, 2006 dalam
Hanggarwati , 2015).
Menurut (Shin et al. 2012) pengendalian
Pengaruh mekanis dari effleurage adalah
pengaturan pernapasan secara
membantu kerja pembuluh darah balik
sadar dilakukan oleh korteks
(vena) dan menyebabkan timbulnya
serebri, sedangkan pernapasan
panas tubuh sehingga manipulasi
yang spontan atau automatik
effleurage dapat berfungsi sebagai
dilakukan oleh medulla oblongata.
pemanasan (warming up) (Shirbeigi et
Napas dalam lambat dapat
al. 2015). Pengaruh fisiologis dari
menstimulasi respons saraf otonom
gosokan yang kuat mempengaruhi
melalui pengeluaran
sirkulasi darah pada jaringan yang
neurotransmitter endorphin yang
berefek pada penurunan respons
saraf simpatis dan peningkatkan
respons parasimpatis. Stimulasi
saraf simpatis meningkatkan
aktivitas tubuh, sedangkan respons
parasimpatis lebih banyak
menurunkan ativitas tubuh atau
relaksasi sehingga dapat
menurukan aktivitas metabolik
(Shirbeigi et al. 2015).

Pijat (Massage Efflurage)

Massage (pijatan) adalah tindakan
penekanan oleh tangan pada
jaringan lunak, biasanya otot
tendon atau ligamen, tanpa
menyebabkan pergeseran atau
perubahan posisi sendi guna
menurunkan nyeri, menghasilkan
relaksasi, dan/atau meningkatkan
sirkulasi. Gerakan-gerakan dasar
meliputi : gerakan memutar yang
dilakukan oleh telapak tangan,
gerakan menekan dan mendorong
kedepan dan kebelakang
menggunakan tenaga, menepuk- nepuk,
memotong- motong, meremas-
remas, dan gerakan meliuk-liuk.
Setiap gerakan gerakan
menghasilkan tekanan, arah,
kecepatan, posisi tangan dan
gerakan yang berbeda-beda untuk
menghasilkan efek yang di inginkan
 REAL in Nursing Journal
(RNJ), Vol. 1, No. 3 Utami, A.D. &
Kartika, I.R. (2018). RNJ. 1(3) : 123-
132
paling dalam dan di otot-otot merupakan teknik
masase yang aman, mudah, tidak perlu
banyak alat, tidak perlu biaya, tidak memiliki Pada hipokampus hal-hal yang menyenangkan akan
efek samping dan dapat dilakukan sendiri
atau dengan bantuan orang (Nisofa, 2002
dalam Hanggarwati, 2015).
Guided Imagery
Berdasarkan 2 jurnal literatur yang membahas
tentang terapi Guided Imagery. Guided
imagery merupakan imajinasi yang
dirancang secara khusus untuk mencapai
efek positif. Dengan membayangkan hal-hal
yang menyenangkan maka akan terjadi
perubahan aktifitas motorik sehingga otot-
otot yang tegang menjadi relaks, respon
terhadap bayangan menjadi semakin jelas. Guided imagery adalah sebuah teknik yang
Hal tersebut terjadi karena rangsangan
imajinasi berupa hal-hal yang
menyenangkan akan dijalankan kebatang
otak menuju sensor thalamus untuk
berfungsi sebagai pengalih perhatian dari
stimulus yang menyakitkan dengan
demikian dapat mengurangi respon
nyeri (Jacobson, 2006, dalam
Kristanti, 2014). Efek guided
imagery and music (GIM) membuat
responden merasa rileks dan
tenang. Responden menjadi rileks
dan tenang saat mengambil
oksigen di udara melalui hidung,
oksigen masuk kedalam tubuh
sehingga aliran darah menjadi
lancar serta dikombinasikan
dengan imajinasi terbimbing
menyebabkan seseorang
mengalihkan perhatiannya yang
membuatnya senang dan bahagia
sehingga melupakan nyeri yang di
alaminya. Inilah yang menyebabkan
diformat. Sebagian kecil rangsangan itu
ditransmisikan ke amigdala dan hipokampus,
sebagian lagi dikirim ke korteks serebi.
Sehingga pada korteks serebi akan terjadi
asosiasi pengindraan.
diproses menjadi sebuah memori (Ouyang dan
Chen 2014). Ketika terdapat rangsangan
berupa imajinasi yang menyenangkan memori
yang tersimpan akan muncul kembali dan
menimbulkan suatu persepsi. Dari hipokampus
rangsangan yang telah mempunyai makna
dikirim ke amigdala yang akan membentuk
pola respon yang sesuai dengan makna
rangsangan yang diterima. Sehingga subjek
akan lebih mudah untuk mengasosiasikan
dirinya dalam menurunkan sensasi nyeri yang
di alami (Nurhanifah, Afni, & Rahmawati,
2018)..
memanfaatkan cerita atau narasi untuk
mempengaruhi pikiran, sering dikombinasi
dengan latar belakang musik. Guided imagery
dapat
126|RNJ
nyeri mengalami penurunan setelah
dilakukan teknik relaksasi Guided
Imagery. (Nurhanifah, Afni, &
Rahmawati, 2018). Selain itu,
mendengarkan murottal Al-qur’an juga
dapat mengurangi nyeri (Kartika,
2015).
Selain itu Ada pengaruh yang signifikan
Guided Imaginary Terhadap
Penurunan Nyeri Pada Pasien
Gastritis di Wilayah Kerja Puskesmas
Karang Banjarmasin dengan hasil dari
15 orang responden yang mengalami
tidak nyeri Sesudah diberikan tindakan
Guided Imagery sebanyak 10 orang
(66,7%), dan yang mengalami nyeri
ringan sebanyak 5 orang (33,3%)
(Nurhanifah, Afni, & Rahmawati, 2018)
Teknik Kompres Hangat REAL in Nursing Journal
(RNJ), Vol. 1, No. 3 Utami, A.D. &
Penggunaan kompres hangat diharapkan
Kartika, I.R. (2018). RNJ. 1(3) : 123-
dapat meningkatkan relaksasi otot- 132
otot dan mengurangi nyeri akibat
spasme atau kekakuan serta Menurut teori gate-control kompres hangat dapat
memberikan rasa hangat lokal. mengaktifkan (merangsang) serat-serat non-
Pada umumnya panas cukup nosiseptif yang berdiameter besar ( A-α dan A-
berguna untuk pengobatan. Panas β) untuk „‟menutup gerbang‟' bagi serat- serat
meredakan iskemia dengan yang berdiameter kecil ( A-δ dan C) yang
menurunkan kontraksi dan berperan dalam menghantarkan nyeri,
meningkatkan sirkulasi. Kompres sehingga nyeri dapat dikurangi (Jeon et al.
hangat dapat menyebabkan 2015). Upaya menutup pertahanan tersebut
pelepasan endorfin tubuh sehingga merupakan dasar terapi menghilangkan nyeri.
memblok transmisi stimulasi nyeri. Berdasarkan latar belakang diatas penulis
(Subekti & Utami, 2011) berminat melakukan penerapan terapi kompres
air hangat untuk mengurangi nyeri pada
gangguan gastritis (Amin, 2017)

Relaksasi Genggam Jari

Relaksasi genggam jari adalah sebuah teknik
relaksasi yang sangat sederhana dan mudah
dilakukan oleh siapapun yang berhubungan
dengan jari tangan serta aliran energi di dalam
tubuh kita. Teknik genggam jari disebut juga
finger hold (Fang et al. 2017) menggenggam
jari sambil menarik nafas dalam-dalam
(relaksasi) dapat mengurangi dan
menyembuhkan ketegangan fisik dan emosi,
karena genggaman jari akan menghangatkan
titik-titik keluar dan masuknya energi pada
meredian (energi channel) yang terletak pada
jari tangan kita (Rogayah, 2017).

Titik-titik refleksi pada tangan akan memberikan

rangsangan secara refleks (spontan) pada saat
genggaman. Rangsangan tersebut akan mengalirkan
semacam gelombang kejut atau listrik menuju
otak. Gelombang tersebut diterima otak dan
diproses dengan cepat, lalu diteruskan menuju
saraf pada organ tubuh yang mengalami
gangguan, sehingga sumbatan dijalur energi
menjadi lancar. (Wijayanti & Dirdjo, 2015). Data
penelitian dilengkapi dengan tabel Matriks, dengan
sbb :

127|RNJ
 REAL in Nursing Journal (RNJ), Vol. 1, No. 3
Utami, A.D. & Kartika, I.R. (2018). RNJ. 1(3) : 123-132

NO. SITASI JENIS PENELITIAN SAMPEL/ TEMPAT INTERVENSI/ PENGAMBILAN DATA HASIL

1. (Nurhanifah, Artikel penelitian/

15 responden Metode pre exsperimental design dengan Ada pengaruh yang signifikan guided
Afni, & kuantitatifKlien gastris di wilayah kerja desain one group pretest-posttest design, imaginary terhadap penurunan
Rahmawati, puskesmas karang mekar nyeri pada pasien gastritis di
2018) Banjarmasin, wilayah kerja puskesmas karang
banjarmasin.
2. (Ragoyah, 2017) Artikel penelitian/
36 sampel Desain quasi eksperiment control group
kuantitatifDi RS. Sukmul Sisma Medika dan pretest – postest dengan pengambilan Tehnik relaksasi otogenik dan distraksi
RS. Harum sisma medika pasien sampel non randomized lebih efektif terhadap penurunan
dengan gastritis tingkat nyeri pasien gastritis.

3. (Hanggarwati Artikel penelitian/

3 orang Single case experimental designs Keefektifan distraksi tergantung pada
Novia Devi, kuantitatif Pasien dengan gastritis akut di atau eksperimen dengan kemampuan pasien untuk
2015) ruang instalasi gawat darurat (IGD) subjek berjumlah sedikit. menerima dan membangkitkan
Rsud Abdul Wahab Sjahranie input sensori selain nyeri.
Samarinda.

4. (Thahir , N, dan Artikel penelitian/

70 responden Desain pre-eksperimen dengan One Ada pengaruh pemberian relaksasi
Nurlela 2018) kuantitatif Penderita gastritis di ruang rawat Group pretest-Post test design. napas dalam terhadap
inap RSUD Haji Makassar. penurunan nyeri pada penderita
gastritis di ruang rawat inap
RSUD Haji Makassar
5. (Subekti,T dan Artikel penelitian/
3 orang Single case experimental designs atau
Utami, M.S., kuantitatif Penderita tukak lambung pada eksperimen dengan subjek berjumlah Relaksasi yang diberikan secara indi-
2011) Suatu rumah sakit. sedikit. vidual sebagai terapi maupun
sebagai self help dapat
menurunkan stres dan keluhan
tukak lambung

128|RNJ
 REAL in Nursing Journal (RNJ), Vol. 1, No. 3
Utami, A.D. & Kartika, I.R. (2018). RNJ. 1(3) : 123-132

NO. SITASI JENIS PENELITIAN SAMPEL/ TEMPAT INTERVENSI/ PENGAMBILAN DATA HASIL
(Wijayanti & Artikel penelitian/
Di ruang instalasi gawat darurat Penelitian preexperimental design
Kombinasi relaksasi genggam jari dan nafas
Dirdjo, 2015) kuantitatif rsud. Abdul wahab sjahranie
dengan pendekatan pretest-posttest dalam akan menghasilkan rasa nyaman
samarinda. design. karena dapat membebaskan mental dan fisik
dari ketegangan dan stress, sehingga dapat
meningkatkan toleransi terhadap nyeri dan
tubuh meresponnya dengan penurunan
denyut jantung, penurunan respirasi dan
penurunan ketegangan otot
Penelitian study
(Amin, Mia kasus 1 orang pastisipan Metode studi kasus (case study). Terapi kompres hangat terbukti dapat
Khoirul, 2017) Pasien gastritis di ruang dahlia rsud menurunkan nyeri pada pasien gastritis
dr. Soedirman kebumen
( Waluyo, S.J eksperimental
& Artikel penelitian/
Periode September 2016–
Penelitian semu (quasi
Pemberian metode teknik relaksasi nafas
Suminar, S., kuantitatif November 2016. Rata-rata dalam eksperimental) dengan desain pre dan dalam dalam mengurangi rasa nyeri pada
2017) tiga bulan terakhir ada 24 pasien post test without control design pasien gastritis
gastritisyang dirawat inap di Klinik
Mboga, Sukoharjo

(Supetran, I Artikel penelitian/

12 orang Penelitian preexperimental design
Ada perbedaan tingkat nyeri sebelum dan
2018) kuantitatif Semua penderita gastritis yang dengan pendekatan pretest-posttest sesudah dilakukan teknik relaksasi otot
dirawat di ruang jambu pada tahun design. progresif dalam menurunkan tingkat nyeri
2015 pasien gastritis di

(Ruhman, M. Artikel penelitian/

3 kasus Single case experimental designs atau Adanya pengaruh pemberian relaksasi nafas
dengan subjek
2017) kuantitatif Di ruang unit gawat darurat RSUD eksperimen berjumlah
dalam dan relaksasi aromaterapi bunga
Muhammad parikesit
sedikit mawar terhadap perubahan skala nyeri
tenggarong. pasien

129|RNJ
 REAL in Nursing Journal (RNJ), Vol. 1, No. 3
Utami, A.D. & Kartika, I.R. (2018). RNJ. 1(3) : 123-132
oleh karena itu memudahkan dalam
SIMPULAN proses penyembuhan dan dapat
Gastritis merupakan peradangan yang dilakukan secara mandiri oleh pasien.
mengenai mukosa lambung.
Peradangan ini dapat mengakibatkan UCAPAN TERIMAKASIH
pembengkakan mukosa lambung Terima kasih dari penulis kepada Allah SWT
sampai terlepasnya epitel mukosa atas rahmat Nya sehingga literature
superfisial yang menjadi penyebab review ini dapat diselesaikan.
terpenting gangguan dalam sistem Selanjutnya penulis ucapkan terima
pencernaan. Salah satu manifestasi
klinis yang terjadi pada pasien gastritis
adalah nyeri. Nyeri yang dirasakan
adalah nyeri ulu hati atau nyeri
epigastrium. Nyeri adalah pengalaman
sensori dan emosional yang tidak
menyenangkan akibat kerusakan
jaringan yang aktual dan potensial.
Beberapa tindakan mandiri yang dapat
di lakukan perawat untuk membantu
klien yaitu dengan menggunakan

Manajemen Nyeri digunakan untuk

menghilangkan atau mengurangi nyeri
dan meningkatkan rasa nyaman.
Literatur Review ini secara
komprehensif merangkum, menilai dan
meninjau literatur yang tersedia
tentang nyeri gastritis dan terapi
komplementer untuk menurunkan nyeri
pada pasien gastritis. Hasil terapi
komplementer yakni menggunakan
komunikasi terapeutik untuk
mengetahui pengalaman nyeri pasien
dengan
menggunakan teknik distraksi, relaksasi
(Menggunakan napas dalam), pijat
efflurage, guided imaginary, kompres
air hangat, teknik relaksasi otot
progresif dalam, relaksasi genggam
jari. Berdasarkan beberapa penjelasan
yang telah dikemukakan, bahwa terapi
komplementer yang paling sering
digunakan adalah relaksasi nafas
dalam, karena relaksasi nafas dalam
yang digunakan untuk proses terapi
tersebut sangat membantu
meringankan nyeri yang dialami pasien

kasih kepada Dosen EBN atas bimbingannya
sehingga mempermudah kami dalam
membuat literature Review ini.
DAFTAR PUSTAKA
Amin, M. K. (2017). “Penerapan Terapi Kompres
Air Hangat Untuk Mengurangi Nyeri Pada
Pasien Gastritis Di Ruang Dahlia RSUD Dr.
Soedirman Kebumen. Karya Tulis Ilmiah.
Program Studi Profesi Ners: STIKes
Muhammadiyah Samarinda.
Ben, Hui et al. (2012). “Observation Of Pain-
Sensitive Points Along The Meridians In
Patients With Gastric Ulcer Or Gastritis.”
Evidence-Based Complementary And Alternative
Medicine: 1–7.
Fang, Wen-Jie et. al. (2017). “Chinese Herbal
Decoction As A Complementary Therapy For
Atrophic Gastritis : A Systematic Review And
Meta-Analysis 14: 297–319.
Chen, H et al. (2010). “Rabeprazole Combined
With Hydrotalcite Is Effective For Patients
With Bile Reflux Gastritis After Cholecystectomy.”
Canadian Journal Of Gastroenterology 24(3):
197–201.
Hanggarwati, N. D. (2015). Analisis Praktik
Klinik
Keperawatan Pada Pasien Gastritis Dalam
Dan Pijat Efflurage Terhadap
Nyeri
Abdomen. Karya Tulis Ilmiah. Program Studi
Profesi Ners: STIKes Muhammadiyah
Samarinda.
Indayani. (2018). “Pengaruh Pemberian Jus
Buah
Pepaya ( Carica Papaya ) Terhadap Tingkat
Nyeri Kronis Pada Penderita Gastritis Di
Wilayah Puskesmas Mungkid.” STIKES PKU
Muhammadiyah Surakarta: 353–65.
Jeon, Woo-Young et al. (2015). “Curcuma
Aromatica Water Extract Attenuates Ethanol-
Induced Gastritis Via Enhancement Of
130|RNJ

Utami, A.D. & Kartika, I.R. (2018). RNJ. 1(3) : 123-132
Antioxidant Status .” Evidence-Based
Complementary And Alternative Medicine
2015: 1–7.
Kartika, I. (2015). Pengaruh Mendengar
Murottal
Al-Qur'an Terhadap Penurunan Intensitas
Nyeri Pasien Pasca Operasi Apendisitis.
Jurnal Riau: Universitas Riau.
Krisanti, N. (2014). “Pemberian Guided
Imagery
Relaxation Terhadap Penurunan Nyari
Abdomen Pada Asuhan Keperawatan Ny.S
Dengan Dispepsia Di Ruang IGD RSUD
Karanganyar.” Pemberian Terapi Batuk
Efektif Dalam Pengeluaran Sputum Pada
Asuhan Keperawatan Tn.S Dengan Ppok
Diruang Bugenvil Rsud Dr.Soedirman
Mangun Sumarso Wonogiri.
Nurhanifah, D, Afni, A.R.N & Rahmawati. (2018).
“Pengaruh Guided Imaginary Terhadap
Penurunan Nyeri Pada Klien Gastritis Di
Wilayah Kerja Puskesmas Di Banjarmasin).
Healthy Mu-Journal. 2(1): 24–30.
Ouyang, H., Dan J. D.Z. Chen. 2014. “Review
Article: Therapeutic Roles Of Acupuncture In
Functional Gastrointestinal Disorders.” Alimentary
Pharmacology And Therapeutics 20(8): 831–
41.
Ruhman, M. (2017). “Analisis Praktik Klinik
Keperawatan Pada Pasien Dispepsia
Dengan Intervensi Relaksasi Nafas Dalam
Dan Relaksasi Aromaterapi Bunga Mawar
Terhadap Perubahan Skala Nyeri Di Ruang
Unit Gawat Darurat Rsud Aji Muhammad .
Karya Tulis Ilmiah. Program Studi Profesi
Ners: STIKes Muhammadiyah Samarinda.
Raghavan, S, Dan J Holmgren. (2012). “Effects Of
Oral Vaccination And Immunomodulation By
Cholera Toxin On Experimental.” Society
70(8): 4621–27.
Rogayah. (2017). “Pengaruh
Tehnik Relaksasi
REAL in Nursing Journal (RNJ), Vol. 1, No. 3
Otogenik Dan Distraksi Terhadap Tingkat Nyeri
Pasien Pada Penyakit Gastritis Di Rs .
Sukmul Sisma Medika Dan Rs . Harum
Sisma Medika Jakarta.” NEONATUS 7(2):
42–55.
Shin, K. Y. et al. (2012). “Characteristics Of The
Pulse Wave In Patients With Chronic
Gastritis And The Healthy In Korean
Medicine.” Proceedings Of The Annual
International Conference Of The IEEE
Engineering In Medicine And Biology
Society, EMBS (August): 992–95.
Shirbeigi, L, N Halavati, L Abdi, Dan J Aliasl.
(2015). “Dietary And Medicinal Herbal
Recommendation For Management Of
Primary Bile Reflux Gastritis In Traditional
Persian Medicine.” Iran J Public Health 44(8):
1166–68.
Subekti, Tri, & Utami, M.S. (2011). “Metode
Relaksasi Untuk Menurunkan Stres Dan
Keluhan Tukak Lambung Pada Penderita
Tukak Lambung Kronis.” Jurnal Psikologi
38(2): 147–63.
Https://Jurnal.Ugm.Ac.Id/Jpsi/Article/Downloa
d/7649/5929.
Supetran, I. (2018). “Efektifitas Penggunaan
Teknik Relaksasi Otot Progresif Dalam
Menurunkan Tingkat Nyeri Pasien Gastritis
Di Rumah Sakit Daerah Madani Palu.”
PROMOTIF: Jurnal Kesehatan Masyarakat
6(1).
Thahir, Nuryanti & Nurlela.
(2018). “Pengaruh
Relaksasi Napas Dalam Terhadap
Penurunan Intensitas Nyeri Pada Pasien
Gastritis Di Ruang Rawat Inap Rsud Haji
Makassar.” Patria Artha Journal Of Nursing
Science 2(2): 129–34. Http://Ejournal.Patria-
Artha.Ac.Id/Index.Php/Jns.
Waluyo, Sunaryo Joko, & Suminar, Seka.
(2017).
 REAL in Nursing Journal (RNJ), Vol. 1, No. 3
Utami, A.D. & Kartika, I.R. (2018). RNJ. 1(3) : 123-132

“Perubahan Skala Nyeri Sedang Pada

Pasien Gastritis Di Klinik Mboga Sukoharjo A
N.” 5(1): 20–32.

Wijayanti, Tri, & Dirdjo, M.M. (2015). “Analisis

Praktik Klinik Keperawatan Pada Pasien
Gastritis Dengan Pemberian Relaksasi Nafas
DalamDan Relaksasi Genggam Jari
Terhadap Nyeri Akut Akibat Gastritis Instalasi
Gawat Darurat Rumah Sakit Umum Daerah
Abdul Wahab Sjahranie Samarinda Tahun
2015.”Sekolah Tinggi Ilmu Kesehatan
Muhammadiyah Samarinda.
 ANALISA JURNAL

IDENTITAS JURNAL
Judul Asli : Terapi Komplementer Guna Menurunkan Nyeri Pasien
Gastritis:Literatur Review.
Penulis/ pengarang : Andinna Dwi Utami & Imelda Rahmayunia Kartika

PICOT ANALISA
P (POPULATION Dalam menurunkan nyeri digunakan terapi komplementer teknik
OR PROBLEM) nafas dalam pada gastritis. Peradangan ini dapat mengakibatkan
pembengkakan mukosa lambung sampai terlepasnya epitel mukosa
superfisial yang menjadi penyebab terpenting gangguan dalam
sistem pencernaan. Nyeri adalah pengalaman sensori dan emosional
yang tidak menyenangkan akibat kerusakan jaringan yang aktual dan
potensial. Manajemen Nyeri yang menggunakan teknik distraksi,
relaksasi Menggunakan napas dalam (dwi et al. 2018)
I Adanya pengaruh pemberian relaksasi nafas dalam terhadap
(INTERVENTION) perubahan skala nyeri sebelum dan sesudah diberikan intervensi,
yaitu pada kasus seorang pasien dilakukan intervensi selama 10-
15 menit, setelah itu peneliti meminta pasien istrahat sekitar 30-35
menit, selanjutnya peneliti mengkaji ulang nyeri dan hasilnya
pasien mengatakan nyerinya berkurang dan hasil ini dibuktikan
dengan observasi wajah pasien sudah lebih nyaman dan terasa
rileks, pasien mengaatkan skala nyeri dari 6 (nyeri sedang)
menurun menjadi 3 (nyeri ringan).
Metode yang digunakan dalam penulisan literatur review ini
diawali dengan pemilihan topik, kemudian ditentukan keyword
untuk pencarian jurnal. Beberapa database antara lain Google
Scholar, dan Pro Quest. Pencarian jurnal ini dibatasi tahunnya
mulai dari tahun 2009 sampai tahun 2019. Keyword yang
digunakan adalah ‘Nyeri Gastritis, Terapi Komplementer’. Dua
puluh jurnal Bahasa Indonesia dan jurnal Bahasa Inggris dipilih
berdasarkan kriteria inklusi. Kriteria inklusi dalam literatur review
ini adalah terapi komplementer terhadap nyeri gastritis.

C tidak ada jurnal pembanding.

(COMPARATION)
O (OUTCOME) Hasil penelitian ini dari Literatur review ini menelaah 20 jurnal
artikel True Experiment, tentang terapi komplementer terhadap
penurunan nyeri pada pasien gastritis dan hanya memakai 10 jurnal
yang inklusi sesuai dengan keyword.
menggunakan teknik distraksi, relaksasi (Menggunakan napas
dalam), pijat efflurage, guided imaginary, kompres air hangat,
 teknik relaksasi otot progresif dalam, relaksasi genggam jari.
Berdasarkan beberapa penjelasan yang telah dikemukakan, bahwa
terapi komplementer yang paling sering digunakan adalah relaksasi
nafas dalam, karena relaksasi nafas dalam yang digunakan untuk
proses terapi tersebut sangat membantu meringankan nyeri yang
dialami pasien oleh karena itu memudahkan dalam proses
penyembuhan dan dapat dilakukan secara mandiri oleh pasien.

T (TIME) Desember 2018 , stikes fort de kock

 ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013

EFEKTIFITAS TEKNIK RELAKSASI NAFAS DALAM DAN GUIDED IMAGERY

TERHADAP PENURUNAN NYERI PADA PASIEN POST
OPERASI SECTIO CAESARE DI IRINA D
BLU RSUP Prof. Dr. R. D. KANDOU
MANADO

Chandra Kristianto Patasik

Jon Tangka
Julia Rottie

Program Studi Ilmu Keperawatan Fakultas Kedokteran

Universitas Sam Ratulangi Manado
E-mail:cha_chris91@ymail.com

ABSTRACT: Pain is an unpleasant symptom that felt by patients post sectio caesarea.
Alternatives to reduce pain with deep breathing relaxation techniques and guided
imagery not definitely known how its effectiveness. The purpose of this research was
to determine the effectivity of deep breathing relaxation techniques and guided
imagery to reduction pain in post surgery patients sectio caesarea. This research is an
analytical research with quasi-experimental research methods. The research design
was a single group pre-post test without control group. The sampling technique used is
accidental sampling where found samples as many as 20 people. The data analysis
using paired sample t-test in SPSS 17 programe at 95% significance level (α=0.05).
The results showed that deep breathing relaxation techniques and guided imagery
proved to be effective in reducing pain intensity in post surgery patients sectio
caesarea in the Irina D Department of RSUP Prof. Dr. R. D. Kandou Manado (p
value=0.000; α 0.05) which means that the hypothesis is accepted. Conclusion, deep
breathing relaxation techniques and guided imagery can reduce pain intensity in post
surgery patients sectio caesarea in the Irina D Department of RSUP Prof. Dr. R. D.
Kandou Manado. Implementation of deep breathing relaxation techniques and guided
imagery to reduce pain in post surgery patients sectio caesarea can be be done
according to the SOP so not just focus on the pharmacological treatment only.
Keywords: Deep Breathing Relaxation Techniques, Guided Imagery, Pain, Sectio
Caesarea.

ABSTRAK: Nyeri merupakan suatu gejala yang tidak menyenangkan yang dialami oleh
pasien post operasi sectio caesarea. Alternatif untuk menurunkan nyeri yaitu dengan
menggunakan teknik relaksasi nafas dalam dan guided imagery bagaimana
efektifitasnya belum jelas diketahui. Tujuan penelitian ini adalah untuk mengetahui
efektifitas teknik relaksasi nafas dalam dan guided imagery terhadap penurunan nyeri
pada pasien post operasi sectio caesarea. Penelitian ini merupakan penelitian analitik
dengan metode penelitian kuasi eksperimen.Desain penelitian adalah satu kelompok
pre-post tes tanpa kelompok kontrol.Teknik pengambilan sampel yaitu Accidental
Sampling dimana didapatkan sampel sebanyak 20 responden. Teknik analisa data
menggunakan uji paired sampel t-tes program SPSS 17 pada tingkat kemaknaan 95%
(α=0,05). Hasil penelitian menunjukkan bahwa teknik relaksasi nafas dalam dan
guided imagery terbukti efektif dalam menurunkan intensitas nyeri pada pasien post
operasi sectio caesarea di Irina D BLU RSUP Prof. Dr. R. D. Kandou Manado (nilai
p=0,000; α 0,05) yang berarti hipotesis diterima. Kesimpulan, teknik relaksasi nafas
dalam dan guided imagery mampu menurunkan intensitas nyeri pada pasien post
operasi sectio caesarea di Irina D BLU RSUP Prof. Dr. R.D.

1
ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013

Kandou Manado. Penerapan teknik relaksasi nafas dalam dan guided imagery untuk
menurunkan nyeri pada pasien post operasi sectio caesarea dapat dilakukan sesuai
dengan SOP agar tidak hanya terpaku pada penaganan secara farmakologis saja.
Kata kunci: Teknik Relaksasi Nafas Dalam, Guided Imagery, Nyeri, Sectio Caesarea.
efek samping yang timbul
setelah menjalani suatu
PENDAHULUAN operasi.Nyeri yang
Dewasa ini, ilmu pengetahuan dan disebabkan oleh operasi
teknologi telah meningkat pesat. biasanya membuat
Kemajuan teknologi dan ilmu pasien merasa sangat
dibidang kesehatan membawa kesakitan.Ketidaknyamanan
manfaat yang besar bagi manusia, atau nyeri bagaimanapun
termasuk pada penatalaksanaan keadaannya harus diatasi
sectio caesarea.Sectio caesarea dengan manajemen nyeri,
merupakan salah satu cara yang karena kenyamanan
digunakan dibidang kesehatan merupakan kebutuhan dasar
untuk membantu persalinan ketika manusia.
ada masalah tak terduga terjadi
selama persalinan, seperti faktor 2
dari ibu yaitu panggul yang
sempit, faktor dari janin yang
letaknya lintang, tidak cukup
ruang bagi janin untuk melalui
vagina, dan kelainan pada janin
seperti berat badan janin melebihi
4000 gram (National Institute of
Health, 2012).Sectio caesarea
adalah operasi bedah dimana
dokter kandungan membuat
sebuah lubang di perut dan rahim
ibu kemudian mengeluarkan janin
dari lubang tersebut (National
Institute for Clinical Excellence,
2004).
Berdasarkan data yang
ditemukan di Irina D BLU
RSUP Prof. Dr. R. D. Kandou
Manado terdapat 1.504 operasi
sectio caesarea pada tahun 2011
dan 1.511 operasi sectio
caesarea pada tahun 2012. Ini
menunjukkan bahwa banyaknya
operasi sectio caesarea pada saat
ini yang dilakukan di BLU
RSUP Prof. Dr. R. D. Kandou
Manado, walaupun operasi ini
sangat beresiko.
Respon nyeri yang
dirasakan oleh pasien merupakan
 Nyeri merupakan sensasi
yang sangat tidak menyenangkan
dan bervariasi
pada tiap individu.Nyeri dapat
mempengaruhi seluruh pikiran
seseorang, mengatur aktivitasnya,
dan mengubah kehidupan orang
tersebut.Nyeri merupakan faktor
psikososial yang perlu diungkap
lewat komunikasi terapeutik, karena
seorang perawat perlu mendapatkan
data baik secara subjektif maupun
objektif untuk menilai seberapa besar
pengaruh nyeri tersebut pada pasien
(Berman, Snyder, Kozier, & Erb,
2003).
Penanganan nyeri dengan
melakukan teknik relaksasi
merupakan tindakan keperawatan
yang dilakukan untuk mengurangi
nyeri. Penanganan nyeri dengan
tindakan relaksasi mencakup teknik
relaksasi nafas dalam dan guided
imagery.Beberapa penelitian telah
menunjukkan bahwa relaksasi nafas
dalam sangat efektif dalam
menurunkan nyeri pasca operasi
(Sehono, 2010).
Relaksasi adalah sebuah
keadaan dimana seseorang terbebas
dari tekanan dan kecemasan atau
kembalinya keseimbangan
(equilibrium) setelah terjadinya
gangguan.Tujuan dari teknik relaksasi
adalah mencapai keadaan relaksasi
menyeluruh, mencakup keadaan
relaksasi secara fisiologis, secara
kognitif, dan secara behavioral. Secara
fisiologis, keadaan relaksasi ditandai
dengan penurunan kadar epinefrin dan
non epinefrin dalam darah, penurunan
frekuensi denyut jantung (sampai
mencapai 24 kali per menit),
penurunan tekanan darah, penurunan
frekuensi nafas (sampai 4-6 kali per
menit), penurunan ketegangan otot,
metabolisme menurun, vasodilatasi
dan peningkatan temperatur pada
extermitas (Rahmayati, 2010).
ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013
teknik relaksasi nafas dalam dan
guided imagery karena
Teknik relaksasi nafas penanganan nyeri berfokus
dalam akan lebih efektif bila hanya pada penanganan secara
dikombinasikan dengan beberapa farmakologis saja.
teknik lainnya, seperti guided Berdasarkan uraian
imagery. Guided imagery tersebut di atas maka penulis
merupakan teknik yang merasa tertarik untuk mengetahui
menggunakan imajinasi seseorang lebih lanjut mengenai efektifitas
untuk mencapai efek positif teknik relaksasi nafas dalam dan
tertentu (Smeltzer, Bare, Hinkle, guided imagery terhadap
& Cheever, 2010).Teknik ini penurunan nyeri abdomen pada
dimulai dengan proses relaksasi pasien post operasi sectio
pada umumnya yaitu meminta caesareadi
kepada klien untuk perlahan-lahan
menutup matanya dan fokus pada
nafas mereka, klien didorong
untuk relaksasi mengosongkan
pikiran dan memenuhi pikiran
dengan bayangan untuk membuat
damai dan tenang (Rahmayati,
2010).
Penelitian yang dilakukan
oleh Syahriyani (2010), tentang
pengaruh teknik relaksasi
terhadap perubahan intensitas
nyeri pada pasien post operasi
apendiktomi di ruang perawatan
bedah RSU TK II Pelamonia
Makassar, menunjukkan bahwa
intensitas nyeri responden
sebelum dan sesudah pemberian
teknik relaksasi mengalami
peningkatan penurunan nyeri
dari nyeri ringan 20,00% ke
66,67%, nyeri sedang 53,33% ke
20,00%, dan nyeri berat 26,67%
ke 13,33%. Uji lebih lanjut
membuktikan ada pengaruh
pemberian teknik relaksasi
terhadap perubahan intensitas
nyeri pada pasien post operasi
apendiktomi di ruang perawatan
bedah RSU TK II Pelamonia
Makassar.
Hasil survei sementara di
Irina D BLU RSUP Prof. Dr. R.
D. Kandou Manado pada salah
seorang perawat senior
menyatakan umumnya perawat
jarang bahkan tidak melakukan

Irina D BLU RSUP Prof. Dr. R. D.
Kandou Manado.
METODE PENELITIAN
Jenis penelitian ini adalah analitik dengan
metode penelitian kuasi eksperimen.Desain
penelitian adalah satu kelompok pre-post
tes tanpa kelompok kontrol.
Penelitian dilaksanakan di Irina D BLU
RSUP Prof. Dr. R. D. Kandou Manado pada
tanggal 7 Juni – 15 Juni 2013.
Populasi dalam penelitian ini adalah semua
pasien yang telah menjalani operasi sectio
caesarea di Irina D BLU RSUP Prof. Dr. R.
D. Kandou Manado dengan teknik
pengambilan sampel Accidental Sampling.
Kriteria inklusi dalam penelitian ini
adalah pasien post sectio caesareahari
pertama, pasien yang bersedia menjadi
responden, pasien yang reaksi analgetiknya
telah hilang atau 6 jam setelah pemberian
3
analgetik dan belum mendapatkan
analgetik lagi. Sedangkan kriteria eksklusi
dalam penelitian ini adalah pasien yang
telah diberikan teknik relaksasi lainnya,
pasien yang telah melakukan operasi sectio
caesarea sebelumnya, pasien sectio
caesarea yang mengalami komplikasi.
Instrumen yang digunakan dalam
penelitian ini berupa lembar observasi yang
berisi tentang data umum responden, dan
lembar isian nyeri yang terdiri dari nomor,
inisial, umur, jam post operasi sectio
caesarea, jam terjadinya nyeri, hasil skala
nyeri sebelum dilakukan tindakan, lama dan
jumlah tindakan, dan hasil skala nyeri
sesudah dilakukan tindakan serta lembar
intensitas nyeri berupa skala intensitas nyeri
O poin dengan kata-kata penjelas dan
prosedur teknik relaksasi nafas dalam dan
guided imagery.
Data primer diambil langsung dari
responden dengan cara penggunaan lembar
observasi dan data sekunder terdiri dari
gambaran umum lokasi penelitian dan data
ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013
kerugian yang ditimbulkan
(balancing harms and benefits).
pasien yang telah menjalani operasi
sectio caesarea.
Prosedur teknik relaksasi
nafas dalam dan guided imagery
yaitu ciptakan lingkungan yang
tenang, jaga privasi pasien,
usahakan tangan dan kaki pasien
alam keadaan rileks, minta pasien
untuk memejamkan mata dan
usahakan agar pasien
berkonsentrasi, minta pasien
menarik nafas melalui hidung
secara perlahan-lahan sambil
menghitung dalam hati “hirup,
dua, tiga”, selama pasien
memejamkan mata
kemudian minta pasien untuk
membayangkan hal-hal yang
menyenangkan atau keindahan,
minta pasien untuk
menghembuskan udara melalui
mulut dan membuka mata secara
perlahan-lahan sambil menghitung
dalam hati “hembuskan, dua,
tiga”, minta pasien untuk
mengulangi lagi sama seperti
prosedur sebelumnya sebanyak
tiga kali selama lima menit.
Teknik pengolahan data
pada penelitian ini terdiri dari
koding, editing, tabulasi data,
dan entri data.sedangkan analisa
data dilakukan dengan pengujian
analisa univariat dan bivariat.
Menurut Yurisa 2008,
etika penelitian memiliki berbagai
macam prinsip, namun terdapat
empat prinsip utama yang perlu
dipahami, yaitu menghormati
harkat dan martabat manusia
(respect for human dignity),
menghormati privasi dan
kerahasiaan subyek penelitian
(respect for privacy and
confidentiality), keadilan dan
inklusivitas (respect for justice
and inclusiveness),
memperhitungkan manfaat dan
 Tingkat Pendidikan n %
HASIL dan PEMBAHASAN 1 5,0
Tabel 1. Distribusi menurut umur di Irina D SMP 1 5,0
BLU RSUP Prof. Dr. R. D. Kandou SMA 18 90,0
Manado (n=20 orang) Total 20 100,0
Banyak Responden Sumber : Data primer
Umur
%
10 – 20 Tahun 2 10,0
Tabel 3. Distribusi menurut pekerjaan di
21 – 30 Tahun 10 50,0 Irina D BLU RSUP Prof. Dr. R. D. Kandou
31 – 40 Tahun 6 30,0
Manado
(n=20 orang)
>40 Tahun 2 10,0 Banyak
Total 20 100,0 Responden
Sumber : Data primer Pekerjaan
n %
Tabel 2. Distribusi menurut tingkat pendidikan Ibu Rumah Tangga 15 75,0
di Irina D BLU RSUP Prof. Dr. R. D. Wiraswasta 5 25,0
Kandou Manado (n=20 orang) Total 20 100,0
Banyak Responden Sumber : Data primer

4
ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013

Tabel 4. Distribusi menurut intensitas nyeri Tabel 6. Hasil analisis perbandingan rata-rata
sebelum dilakukan teknik relaksasi nafas intensitas nyeri sebelum dilakukan teknik
dalam dan guided imagery di Irina D BLU relaksasi nafas dalam dan guided imagery
RSUP Prof. Dr. R. D. Kandou Manado dan intensitas nyeri sesudah dilakukan teknik
(n=20 orang) relaksasi nafas dalam dan guided imagery di
Banyak Responden Irina D BLU RSUP Prof. Dr. R. D. Kandou
Intensitas Nyeri
n % Manado (n=20 orang)
Tidak Nyeri 0 0,0 Std.
Nyeri Ringan 0 0,0 Intensit Std. erro
Nyeri Sedang 5 25,0 Mea p
Nyeri Hebat 12 60,0 v
Nyeri Sangat 3 15,0 a
l
Hebat u
Nyeri Terhebat 0 0,0 e
Total 20 100,0
Sumber : Data primer as Deviati r N
n
Nyeri on mea
n
Sebelu
6,15 1,089 0,24
m 10,10 0,00
Sesuda 0,21 0 0 20
3,05 0,945
h 1
Sumber : Data primer

Tabel 5. Distribusi menurut intensitas nyeri Penelitian yang dilakukan

sesudah dilakukan teknik relaksasi nafas di Irina D BLU RSUP Prof. Dr. R.
dalam dan guided imagery di Irina D BLU D. Kandou Manado ini
RSUP Prof. Dr. R. D. Kandou Manado menggunakan 20 orang sampel.
(n=20 orang) Berdasarkan umur responden
Banyak Responden paling banyak berumur 21-30
Intensitas Nyeri n % tahun yaitu 10 orang (50,0%).
Tidak Nyeri 0 0,0 Umur responden adalah variabel
Nyeri Ringan 13 65,0
penting yang akan mempengaruhi
reaksi maupun ekspresi responden
Nyeri Sedang 7 35,0
terhadap rasa nyeri. Semakin
Nyeri Hebat 0 0,0
Nyeri Sangat 0 0,0
meningkatnya umur, semakin
Hebat tinggi reaksi maupun respon
Nyeri Terhebat 0 0,0 terhadap nyeri yang dirasakan.
Total 20 100,0 Berdasarkan tingkat pendidikan,
responden paling banyak
Sumber : Data primer
berpendidikan SMA yaitu 18
orang (90,0%). Tingkat
pendidikan seseorang sangat
mempengaruhi pengetahuan
seseorang.Semakin tinggi tingkat
pengetahuan seseorang, semakin
tinggi tingkat pencegahan
berbagai jenis penyakit maupun
kelainan-kelainan yang dapat
mengakibatkan operasi. Menurut
Nikita 2012, semakin tinggi
tingkat pendidikan seseorang
maka akan semakin tinggi
kemampuan seseorang untuk
menyerap informasi dan
mengimplementasikannya ke
dalam perilaku dan gaya hidup
sehari-hari, khususnya dalam
5
kepeduliannya pada tingkat
kebutuhan kesehatan.
Berdasarkan pekerjaan,
responden paling banyak hanya
bekerja sebagai ibu rumah
tangga yaitu 15 orang (75,0%)
sementara yang lainnya
ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013

sebagai wiraswasta. Pekerjaan memiliki peran dua jenis operasi yang dilakukan
penting dalam tingkat kesehatan berdasarkan keadaan pasien yaitu
seseorang.Beban berat yang dilakukan oleh Cito dan elektif.Operasi Cito
seseorang sesuai dengan pekerjaannya dapat merupakan operasi yang
menyebabkan timbulnya berbagai penyakit harus segera dilakukan karena
maupun kelainan-kelainan. Nikita berpendapat darurat.Pasien yang menjalani
bahwa pekerjaan dan aktifitas seseorang operasi Cito tidak dapat
menuntut beban kerja berat yang semakin mempersiapkan diri untuk
beresiko untuk mengalami penyakit dan menghadapi kemungkinan-
pekerjaan seseorang yang kurang kemungkinan yang terjadi setelah
memperhatikan kehati-hatian akan beresiko operasi seperti nyeri.Berbeda
untuk mengalami cedera. Cedera yang dengan operasi elektif, pasien
dialami seseorang kadang-kadang menyebabkan sudah dipersiapkan sejak lama
seseorang harus menjalani operasi. sesuai jadwal sehingga pasien
Frekuensi pasien yang datang untuk dapat mempersiapkan diri untuk
melakukan persalinan di BLU RSUP Prof. menghadapi nyeri setelah selesai
Dr. R. D. Kandou Manado cukup banyak operasi. Dalam penelitian ini,
karena rumah sakit ini merupakan rumah responden yang menjalani operasi
sakit rujukan. Tidak semua pasien yang Cito lebih banyak yaitu 17
datang dapat melakukan persalinan secara responden (85,0%) sedangkan
normal karena mengalami beberapa yang lainnya menjalani operasi
hambatan seperti faktor dari ibu yaitu elektif.
panggul yang sempit, faktor dari janin yang Respon nyeri yang
letaknya lintang, tidak cukup ruang bagi dirasakan oleh setiap pasien
janin untuk melalui vagina, dan kelainan berbeda-beda sehingga perlu
pada janin seperti berat badan janin melebihi dilakukan eksplorasi untuk
4000 gram, atau secara faktor sosial yaitu menentukan nilai nyeri tersebut.
keinginan orang tua untuk melahirkan sesuai Menurut Syahriyani (2010),
dengan waktu yang telah ditentukan, perbedaan tingkat nyeri yang
sehingga harus dilakukan suatu operasi yaitu dipersepsikan oleh pasien
sectio caesarea. Selama periode penelitian disebabkan oleh kemampuan
pada 7 Juni sampai 15 Juni 2013 didapatkan sikap individu dalam merespon
20 responden yang menjalani operasi sectio dan mempersepsikan nyeri yang
caesarea, dan 60,0% dari responden tersebut dialami. Kemampuan
mengalami nyeri hebat bahkan nyeri sangat mempersepsikan nyeri
hebat (15,0%) dan yang lainnya mengalami dipengaruhi oleh beberapa faktor
nyeri sedang (25,0%). Intensitas nyeri ini dan berbeda diantara individu.
diukur menggunakan skala intensitas nyeri Tidak semua orang terpajan
12 poin dengan kata-kata penjelas.Nyeri terhadap stimulus yang sama
merupakan efek samping yang dialami mengalami intensitas nyeri yang
pasien setelah menjalani suatu operasi.Nyeri sama. Sensasi yang sangat nyeri
yang dirasakan oleh pasien diakibatkan oleh bagi seseorang mungkin hampir
terputusnya kontinuitas jaringan karena tidak terasa bagi orang lain. Salah
insisi.Jenis operasi juga mempengaruhi satu upaya untuk menurunkan
respon nyeri seseorang terhadap nyeri.Ada nyeri adalah dengan menggunakan
teknik farmakologis dan teknik
nonfarmakologis. Teknik
farmakologis yaitu dengan
menggunakan obat-obatan
sedangkan teknik perubahanintensitas nyeri, dimana
nonfarmakologis salah satunya responden hanya mengalami dua
yaitu dengan relaksasi nafas tingkat nyeri yaitu nyeri sedang
dalam dan guided imagery. Pada (35,0%) dan nyeri ringan (65,0%).
penelitian ini, sesudah dilakukan Tidak ada lagi yang mengalami
teknik relaksasi nafas dalam dan nyeri hebat dan sangat hebat.
guided imagery terjadi

6
ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013
relaksasi terhadap perubahan
intensitas nyeri pada pasien post
Efek relaksasi nafas dalam operasi apendektomi, dengan hasil
dan guided imagery membuat yaitu ada pengaruh yang
responden merasa rileks dan signifikan pada intensitas nyeri
tenang. Responden menjadi rileks pasien post operasi apendektomi
dan tenang saat mengambil sesudah dilakukan teknik
oksigen di udara melalui hidung, relaksasi, dari 4 orang yang
oksigen masuk kedalam tubuh mengalami nyeri hebat (40,0%)
sehingga aliran darah menjadi sesudah dilakukan teknik relaksasi
lancar serta dikombinasikan menjadi 2 orang (20,0%), nyeri
dengan guided imagery sedang 5 orang (50,0%) menjadi 2
menyebabkan pasien mengalihkan orang (20,0%), dan tidak
perhatiannya pada nyeri ke hal-hal
yang membuatnya senang dan
bahagia sehingga melupakan nyeri
yang sedang dialaminya. Inilah
yang menyebabkan intensitas
nyeri yang dirasakan pasien post
operasi sectio caesareaberkurang
setelah dilakukan teknik relaksasi
nafas dalam dan guided imagery.
Adanya perubahan
intensitas nyeri sebelum dan
sesudah dilakukan teknik
relaksasi nafas dalam dan guided
imagery juga dapatdiketahui
setelah dilakukan uji statistik
menggunakan uji paired sample
t-testpada tingkat kemaknaan
95% (α = 0,05). Nilai mean
sebelum dilakukan teknik
relaksasi nafas dalam dan guided
imagery yaitu 6,15 sedangkan
sesudah dilakukan teknik
relaksasi nafas dalam dan guided
imagery yaitu 3,05. Hasil analisi
diperoleh nilai p=0,000 dengan
kata lain p<0,05. Oleh karena itu
maka hipotesis diterima. Jadi,
hasil penelitian ini menunjukkan
bahwa teknik relaksasi nafas
dalam dan guided imagery
terbukti efektif dalam
menurunkan intensitas nyeri
pada pasien post operasi sectio
caesarea.
Hasil ini mendukung
penelitian sebelumnya yang
dilakukan oleh Nikita (2012) yang
meneliti tentang pengaruh teknik

nyeri yang semula 1 orang (10,0%) menjadi
9 orang (60,0%). Namun yang membedakan
penelitian ini dan penelitian yang dilakukan
oleh Nikita (2012) adalah tempat penelitian,
jumlah responden, tindakan relaksasi, dan
operasi yang dialami responden. Nikita
(2012) melakukan penelitian di Irina A pada
- responden post operasi apendektomi dan
hanya menggunakan teknik relaksasi nafas
dalam saja, sedangkan penelitian ini
dilakukan di Irina D pada 20 responden post
operasi sectio caesarea dan menggunakan
teknik relaksasi nafas dalam yang
dikombinasikan dengan guided imagery.
SIMPULAN
Kesimpulan dari penelitian ini yaitu tingkat
nyeri pada pasien post operasi sectio
caesarea sebelum dilakukan teknik relaksasi
nafas dalam dan guided imagery di Irina D
BLU RSUP Prof. Dr. R. D. Kandou Manado
sebagian besar mengalami nyeri hebat
7
sampai sangat hebat, tingkat nyeri pada
pasien post operasi sectio caesarea sesudah
dilakukan teknik relaksasi nafas dalam dan
guided imagery di Irina D BLU RSUP Prof.
Dr. R. D. Kandou Manado sebagian besar
mengalami penurunan ke kategori nyeri
ringan selebihnya ke kategori nyeri sedang,
dan teknik relaksasi nafas dalam dan guided
imagery efektifterhadap penurunan nyeri
pada pasien post operasi sectio caesarea.
DAFTAR PUSTAKA
A service of the U.S. National Library of
Medicine, 2012.Cesarean
Section.http://www.nlm.nih.gov/medli
neplus/cesareansection.html diakses
pada tanggal 01 April 2013 pukul 18.
30 WITA
Berman A. Snyder S. Kozier B & Erb G.
2003.Buku Ajar Praktik Keperawatan
KlinisKozier & Erb edisi 5. Jakarta:
Penerbit Buku Kedokteran EGC
Hastono, Sutanto Priyo. 2007. Analisis
Data Kesehatan.Depok: SPH
 ejurnal keperawatan (e-Kp) Volume 1. Nomor 1. Agustus 2013
Nyeri. http://www.forexsid.com/
2011/03/mekanisme-terjadinya-
Jayanthi, Niken. 2010. Analisa nyeri.html diakses pada tanggal 04
Data. April 2013 pukul 20.30 WITA
http://rentalhikari.wordpress.com Smeltzer. Suzanne C. Bare Brenda G.
/2010 Hinkle Janice L & Cheever Kerry H.
' 03/23/analisa-data/ diakses pada
tanggal 15 Mei 2013 pukul 13.20
WITA
Jayanthi, Niken. 2010. Teknik Relaksasi
Nafas Dalam. http://rentalhikari.
wordpress.com/2010/03/23/teknik-
relaksasi-nafas-dalam/ diakses pada
tanggal 01 April 2013 pukul 17.40
WITA
Mawei, Nikita Mayumi. 2012.
Pengaruh
Teknik Relaksasi Terhadap Perubahan
Intensitas Nyeri Pada Pasien Post
Operasi Apendektomi.
National Institute for Clinical
Excellence,
2004.Caesarean Section.http://
www.nice.org.uk/nicemedia/pdf/CG01
3publicinfoenglish.pdf didownloa d
pada tanggal 05 April 2013 pukul 21.00
WITA
Oxorn H & Forle W. 2010.Ilmu
Kebidanan:
Patologi & Fisiologi Persalinan.
Yogyakarta: Yayasan Essentia Medika
Rahmayati, Yeni Nur. 2010.
Pengaruh Guided Imagery
Terhadap Tingkat
Kecemasan Pada Pasien Skizoafektif
Di RSJD SURAKARTA.
http://etd.eprints.ums.ac.id/9482/1/J21
0060060.pdf didownload pada tanggal
3.04 Mei 2013 pukul 17.00 WITA
Sehono, Endrayani. 2010. Pengaruh
Teknik
Relaksasi Guided Imagery Terhadap
Penurunan Nyeri Pada Pasien Pasca
Operasi Fraktur Di RSUD DR.
Moewardi.
http://etd.eprints.ums.ac.id/10412/ di
download pada tanggal 03 Mei 2013
pukul 12.40 WITA
Sidauruk P. 2011.Mekanisme
Terjadinya
 ANALISA JURNAL

IDENTITAS JURNAL

Judul Asli : Efektifitas Teknik Relaksasi Nafas Dalam Dan Guided Imagery Terhadap
Penurunan Nyeri Pada Pasien Post Operasi Sectio Caesare Di Irina D Blu
Rsup Prof. Dr. R. D. Kandou Manado

Penulis/ pengarang : Chandra Kristianto, Patasik Jon Tangka, Julia Rottie

PICOT ANALISA
P (POPULATION Populasi dalam penelitian ini adalah semua pasien yang telah menjalani
OR PROBLEM) operasi sectio caesarea di Irina D BLU RSUP Prof. Dr. R. D. Kandou
Manado dengan teknik pengambilan sampel Accidental Sampling.
Masalah Nyeri Pada Pasien Post Operasi Sectio Caesare. Nyeri
merupakan suatu gejala yang tidak menyenangkan yang dialami oleh
pasien post operasi sectio caesarea. Alternatif untuk menurunkan
nyeri yaitu dengan menggunakan teknik relaksasi nafas dalam.
I Jenis penelitian ini adalah analitik dengan metode penelitian kuasi
(INTERVENTION) eksperimen.Desain penelitian adalah satu kelompok pre-post tes
tanpa kelompok kontrol
Intervensi :
- Prosedur teknik relaksasi nafas dalam dan guided imagery yaitu
ciptakan lingkungan yang tenang, jaga privasi pasien, usahakan tangan
dan kaki pasien alam keadaan rileks, minta pasien untuk memejamkan
mata dan usahakan agar pasien berkonsentrasi, minta pasien menarik
nafas melalui hidung secara perlahan-lahan sambil menghitung dalam
hati “hirup, dua, tiga”, selama pasien memejamkan mata.
- kemudian minta pasien untuk membayangkan hal-hal yang
menyenangkan atau keindahan, minta pasien untuk menghembuskan
udara melalui mulut dan membuka mata secara perlahan-lahan sambil
menghitung dalam hati “hembuskan, dua, tiga”, minta pasien untuk
mengulangi lagi sama seperti prosedur sebelumnya sebanyak tiga kali
selama lima menit.

C Jurnal pembanding penelitian sebelumnya yang dilakukan oleh Nikita

(COMPARATION) (2012) yang meneliti tentang pengaruh teknik relaksasi terhadap
perubahan intensitas nyeri pada pasien post operasi apendektomi,
dengan hasil yaitu ada pengaruh yang signifikan pada intensitas nyeri
pasien post operasi apendektomi sesudah dilakukan teknik relaksasi,
dari 4 orang yang mengalami nyeri hebat (40,0%) sesudah dilakukan
teknik relaksasi menjadi 2 orang (20,0%), nyeri sedang 5 orang
(50,0%) menjadi 2 orang (20,0%), dan tidak

nyeri yang semula 1 orang (10,0%) menjadi

10 orang (60,0%). Namun yang membedakan penelitian ini dan
 penelitian yang dilakukan oleh Nikita (2012) adalah tempat
penelitian, jumlah responden, tindakan relaksasi, dan operasi yang
dialami responden. Nikita (2012) melakukan penelitian di Irina A
pada
- responden post operasi apendektomi dan hanya menggunakan
teknik relaksasi nafas dalam saja, sedangkan penelitian ini dilakukan
di Irina D pada 20 responden post operasi sectio caesarea dan
menggunakan teknik relaksasi nafas dalam yang dikombinasikan
dengan guided imagery.

O (OUTCOME) Efek relaksasi nafas dalam dan guided imagery membuat responden
merasa rileks dan tenang. Responden menjadi rileks dan tenang saat
mengambil oksigen di udara melalui hidung, oksigen masuk kedalam
tubuh sehingga aliran darah menjadi lancar serta dikombinasikan
dengan guided imagery menyebabkan pasien mengalihkan
perhatiannya pada nyeri ke hal-hal yang membuatnya senang dan
bahagia sehingga melupakan nyeri yang sedang dialaminya. Inilah
yang menyebabkan intensitas nyeri yang dirasakan pasien post operasi
sectio caesareaberkurang setelah dilakukan teknik relaksasi nafas
dalam dan guided imagery.
Adanya perubahan intensitas nyeri sebelum dan sesudah
dilakukan teknik relaksasi nafas dalam dan guided imagery juga
dapatdiketahui setelah dilakukan uji statistik menggunakan uji
paired sample t-testpada tingkat kemaknaan 95% (α = 0,05). Nilai
mean sebelum dilakukan teknik relaksasi nafas dalam dan guided
imagery yaitu 6,15 sedangkan sesudah dilakukan teknik relaksasi
nafas dalam dan guided imagery yaitu 3,05. Hasil analisi diperoleh
nilai p=0,000 dengan kata lain p<0,05. Oleh karena itu maka
hipotesis diterima. Jadi, hasil penelitian ini menunjukkan bahwa
teknik relaksasi nafas dalam dan guided imagery terbukti efektif
dalam menurunkan intensitas nyeri pada pasien post operasi sectio
caesarea.
Kesimpulan dari penelitian ini yaitu tingkat nyeri pada pasien
post operasi sectio caesarea sebelum dilakukan teknik relaksasi nafas
dalam dan guided imagery di Irina D BLU RSUP Prof. Dr. R. D.
Kandou Manado sebagian besar mengalami nyeri hebat sampai sangat
hebat, tingkat nyeri pada pasien post operasi sectio caesarea sesudah
dilakukan teknik relaksasi nafas dalam dan guided imagery di Irina D
BLU RSUP Prof. Dr. R. D. Kandou Manado sebagian besar mengalami
penurunan ke kategori nyeri ringan selebihnya ke kategori nyeri sedang,
dan teknik relaksasi nafas dalam dan guided imagery efektifterhadap
penurunan nyeri pada pasien post operasi sectio caesarea.

T (TIME) Penelitian dilaksanakan di Irina D BLU RSUP Prof. Dr. R. D. Kandou

Manado pada tanggal 7 Juni – 15 Juni 2013.
 http://ejournal.poltekkes-smg.ac.id/ojs/index.php/J-SiKep

Research Article Jurnal Studi Keperawatan Open Access

Pengaruh Teknik Relaksasi Terhadap

Penurunan Nyeri Epigastrium Pada Pasien Gastritis

Nuryanti Erni1, Abidin M Zainal2, Normawati Ajeng Titah 3

1,2,3 Prodi D-III Keperawatan Blora, Poltekkes Kemenkes Semarang, Indonesia

*Corresponding author : Erni Nuryanti

Email: erninuryanti@gmail.com

Received: March 9, 2020; Accepted: March 20, 2020, Published : March

31, 2020

ABSTRACT
Background: Today the frequency of psychosomatic illnesses experienced
by a person is increasing. One such psychosomatic disease is
gastritis. Pharmacotherapy for gastritis often results in less
satisfactory results. Meanwhile the other alternatives to overcome
these problems can be done with relaxation exercises. Relaxation can
increase the sensitivity of baro-reflect and decrease sympathetic
nerve activity and activate the correction so that there will be a
decrease of pain level.
Objective: To know the effect of relaxation technique on the reduction of epigastria
pain in gastritis patients.
Research Method: The design of the research used is one group pre test
and post test design, where the patient came to check the level of
pain with the scale of pain then done relaxation. After the relaxation
was done and then re-check in the same way. Bivariate analysis used
Wilcoxon Test.
Results: The statistical results obtained p = 0,000 (P <0.05) which means
that there is a very significant difference in the average value of the
pain scale before relaxation with the average of pain scale after
relaxation.
Conclusion: There is a relaxation effect on the reduction of epigastria pain in gastritis
patients

inflamasi. Pasien yang

Keyword: Relaxation, Pain, Epigastria mengalami gastritis
menyebabkan tidak dapat
melakukan kegiatan sehari-
Pendahuluan hari secara normal
(Hawari,2013).
Gastritis merupakan
Gejala yang umum terjadi
penyakit yang sering dialami
oleh seseorang.Gastritis atau pada penderita gastritis
yang lebih dikenal sebagai maag adalah rasa tak nyaman
yang berasal dari bahasaYunani (nyeri) pada epigastrium,
yaitu gastro yang berarti perut kembung, sakit kepala
perut /lambung dan itis yang dan mual yang dapat
berarti peradangan atau mengganggu aktifitas sehari-
hari. Dampak fisiologis pada
nyeri epigastrium menyebabkan
munculnya stimulasi simpatik
berupa dilatasi saluran
dan irreguler, nausea,
bronchial, peningkatan respirasi
vomitus, kelelahan
rate, peningkatan heart rate,
dan keletihan (Potter
vasokontriksi perifer,
& Perry, 2009).
peningkatan tekanan darah,
Menurut data yang
peningkatan nilai gula darah,
diperoleh dari Dinas
diaphoresis, peningkatan
Kesehatan Kabupaten
kekuatan otot, dilatasi pupil.
Blora penyakit
Sedangkan pada nyeri berat
gastritis merupakan
banyak ditemukan stimulasi
urutan daftar 3
para simpatik (nyeri berat dan
penyakit yang paling
dalam) seperti muka pucat, otot
sering dikeluhkan
mengeras, penurunan heart rate
dan tekanan darah, nafas cepat pasien, tahun 2015
tercatat data terakhir
bulan Agustus
sebanyak 125 pasien
dan bulan September
meningkat menjadi
155 pasien (DKK
Blora, 2015).
Berdasarkan studi
pendahuluan yang
dilakukan peneliti di
RSUD dr R Soetijono
Blora data tentang
jumlah pasien
gastritis yang
didapatkan peneliti di
rekam medis
mengalami
peningkatan yaitu
tahun 2012 sebanyak
155 orang, tahun
2013 sebanyak 172
orang, tahun 2014
sebanyak 198
orang,data tiga bulan
terakhir tahun 2016 di
Ruang Dahlia
menunjukkan pada
bulan September
jumlah pasien gastritis
sebanyak 28 orang,
pada bulan Oktober
sebanyak 30 orang
sedangkan pada bulan
November sebanyak
33 orang.
Hasil wawancara
awal dengan perawat
di ruangan ternyata dengan penggunaan
untuk penatalaksanaan secara
gastritis dengan keluhan farmakologi.Pengguna
mual- muntah, an obat farmakologi
anoreksia, nyeri dalam
epigastrium lebih sering

J-SiKep Team *Corresponding author email :

erninuryanti@gmail.com
 Title : Pengaruh Teknik Relaksasi Terhadap Penurunan Nyeri Epigastrium Copyright:
Pada @ 2020 Nuryanti Erni,
Pasien Gastritis et.al

dilakukan untuk mengatasi rasa

buku DOI (Daftar Obat Indonesia) dan ISO nyeri tersebut adalah dengan
serta hasil wawancara sebagai studi relaksasi. progresif memberikan
pendahuluan dengan perawat jaga pengaruh yang paling baik untuk
Ruang Dahlia RSUD dr jangka waktu yang relatif singkat
SoetijonoBlora, menyebutkan obat – dalam mengatasi nyeri pada pasien
obatan yang sering dipakai untuk gastritis.
mengobati penderita gastritis adalah Berdasarkan hasil studi
Ranitidin,Cimetidin, dan Ulsikur. pendahuluan pada 7 penderita
Sutrisno (2012) mengatakan gastritis, 5 orang mengatakan bahwa
bahwa farmakoterapi terhadap setelah diberikan tindakan relaksasi
gastritis sering menimbulkan hasil progresif nyeri epigastriumnyanya
kurang memuaskan.Sedangkan berkurang tanpa mereka diberi obat.
alternatif lain untuk mengatasi Dari fenomena ini peneliti tertarik
masalah tersebut dari sisi ingin melakukan penelitian
keperawatan dapat dilakukan ”Pengaruh tehnik relaksasi terhadap
dengan latihan relaksasi progresif. penurunan nyeri epigastrium pada
Namun berdasarkan pengalaman pasien gastritis di RSUD dr Soetijono
peneliti setelah dilakukan Blora”.
pendekatan di rumah sakit terbukti
teknik relaksasi belum banyak
dilakukan,bahkan sangat jarang
dilakukan khususnya untuk
mengurangikeluhan nyeri
epigastrium pada penderita
gastritis.Menurut (Evi Lina Sutrisno,
1998) teknik relaksasi progresif ini
telah diketahui efektif menurunkan
gejala fisik pada pasien gastritis dan
ulkus peptikum. Penelitian Chappel,
Stefano dan Rogerson (1992)
menggunakan pelatihan relaksasi
terhadap pasien gastritis dan ulkus
peptikum dengan menurunkan
intensitas kekambuhan.
Teknik relaksasi sangat
berperan dalam mengurangi keluhan
fisik dan meminimalkan efek – efek
dari stres, sehingga memungkinkan
pasien dapat mengontrol tubuh
merespon ketegangan dan
kecemasan sehingga dapat
menurunkan produksi asam lambung
(KazierdanErb,2008). Menurut
Gunawan (2001) mengatakan bahwa
relaksasi berguna mengurangi stres
atau ketegangan jiwa yang
merupakan salah satu cara untuk
mencegah dan menurunkan rasa
nyeri. Relaksasi dapat meningkatkan
sensitifitas baroreflek dan
menurunkan aktifitas syaraf simpatis
dan mengaktifasi kemoreflek
sehingga menawarkan efek pada
penurunan tingkat nyeri. Dengan
tindakan relaksasi diharapkan nyeri
pada epigastrium akan menurun.
Tindakan relaksasi yang mudah
 n
Metode Penelitian s
i
Desain penelitian yang (n) (%)
digunakan adalah dengan metode <20 2 6.7
one group pre test and post test 20-40 11 36.7
design, dimana pasien datang 41-60 14 46.7
>60 3 10.0
dilakukan pengecekan tingkat nyeri
Total 30 100.0
dengan skala nyeri lalu dilakukan
relaksasi. Setelah dilakukan relaksasi
Pada tabel 1 menunjukkan
dilakukan pengecekan ulang dengan
bahwa jumlah tertinggi dari
cara yang sama. Penelitian ini
responden dengan gastritis adalah
melakukan intervensi terhadap
berusia 41-60 yaitu sejumlah 14
responden berupa relaksasi untuk
(46.7%) sedangkan jumlah terendah
menurunkan nyeri epigastrium pada
dari respondendengan gastritis
pasien gastritis, sampel yang dipilih
adalah berusia <20 yaitu sejumlah 2
secara total sampling terhadap
(6.7%).
pasien gastritis yang dirawat di RSUD
dr R Soetijono Blora. Data diolah dan Tabel 2. Distribusi pasien gastritis berdasarkan
dianalisa dengan analisis univariat jenis kelamin di RSUD dr R Soetijono
dan bivariat. Analisis bivariat ini Blora tahun 2017 (n=30)
dilakukan untuk menguji hipotesis Frekue
pengaruh antara variable n
independen dengan variable Jenis Persentase
si
dependen. Uji statistik yang kelamin (n) (%)
digunakan dengan menggunakan uji Laki-laki 21 70
Paired Sample T–Test. Perempuan 9 30
Jumlah 32 100
Hasil dan Pembahasan Pada tabel 5.2 menunjukkan
bahwa jumlah tertinggi dari
Hasil responden dengan gastritisa dalah
Tabel 1 Distribusi pasien gastritis berdasarkan berjenis kelamin laki-laki yaitu
usia di RSUD dr R Soetijono Blora sebanyak 21(70%) sedangkan
tahun 2017(n=30) selebihnya berjenis kelamin sejumlah
Jenis kelamin Frekue
Persentase 9 (30%).

Citation: Nuryanti Erni, Abidin M Zainal & Normawati Ajeng Titah (2020) Pengaruh Teknik Relaksasi Terhadap Page 2 of 5
Penurunan Nyeri Epigastrium Pada Pasien Gastritis. Jurnal Studi Keperawatan Vol. 1 No. 1
 Title : Pengaruh Teknik Relaksasi Terhadap Penurunan Nyeri Epigastrium Copyright:
Pada @ 2020 Nuryanti Erni,
Pasien Gastritis et.al

nyeri 4 (nyeri sedang) sejumlah 8 responden

Tabel 3. Distribusi pasien gastritis berdasarkan (26.7%). Dengan rata-rata skala nyeri 5.13.
status pernikahan di RSUD dr R
Soetijono Blora tahun 2017 (n=30) Tabel 6. Hasil pengukuran skala nyeri setelah
Frekue relaksasi pasien gastritisdi RSUD dr
n R Soetijono Blora tahun 2017
s (n=30)
Status Persentase
i Skala nyeri
Frekuensi (f) Prosentase (%)
pernikah
an (n) (%) 1 (nyeri
Menikah 26 86.7 ringan) 3 10.0
Belum 4 13.3 2 (nyeri
menikah ringan) 6 20.0
Jumlah 32 100 3 (nyeri
Pada tabel 3 menunjukkan bahwa jumlah ringan) 10 33.3
tertinggi dari responden dengan gastritisadalah 4 (nyeri
berstatus menikah yaitu sebanyak 26 (86.7%) sedang) 8 26.7
sedangkan selebihnya berstatus belum menikah 5 (nyeri
sejumlah 4 sedang) 3 10.0
(13.3% Total 30 100.0
).
Tabel 4.
Distrib
usipasien gastritis berdasarkan
suku bangsa di RSUD dr R Soetijono Blora
tahun 2017 (n=30)
Suku FrekuensiPersentase
bangsa (n) (%)
Suku
ja
w
a 30 100
Luar
ja
w
a 0 0
Jumlah 32 100
Pada tabel 5.4 menunjukkan bahwa
seluruh responden dengan gastritismempunyai
suku jawa yaitu sebanyak 30 (100%).

Tabel 5 : Hasil pengukuran skala nyeri sebelum

relaksasi pasien gastritis di RSUD dr R
Soetijono Blora tahun 2017 (n=30)
Skala nyeri Frekuensi (f) Prosentase (%)
4 (nyeri sedang) 8 26.7
5 (nyeri sedang) 10 33.3
6 (nyeri sedang) 12 40.0
Total 30 100.0
Mean: 5.13
SD : 0.819
Berdasarkan tabel 5 dapat diketahui
bahwa distribusi skala nyeri sebelum dilakukan
relaksasi yang tertinggi adalah skala nyeri 6
(nyeri sedang) sejumlah 12 responden (40%),
kemudian skala nyeri 5(nyeri sedang) sejumlah
10 responden (33.3%) dan yang terendah skala
 progresif didapatkan nilai p-value
Mean : 3.07 sebesar 0,000 (>0,05) yang berarti
SD : 1.143 data berdistribusi tidak normal pada
Berdasarkan tabel 6 dapat responden. Sedangkan pada
diketahui bahwa distribusi skala nyeri responden sesudah dilakukan
setelah dilakukan relaksasi progresif relaksasi didapatkan p-value sebesar
yang tertinggi adalah skala nyeri 3 0,029 (>0,05) yang berarti data
(nyeri ringan) dan skala nyeri 4 (nyeri berdistribusi tidak normal.
sedang) sejumlah 9 responden Setelah mengetahui data tidak
(28.1%), kemudian skala nyeri 2 berdistribusi normal maka uji
(nyeri ringan) sejumlah 7 responden alternatif yang digunakan adalah uji
(21.9%), selanjutnya skala nyeri 1 Wilcoxon dengan cara mengubah
(nyeri ringan) sejumlah 4 responden data menjadi Ordinal. Dari hasil uji
(12.5%) dan yang terendah skala Wilcoxon dengan menggunakan SPSS
nyeri 5 (nyeri sedang) sejumlah versi 16.0 terhadap skala intensitas
3responden (9.4%). Dengan rata-rata nyeri sebelum dan sesudah
skala nyeri 3.07. mendapat perlakuan relaksasi
menunjukkan hasil sebagai berikut :
Analisis Bivariat
Table 8. Tabel out put rank perlakuan sebelum
Sebelum dilakukan uji beda dan sesudah relaksasi pada pasien
rata-rata antara skala nyeri sebelum gastritisdi RSUD dr R Soetijono Blora
dan sesudah dilakukan relaksasi perlu tahun 2017.
dilakukan uji normalitas skala Mean Sum of
intensitas nyeri sebelum relaksasi dan N
Rank Ranks
sesudah relaksasi dalam dengan uji
Nyeri Skala nyeri
Shapiro-Wilk, karena jumlah 27a 14.00 378.00
responden kurang dari 50. setelah turun
relaksasi Skala nyeri
Tabel 7. Tabel uji normalitas data progresif - 0b .00 .00
p- Nyeri
v sebelum Skala nyeri 3c
arelaksasi tetap
Shapir l nafas
o Statisti u Total
- k df e
Wilk 30
Pre-test 0.720 30 0.000 dalam
Post-test 0.921 30 0.029 Berdasarkan tabel 8 hasil
Dari hasi uji Shapiro-Wilk pada Output ranks menunjukkan
skala nyeri sebelum relaksasi perbandingan skala nyeri sebelum
dan
Citation: Nuryanti Erni, Abidin M Zainal & Normawati Ajeng Titah (2020) Pengaruh Teknik Relaksasi Terhadap Page 3 of 5
Penurunan Nyeri Epigastrium Pada Pasien Gastritis. Jurnal Studi Keperawatan Vol. 1 No. 1
 Title : Pengaruh Teknik Relaksasi Terhadap Penurunan Nyeri Epigastrium Copyright:
Pada @ 2020 Nuryanti Erni,
Pasien Gastritis et.al

menurun. Mekanisme koping

sesudah relaksasi, terdapat 27 responden
dengan hasil skala nyeri setelah
relaksasi progresif lebih rendah dari
pada sebelum relaksasi, sedangkan 3
responden mempunyai skala nyeri
yang sama sebelum dan sesudah
relaksasi.
Table 9. Tabel statistik perlakuan sebelum dan
sesudah relaksasi pada pasien
gastritisdi RSUD dr R SoetijonoBlora
tahun 2017.
Nyeri setelah
relaksasi
progresif - Nyeri
sebelum
relaksasi nafas
dalam
-4.589a
Asymp. Sig. (2-
.000
tailed)
Berdasarkan tabel 9. Hasil
analisis statistik diperoleh hasil p =
0,000(P<0,05) yang berarti ada
perbedaan yang sangat signifikan
nilai rata-rata skala nyeri sebelum
relaksasi dengan rata-rata skala
nyeri setelah relaksasi, sehingga
dapat ditarik kesimpulan bahwa
dengan nilai p= 0,000 maka Ho
ditolak dan Ha diterima, yang artinya
ada pengaruh penggunaan relaksasi
terhadap penurunan tingkat nyeri
pada pasien gastritis di RSUD dr R
Soetijono Blora.
terhadap nyeri bagi setiap orang
akan berbeda dipengaruhi oleh
beberapa faktor diantaranya jenis
kelamin, usia dan pengalaman nyeri
sebelumnya.
Hal ini sesuai dengan teori
yang menyatakan bahwa rasa nyeri
timbul bila jaringan yang rusak, yang
menyebabkan aliran darah
kejaringan dan kulit berkurang
(iskemia) sehingga suplai oksigen
juga berkurang. Hal ini akan
mengakibatkan terkumpulnya
sebagian besar asam laktat dalam
jaringan, yang terbentuk akibat
metabolisme anaerob (metabolisme
tanpa oksigen) dan mungkin juga ada
bahan-bahan kimiawi lainnya seperti
bradikinin dan enzim proteolitik
yang terbentuk dalam jaringan akibat
kerusakan sel, dan apabila bahan-
bahan ini dibandingkan asam laktat
akan merangsang ujung serabut
syaraf nyeri

Pembahasan

Hasil pengukuran skala nyeri pre

relaksasi pada pasien gastritis
Berdasarkan tabel 5 dapat
diketahui bahwa distribusi skala
nyeri sebelum dilakukan relaksasi
yang tertinggi adalah skala nyeri 6
(nyeri sedang) sejumlah 12
responden (40%), kemudian skala
nyeri 5 (nyeri sedang) sejumlah 10
responden (33.3%) dan yang
terendah skala nyeri 4 (nyeri sedang)
sejumlah 8 responden (26.7%).
Dengan rata-rata skala nyeri 5.13
Terjadinya peradangan akan
menimbulkan gejala rubor, kalor dan
dolor. Kalor (nyeri) disebabkan
akibat terjadinya jaringan yang rusak
sehingga suplai oksigen kejaringan
 dirasakan lebih efektif, sederhana
(Guyton&Hall, 1997). Menurut sebuah dan pilihan yang tepat disamping
penelitian di Atlanta for Behavioral terapi medis.
Medicine, dikutip dari Sciencedily, Sedangkan dari hasil Output ranks
temuan ini telah dipresentasikan menunjukkan perbandingan skala
dalam American Psychological nyeri sebelum dan sesudah bimbigan
Association di San Diego, peneliti imajinasi, terdapat 27 responden
menduga faktor hormonal turut dengan hasil skala nyeri setelah
mempengaruhi perbedaan nyeri yang relaksasi progresif lebih rendah
dirasakan laki-laki dan perempuan. daripada sebelum relaksasi,
Beberapa jenis hormon memang sedangkan 3 responden mempunyai
berhubungan sensasi nyeri. Menurut skala nyeri yang sama sebelum dan
Dr. Jenifer Kelly perbedaan hormonal sesudah relaksasi.
antara laki-laki dan perempuan Ketidak berhasilan pemberian
menduga turut mempengaruhi tehnik relaksasi dipengaruhi oleh
respons terhadap nyeri. beberapa faktor : dimana saat
pelaksanaa tehnik relaksasi
Hasil pengukuran skala nyeri setelah lingkungan dalam keadaan tidak
relaksasi pada pasien gastritis tenang. Hal ini sesuai dengan teori
Berdasarkan tabel 6 dapat yang menyatakan bahwa dalam
diketahui bahwa distribusi skala pelaksanaan relaksasi dipengaruhi
nyeri setelah dilakukan relaksasi berbagai faktor. Berbagai macam
yang tertinggi adalah skala nyeri 3 faktor yang mempengaruhi
(nyeri ringan) dan skala nyeri 4 diantaranya adalah keadaan
(nyeri sedang) sejumlah 9 responden lingkungan, ketrampilan dalam
(28.1%), kemudian skala nyeri 2 pemberian relaksasi, serta faktor dari
(nyeri ringan) sejumlah 7 responden dalam peneriman tindakan relaksasi
(21.9%), selanjutnya skala nyeri 1 (Suryanto, 2009).
(nyeri ringan) sejumlah 4 responden Hasil pengukuran skala nyeri pre
(12.5%) dan yang terendah skala dan post guide imagery pada pasien
nyeri 5 (nyeri sedang) sejumlah gastritis
3responden (9.4%). Dengan rata-rata Dari hasil penelitian menunjukan
skala nyeri 3.07. bahwa terdapat perbedaan yang
Dengan dilakukannya relaksasi signifikan terhadap nilai skala nyeri
menunjukkan adanya kecenderungan sebelum dan sesudah perlakuan
penurunan jumlah responden yang dengan p value sebesar 0,000 (p <
mengalami nyeri. Hal ini dikarenakan 0,05). Hal ini sesuai teori bahwa
pemberian tehnik distraksi relaksasi penggunaan relaksasi pada pasien
dapat memberikan perubahan gastritisakan membantu penurunan
signifikan pada penurunan rasa nilai skala nyeri (Tamsuri, 2006).
nyeri, penggunaan relaksasi juga
Citation: Nuryanti Erni, Abidin M Zainal & Normawati Ajeng Titah (2020) Pengaruh Teknik Relaksasi Terhadap Page 4 of 5
Penurunan Nyeri Epigastrium Pada Pasien Gastritis. Jurnal Studi Keperawatan Vol. 1 No. 1
 Title : Pengaruh Teknik Relaksasi Terhadap Penurunan Nyeri Epigastrium Pada Copyright:
Pasien @ 2020 Nuryanti Erni, et.al
Gastr
itis
Kurangnya oksigen dalam darah
memperbesar Hegner, Barbara R, ( 2013), Asisten
kemungkinan terjadinya kecemasan, depresi,
lelah Keperawatan: Suatu Pendakatan Proses
karena proses perfusi ke jaringan tubuh
terhambat Keperawatan, Edisi 6, EGC, Jakarta.
sehingga terjadi metabolisme anaerob.
Dengan Jatman, D, ( 2010 ), Psikologi Perkembangan,
latihan relaksasi tepat dan teratur akan Badan Penerbit Universitas Diponegoro,
memperbaiki oksigenasi ke seluruh jaringan
tubuh Semarang.
termasuk otak, sehingga fungsi otak
sebagai Kaplan dan Sadock, ( 2010 ), Sinopsis Psikiatri,
pengendali kecemasan menjadi lebih baik
dan Bina Rupa Aksara, Jakarta.
tingkat kecemasan dapat diturunkan
sehingga Kozier B and Oliveri, ( 1991 ), Fundamental Of
keluhan fisik dapat diminimalkan (Davis,
2008). Nursing Concept Process Practice, 4thed,
Secara fisiologis latihan relaksasi akan Wesley, California.
mengura
aktivitas
ngi saraf simpatis yang Long, B.C., (2013), Perawatan Medikal Bedah
mangembalikan tubuh pada keadaan
seimbang, pupil, (Suatu Pendekatan Proses
pendengaran, tekanan darah, denyut
jantung, Keperawatan),Edisikedua, Yayasan Ikatan
dan sirkulasi kembali normal dan
pernafasan otot- Alumni Pendidikan Keperawatan Universitas
otot menjadi relaks. Respon relaksasi
merupakan efek Padjajaran, Bandung.
penyembuhan yang memberikan kesempatan
untuk Nursalam, (2013), Konsep dan Penerapan
beristirahat dari stres lingkungan eksternal Keperawa
dan stres Metodologi Penelitian Ilmu tan,
lingkungan internal (Davis, 2008).
Penurunan Pedoman Skripsi, Tesis dan Instrumen
rangsang simpatis juga dapat menurunkan
motilitas Penelitian Keperawatan, Jakarta: Salemba
sekretoris dan mendekati normal,
selanjutnya asam Medika
lambung akan tertahan di sel pariental pada
pH Potter, Patricia A, , (2005), Buku Ajar
mendekati normal sehingga sekresi asam
lambung Fundamental Keperawatan: Konsep, Proses,
mengalam
akan penurunan
i dan terjadi Dan Praktik,Edisi 4, EGC, Jakarta.
penyembuhan luka (Gulton,
1997). Stuart, Gail W, (2011), Buku Saku
Keperawatan Jiwa,Edisi 5, EGC, Jakarta.
Kesimp Smeltzer, Suzanne C, (2012), Buku Ajar
ul
 an
Bedah-
Bru
nne
Keperawatan Medikal r
Skala intensitas nyeri pada pasien
gastritis &Suddart, Edisi 8, EGC, Jakarta.
sebelum relaksasi terbanyak adalah skala
intensitas
nyeri 6. Skala intensitas nyeri pada pasien
gastritis
sesudah relaksasi terbanyak adalah skala
intensitas
nyeri 3. pengaruh relaksasi terhadap
penurunan intensitas nyeri pada pasien gastritis,
dimana didapatkan nilai p 0,000 (<0,05).

Pustaka
P Alimul H, Aziz, (2012), Riset Keperawatan Dan
Teknik Penulisan Ilmiah, Edisi I, Jakarta:
Salemba Medika.
13 Arikunto, Suharsimi. (2012). Prosedur
Penelitian, Suatu Pendekatan Praktek.
Edisi Revisi V. Rineka Cipto. Jakarta.
14 Carpenito, L.J., (1999), Rencana Asuhan dan
Dokumentasi Keperawatan: Diagnosa
Keperawatan dan masalah Kolaboratif,
Edisi kedua, EGC, Jakarta.
15 Carpenito, L.J., (2013), Diagnosa
Keperawatan: Aplikasi Pada praktek
Klinik, Edisi 6, EGC, Jakarta.
16 Dalami, Ernawati dkk, (2012), Asuhan
Keperawatan Jiwa Dengan masalah
Psikososial, Jakarta: Trans Info Medika.
17 Engram, Barbara, (1999), Rencana
Asuhan Keperawatan Medikal bedah,
Volume 3, EGC, Jakarta.
 ANALISA JURNAL

IDENTITAS JURNAL

Judul Asli : Pengaruh Teknik Relaksasi Terhadap Penurunan Nyeri Epigastrium Pada

Pasien Gastritis

Penulis/ pengarang : Nuryanti Erni, Abidin M Zainal2, Normawati Ajeng Titah

PICOT ANALISA
P (POPULATION Masalah penanganan nyeri epigastrium pada pasien gastritis. sampel
OR PROBLEM) yang dipilih secara total sampling terhadap pasien gastritis yang
dirawat di RSUD dr R Soetijono Blora.
Pasien yang mengalami gastritis menyebabkan tidak dapat melakukan
kegiatan sehari-hari secara normal. Gejala yang umum terjadi pada
penderita gastritis adalah rasa tak nyaman (nyeri) pada epigastrium,
perut kembung, sakit kepala dan mual yang dapat mengganggu
aktifitas sehari-hari
I Desain penelitian yang digunakan adalah dengan metode one group
(INTERVENTION) pre test and post test design, dimana pasien datang dilakukan
pengecekan tingkat nyeri dengan skala nyeri lalu dilakukan
relaksasi. Setelah dilakukan relaksasi dilakukan pengecekan ulang
dengan cara yang sama. Penelitian ini melakukan intervensi
terhadap responden berupa relaksasi untuk menurunkan nyeri
epigastrium pada pasien gastritis, sampel yang dipilih secara total
sampling terhadap pasien gastritis yang dirawat di RSUD dr R
Soetijono Blora. Data diolah dan dianalisa dengan analisis univariat
dan bivariat. Analisis bivariat ini dilakukan untuk menguji hipotesis
pengaruh antara variable independen dengan variable dependen. Uji
statistik yang digunakan dengan menggunakan uji Paired Sample T–
Test.
Dengan tindakan relaksasi diharapkan nyeri pada
epigastrium akan menurun. Tindakan relaksasi yang mudah
dilakukan untuk mengatasi rasa nyeri tersebut adalah dengan
relaksasi. progresif memberikan pengaruh yang paling baik untuk
jangka waktu yang relatif singkat dalam mengatasi nyeri pada pasien
gastritis.

C Ada sebuah jurnal pembanding, Menurut sebuah penelitian di

(COMPARATION) Atlanta for Behavioral Medicine, dikutip dari Sciencedily, temuan
ini telah dipresentasikan dalam American Psychological
Association di San Diego, peneliti menduga faktor hormonal turut
mempengaruhi perbedaan nyeri yang dirasakan laki-laki dan
perempuan. Beberapa jenis hormon memang berhubungan
sensasi nyeri. Menurut Dr. Jenifer Kelly perbedaan hormonal
antara laki-laki dan perempuan menduga turut mempengaruhi
respons terhadap nyeri.

O (OUTCOME) Hasil pengukuran skala nyeri pre dan post guide imagery pada
 pasien gastritis. Dari hasil penelitian menunjukan bahwa
terdapat perbedaan yang signifikan terhadap nilai skala
nyeri sebelum dan sesudah perlakuan dengan p value
sebesar 0,000 (p < 0,05). Hal ini sesuai teori bahwa
penggunaan relaksasi pada pasien gastritisakan membantu
penurunan nilai skala nyeri. Skala intensitas nyeri pada
pasien gastritis sebelum relaksasi terbanyak adalah skala
intensitas nyeri 6. Skala intensitas nyeri pada pasien
gastritis, sesudah relaksasi terbanyak adalah skala
intensitasnyeri 3. Ada pengaruh relaksasi terhadap
penurunan intensitas nyeri pada pasien gastritis.

T (TIME) RSUD dr R Soetijono Blora tahun 2017

 Pain 81 (1999) 163–172

Relief of postoperative pain with jaw relaxation, music and their combination

Marion Good a ,*, Michael Stanton-Hicks b, Jeffrey A. Grass b, Gene Cranston Anderson a,
Charles Choi c, Laree J. Schoolmeesters a, Ali Salman a
a
Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA

b
The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106, USA

c
Fairview Health System, 18101 Lorain Avenue, Cleveland, OH 44111, USA

Received 11 September 1998; received in revised form 3 December 1998; accepted 24 December 1998

Abstract

The aim of this randomized controlled trial was to determine the effect of jaw relaxation, music and the combination of relaxation and
music on postoperative pain after major abdominal surgery during ambulation and rest on postoperative days 1 and 2. Opioid medication
provided for pain, following abdominal surgery, does not always give sufficient relief and can cause undesired side effects. Thus,
additional interventions such as music and relaxation may provide more complete relief. Previous studies have found mixed results due to
small sample sizes and other methodological problems. In a rigorous experimental design, 500 subjects aged 18– 70 in five Midwestern
hospitals were randomly assigned by minimization to a relaxation, music, relaxation plus music, or control group. Interventions were
taught preoperatively and tested postoperatively. The same amount of time was spent with subjects in the control group. Pain was
measured with the visual analogue sensation and distress of pain scales. Demographic and surgical variables, and milligrams of parenteral
or oral opioids in effect at the time of testing were not significantly different between the groups, nor did they correlate with pain
scores. Controlling for pretest sensation and distress, orthogonal a priori contrasts and multivariate analysis of covariance indicated
that the three treatment groups had significantly less pain than the controls, (P  0.028 – 0.000) which was confirmed by the univariate
analysis of covariance (P  0.018 –0.000). Post hoc multivariate analysis revealed that the combination group had significantly less
sensation and distress of pain than the control group on all post-tests (P  0.035 – 0.000), and the relaxation and music groups had
significantly less on all tests (P  0.022 – 0.000) except after ambulation. At post ambulation those using relaxation did not have
significantly less pain than the controls on both days and those using music did not on day 1, although there were some univariate effects.
A corresponding significant decrease in mastery of the interventions from pre to post ambulation suggests the need for reminders to focus
on the intervention during this increased activity. Physicians and nurses preparing patients for surgery and caring for them afterward,
should encourage patients to use relaxation and music as adjuvants to medication for postoperative pain.  1999 International
Association for the Study of Pain. Published by Elsevier Science B.V.

Keywords: Pain; Music; Relaxation

1. Introduction e-mail: mpg@po.cwru.edu

Each year in the United States, 23 million people

undergo surgical operations and experience postoperative
pain (Chapman, 1985). The pain increases stress responses,
which in turn increase tissue breakdown metabolism, coa-
gulation and fluid retention, with deleterious effects on
recovery. Pain also interferes with appetite and sleep, and
it can contribute to complications, prolonging hospitaliza-

* Corresponding author. Tel.: +1-216-368-5975; fax: +1-216-368-3542;

 tion (Acute Pain Management Guideline Panel, 1992; prescribed inter- vals. Some patients may be
Mias- kowski, 1993). especially sensitive to pain, or have
Even with medication, most postoperative insufficient response to medication. Others
patients report moderate to severe pain at rest may wish to avoid the side effects of
that increases during ambu- lation (Bonica, increased doses of opioids.
1983; Weis et al., 1983). After activity ceases, Relaxation and music have been
pain may continue but more medication may recommended as adju- vants to medication.
be unavailable, since it can only be given at Both act on pain by decreasing anxiety
0304-3959/99/$20.00  1999 International Association for the Study of Pain. Published by Elsevier Science B.V. P II : S
0 3 04- 395 9( 99 )0 0 0 0 2- 0
 Good
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Pain 81 (1999)
81 (1999) 163–172
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(Borkovec and Sides, 1979; Hanser et al., 1983), lowering muscle them to a control group receiving usual care, three experi-
tension and distracting attention (Good, 1995), thereby mental groups, relaxation, music and combination, and two
affecting the central control processes that modulate pain
transmission. Relaxation directs the mind to concen- trate
on relaxing muscles, breathing evenly and reducing
thoughts. Music is composed of auditory tones and rhythms
that do not direct the mind but distract it, and they relax the
body as well. Music can focus attention, facilitate breathing
and stimulate the relaxation response (Livingston, 1979).
Some studies have found that relaxation and music
reduced pain, but in others results have been mixed due to
small samples and other methodological problems, includ-
ing lack of random assignment, lack of control for pretest
pain, and little practice or assurance that subjects had mas-
tered the techniques (Blankfield, 1991; Henry, 1995; Ste-
venson, 1995; Good, 1996; Sears and Carroll, 1998). In
some studies relaxation or music reduced reports of sensory
and affective pain (Flaherty and Fitzpatrick, 1978; Lawlis
et al., 1985; Levin et al., 1987; Mullooly et al., 1988;
Miller and Perry, 1990), while in others they reduced only
affective pain (Wells, 1982; Horowitz et al., 1984;
Mogan et al.,
1985), had different results on different measures of pain (Good
and Chin, 1998), or on different postoperative days (Good,
1995; Good and Chin, 1998). In other studies relaxa- tion
or music had no effect on pain but reportedly, provided a
relaxing and pleasant experience (Heitz et al., 1992; Zim-
merman et al., 1996; Heiser et al., 1997).
As a result, the usefulness of these interventions remains
unclear. In the randomized controlled trial reported here, jaw
relaxation, music and the combination of relaxation and
music were compared at ambulation and rest in a large
sample with optimum control.

2. Methods

2.1. Sample

An experimental pretest – post-test design, was used

to study 617 subjects recruited from three tertiary care
medical centers and two suburban community hospitals in
a large Midwestern city over a period of 29 months. All
patients spoke English, were scheduled for major
abdominal sur- gery, and were expected to use patient
controlled analgesia (PCA), and to ambulate after surgery.
Patients with laparo- scopic or vaginal surgery, epidural
analgesia, or a diagnosis of psychosis, mental retardation,
or opioid dependence were excluded. The study was
approved by the investigational review board of each
institution and all patients provided informed written
consent preoperatively.
A convenience sample of subjects was selected from the
pre-admission testing appointment schedules of the five
hospitals. After an interview, a computerized minimization
program (Zeller et al., 1997) was used to randomly assign
 Good
Good
et al.
testing sequences, ambulation first or rest first. The
program controlled for gender,
specialty, intestinal surgery, chronic pain, first
surgery and antidepressant/benzodiaze- pine
use. Of the total sample, 165 (27%) were
assigned to the relaxation group, 151 (25%) to
the music group, 149 (24%) to the combination
group, and 152 (25%) to the con- trol group.
Half of the subjects were randomly assigned to
be tested at ambulation first (n  318, 52%)
and half to be tested at rest first (n  299,
49%). There were no significant differences in
the number of subjects assigned to each treat-
2 Their mean age was 45.37 (SD  11.03),
ment group, X (3, N  617)  1.03, P  0.79,
2
or to each testing sequence, X (1, N  617) 
0.21, P  0.65.
After surgery, 76 (12%) subjects no longer
qualified for the study, and 33 (5%) withdrew.
Reasons for disqualifica- tion were epidural
anesthesia, surgery changed or canceled, and
illness or other factors. Reasons for withdrawal
were that patients did not feel well, did not
want to use the treat- ment (n  8), wanted to
rest, or provided no reason. Thus there were
500 subjects in the final sample. The number
of subjects withdrawing did not significantly
2
differ in the four groups, X (3, N  33)  4.21,
P  0.24, or between the two testing
2
sequences, X (1, N  33)  3.67, P  0.06,
et /al.
/ Pain
Pain 81 (1999)
81 (1999) 163–172
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2
or between sequences per group, X (3, N 
surgical 33)  1.09, P 
0.78.
Two hundred twenty-one (44%) subjects in
the final sam- ple missed at least one test, and
28 (6%) missed more than one test. Reasons
for a missed test were adverse symptoms (n 
80), condition at time of test (n  36), refusal
to ambu- late (n  41), early discharge (n 
14), too much pain (n  10), did not like the
music (n  31), and miscellaneous or no
reason given (n  37). Those who had
complete data for at least one of the four tests
were included in the analysis (Everitt and
Dunn, 1991). On Day 1, there were 340
subjects tested during ambulation, and 458 at
rest; on Day 2, there were 401 were tested
during ambulation and 443 at rest.
In the final sample, there were 87 (17%)
men and 413 (83%) women; 350 (70%) were
from the three tertiary care centers, and 150
(30%) from the two community hospitals.
range 20 to 70 years and the majority were
Caucasian (81%), Protestant (52%), married
(61%), employed (69%), had completed a year
or more of college (64%), and had a monthly
household income of 3000 US $ or less (57%).
Over half smoked (52%), and most had
previous surgery (94%), did not drink
alcohol (86%), and did not have chronic pain
(64%), or take benzodiazepines or
antidepressants (85%), or ster- oids (89%).
The mean body mass for the sample was 28.84
2
kg/m , SD  7.94. The final sample underwent
gynecologi- cal (50%), gastro-intestinal (28%),
exploratory (18%) and urinary surgery (4%).
Subjects spent an average of 3 h 15 min, (SD 
1 h 8 min) in surgery. During surgery, cancer
was found in 19%. The majority of surgical
incisions were in the lower abdomen (62%);
with 54% vertical incisions, and 35%
horizontal. Most subjects (93%) received
initial postoperative orders for PCA with a
lockout range of 5 to 10 min, but 4% received
intramuscular analgesics as needed,
 Good
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Pain 81 (1999)
81 (1999) 163–172
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2% intravenous opioids, and 1% other routes. A few (13%) Preoperatively subjects practiced twice with the
progressed to oral medication by the first postoperative day, introduc- tory tape while sitting in a chair, and then twice
and 35% more by day 2, for a total of 48% by day 2. with the
There were 26% subjects receiving relaxation, 26%
receiving music, 24% receiving the combination, and 24% in the
2
control group, X (3, N  500)  0.40, P  0.94. On day 1
within each group, half were tested first during ambu-
lation and half were tested first during rest; the order was
2
reversed on day 2, X (1, N  500)  0, P  0.84.

2.2. Experimental interventions

The interventions, jaw relaxation, music, or a combina-

tion of relaxation and music, were taught preoperatively
with an introductory tape using earphones, and tested with
a treatment tape postoperatively during ambulation and at
rest on days 1 and 2. To control for variations in hospital
practice, all subjects received instruction in getting out of
bed and splinting their incision while ambulating. To con-
trol for expectations and prevent demoralization, the
control subjects were told that this was the treatment they
were assigned to receive and that an important purpose of
the research was to compare pain during ambulation and
at rest. To prevent diffusion of treatments, room
assignments were controlled so that subjects were not
assigned to the same room. To prevent extraneous variation
in the four groups, a similar amount of time was allotted for
instruction, experimenter contact and validation of
effectiveness.
Subjects in the relaxation group used the following pro-
tocol: let the lower jaw drop slightly as though starting a
small yawn; keep the tongue quiet and resting in the bottom
of the mouth; let the lips get soft; breathe slowly and rhyth-
mically with a three-rhythm pattern of inhale, exhale and
rest; stop forming words; do not even think words (Flaherty
and Fitzpatrick, 1978). An introductory tape used preopera-
tively explained the purpose and effects of relaxation and
described the jaw relaxation technique; subjects then prac-
ticed the technique and were coached by the data collector.
Postoperatively, subjects used an intervention tape in which
the relaxation technique was repeated at 1-min intervals.
The music intervention began preoperatively when sub-
jects listened to a half-minute excerpt of each type of
music. Subjects chose one of five types of taped soothing
music: synthesizer, harp, piano, orchestral or slow jazz.
They lis- tened to it while the data collector coached and
reinforced them on letting the music distract or relax
(Good, 1995).
The preoperative combination tape consisted of the pro-
cedures of both the music and relaxation groups. Postopera-
tively, the combination group listened to a tape on which
the relaxation technique was repeated occasionally with the
chosen music playing continuously in the background. In
the combination and music groups, 73 (29%) chose orches-
tral music, 60 (24%) chose piano, 60 (24%) chose jazz, 33
(13%) chose synthesizer, and 24 (10%) chose harp.
 Good
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Pain 81 (1999)
81 (1999) 163–172
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intervention tape, first while sitting and then while getting up and subjects could differentiate between sensation
walking. Subjects’ ability to use the techniques was and distress during induced ischemic pain.
verified using four criteria during preoperative practice and Concurrent validity, comparing post
postoperative testing: (a) face relaxed (b) no grimace or ambulatory scores on the original scales to
frown (c) not talking (d) slow respirations. Each criteria scores on the Melzack (1975) McGill Pain
was observed at specific points in the procedure and given Questionnaire’s Pain Rating Scale- Ranked,
two points if it was present, and one point if it was not. indicated strongly positive correlations for
Mastery was defined as a score of seven out of eight points. sensa- tion (r  0.44, P , 0.001), and
The control group received the same procedures and mea- distress of pain (r  0.55, P , 0.001) (Good,
sures as the treatment groups, but did not receive a tape. 1995). In the present study, correlations of the
Ten minutes of casual conversation took the place of the scores during rest on the original Johnson
intro- ductory tape. During the rest condition, the control scales with the VAS sensation and distress
group scales ranged from r  0.89 to r  0.92. The
was asked to lie quietly 15 reliability of these single-item measures of
changeable states has not been established.
min.
2.3.2. Opioid

2.3. intake

Measu To examine the confounding effects of

analgesic medica- tion, the milligrams of
remen opioid intake during tests at ambula- tion and
rest were calculated by subtracting the total
ts milligrams on the PCA display screen just
before the test from the total after the test. For
those receiving other par-
2.3.1. Sensation and distress of

pain

Postoperative pain is defined as an

unpleasant sensory and affective experience.
The sensory component of pain, defined as the
unpleasant, physical perception of hurt, was
measured with the sensation of pain visual
analogue scale (VAS). The affective
component of pain, defined as the amount of
emotional distress associated with the
sensation, was measured by a VAS distress
scale at the same data points. Pain is
conceptualized in this study as a composite of
sensory and affective pain. The two scales,
adapted from Johnson (1973), were 100-mm
lines with verbal anchors of
‘none’ to ‘most sensation’ and ‘most distress’. The
scales
were introduced preoperatively and were then used to
deter- mine the intensity of past and expected
sensation, and dis- tress of pain.
Postoperatively they were used before and
after a 15 min rest period and at four points
during ambula- tion on postoperative days 1
and 2 (before preparation, after preparation,
after ambulation and after recovery). The pre-
paratory measure was considered the pretest;
all other mea- surements were post-tests.
Construct validity of the original scales was
supported by Johnson (1973), who found that
 Good
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Pain 81 (1999)
81 (1999) 163–172
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enteral or oral opioid medications, the presence of opioid

2.5. Analysis
‘on board’ (i.e. in effect) was recorded if the drug had been given
before testing within the prescribed interval.
To identify potentially confounding covariates (at r .
2.4. Procedure

2.4.1. Preoperative instruction

Names of patients scheduled for major abdominal

surgery were obtained each day by reviewing the
appointment sche- dule in the preadmission testing (PAT)
departments of the five hospitals. A data collector met
patients after their PAT appointment, obtained written
informed consent, randomly assigned and interviewed
them to obtain demographic and other data on variables
that might affect postoperative pain such as past pain,
expected pain, smoking and alcohol use. Subjects were
taught use of the sensation and distress scales; and then
they listened to the intervention teaching tapes.

2.4.2. Postoperative testing

Postoperatively, patients’ charts were reviewed to deter-

mine the surgical procedure, postoperative diagnosis,
length of surgery and amount of analgesic, sedative, or
steroid medication in effect at the time of measurement.
Ninety percent of the testing was done between the hours
of 0930 and 1545 h, at a time agreeable to subjects. To
reduce con- founding, testing on day 1 was done at the
second ambula- tion after surgery rather than the first. To
reduce carryover effects, testing during ambulation and rest
were performed at least 1 h apart. On day 1 after surgery,
the data collector came to the bedside and brought the tape
and tape player to experimental subjects for testing during
the assigned condi- tion, ambulation or rest.
Testing at ambulation consisted of three phases: a 5-min
preparatory period in bed; an ambulation period which
included getting out of bed, walking a comfortable
distance, and returning to bed; and a 10-min recovery
period in bed. Those in the treatment groups listened to the
tape through- out all three phases. Subjects in all four
groups were accom- panied by a nurse data collector. In all
subjects, the data collector measured sensation and distress
four times during ambulation: before and after the 5-min
preparatory period, after ambulation, and after the 10-min
recovery from ambu- lation. Ambulation lasted M  27, SD
 15 min and M  26, SD  7 min on days 1 and 2,
respectively.
During the rest condition, the data collector measured
sensation and distress before and after the 15 min treatment
tape or control condition of resting in bed. On Day 2, the
procedures for ambulation and rest were repeated with the
order of activity reversed. PCA opioid analgesics were not
restricted, but the data collector checked the PCA pump
before and after each treatment, and noted other analgesics
in effect from the chart.
 Good
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Pain 81 (1999)
81 (1999) 163–172
163–172

0.30) (Cook and Campbell, 1979), Pearson’s product
moment correlations were calculated between
the measures of pain and possible covariates.
Multivariate analysis of covariance
(MANCOVA), controlling for identified
covari- ates, was then used to compare post-
test pain at ambulation and rest with three
orthogonal a priori contrasts: (1) the three
treatment groups versus the control group (2)
the com- bination group versus the single
treatment groups, relaxa- tion and music (3)
the relaxation group versus the music group.
The level of significance was set at 0.05. To
deter- mine whether univariate (UV) analysis
confirmed the multi- variate (MV) results,
analysis of covariance (ANCOVA) was used,
controlling for the corresponding pretest.
3. Results
3.2. Overall multivariate
contrasts
While controlling for pretest sensation and
distress, MANCOVA using orthogonal a priori
contrasts indicated that on contrast 1 the three
treatment groups taken together had
significantly less post-test pain than the
controls at all post-tests during ambulation
and rest on both days (Table
2). Comparison of the combination group to the
relaxation and music groups together on
contrast 2 indicated that only at day 1 rest did
subjects using the combination have sig-
nificantly less post-test pain than those using
the individual treatments of relaxation and
music, F(2, 451)  2.96, P 
0.027. On contrast 3 no significant difference was

found
Mean scores for pain sensation and distress
for the four groups during ambulation and rest
on both days are shown in Table 1 and Fig. 1.
At every point after the preparatory pretest, the
control group had higher raw scores on
sensation and distress than any of the
treatment groups.

3.1. Equality of groups and identification of

covariates

One-way ANOVA determined that at the

pretest (pre- paratory) measurement there were
no significant between- group differences in
sensation and distress, except for sen- sation
before rest on day 2, F(3, 439)  2.41, P 
0.033. Also, the following possible
confounding variables were not correlated
with dependent measures and there were no
significant group differences in them: age,
gender, marital status, education, smoking,
alcohol use, chronic pain, pre- operative belief
in intervention effectiveness for pain, num- ber
of previous surgeries, intensity of past or
expected sensation or distress, past use of a
relaxation technique, hours in surgery,
incision length, location, or direction, PCA
milligrams of morphine equivalent used during
each test and number of subjects with PCA or
other opioids on board. Only pretest sensation
and distress scores were cor- related with
ambulation and rest post-test scores and thus
were used as covariates, r  0.44 – 0.86, all P
 0.000.
 Good
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et al. / Pain
Pain 81 (1999)
81 (1999) 163–172
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Table 1

Group means and standard deviations of sensation and distress scores (N  500)

Relaxation Music Combination Control Relaxation Music Combination Control

a b
, 116 89, 122 80, 109 89, 111 98, 109 100, 118 97, 107 106, 109
points (SD) (SD) (SD) (SD) (SD) (SD) (SD) (SD)

Sensation
Ambulation
Preparatory (25) (25) (24) (25) (25) (26) (23) (24)
preparatory (23) (26) (24) (25) (24) (24) (22) (24)
ambulation (26) (27) (26) (24) (24) (26) (23) (26)
recovery (25) (26) (25) (25) (23) (24) (20) (24)

rest (26) (27) (25) (25) (25) (25) (22) (22)

rest (26) (26) (21) (26) (22) (23) (20) (23)

Distress

Ambulation
Preparatory (26) (28) (25) (26) (28) (28) (24) (25)
preparatory (24) (27) (25) (26) (24) (24) (21) (24)
ambulation (28) (27) (28) (26) (25) (26) (23) (26)
recovery (23) (27) (25) (26) (25) (24) (20) (24)

Rest
rest 42 (29) (28) (27) (30) (27) (26) (24) (23)
rest 30 (27) (26) (21) (28) (22) (24) (20) (25)
a
n at ambulation.
b
n at rest.
1 1
between the relaxation and music groups on any test. Uni- variate Similar results were found using multivariate contrasts with the 285
subjects who completed all four tests.
ANCOVA confirmed the multivariate analyses on
contrasts 1 and 2 (Table 2).

3.3. Effect on pain: overall multivariate post-hoc results

Post-hoc MANCOVA showed that each treatment group

had significantly less pain than the control group (Table 3).
Persons who used relaxation had significantly less pain than
the controls on six of the eight post-tests; the exceptions
were the post ambulation tests on days 1 and 2. Persons
who used music had significantly less pain than the control
group at seven post-tests, the only exception being the post-
ambulation test on day 2. However, persons who used the
combination tape had significantly less pain than the con-
trols on all tests. In contrast 2 post-hoc MV tests comparing
the combination group to either the relaxation F(2, 220) 
2.31, P  0.051, or the music group F(2, 226)  1.88, P 
0.078, did not reach significance at day 1 rest.

3.4. Effect on sensation or distress: univariate post-hoc results

Post-hoc UV ANCOVA of sensation and distress on con-

trast 1 (Table 3) confirmed the MV post-hoc analyses for all
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Pain 81 (1999)
81 (1999) 163–172
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treatment versus control group tests except for two

mixed examples of Rao’s paradox. After
ambulation on day 1, sensation did not
significantly differ between the relaxation
group and the controls, P  0.172, but
distress did, P  0.035. On day 2 after
ambulation, distress did not sig- nificantly
differ between the music group and
controls, P  0.051, but sensation did, P 
0.013. In each paradox, the significant UV
factor was not strong enough to carry the other
to MV significance, but it was present.
The UV post-hoc analysis of covariance
comparing the combination versus the
individual interventions at day 1 rest failed to
confirm the non-significant MV post-hoc
analyses; significance was found on three of the
four tests. Compared with the relaxation group,
the combination had significantly less sensation
F(1, 228)  3.75, P  0.027, and less distress,
F(1, 222)  3.84, P  0.026; however,
compared with the music group, the
combination had significantly less distress, F(1,
222)  4.06, P  0.023, but the lower sensation
score was not significant. Three independent
differences are there, but fail to carry the post-
hoc MV test to significance.

3.5. Magnitude of

differences

The magnitude of differences in means

between treat- ment and control groups is of
clinical interest. Significant mean differences
between treatment and control groups, adjusted
for pretests, ranged from 3.64 mm for sensation
and 4.21 mm for distress on day 2 post
ambulation to 8.12
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81 (1999) 163–172
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Fig. 1. Mean sensation and distress scores at ambulation and rest on postoperative day 1 and 2 using 100 mm visual analogue scales. The preparatory measure was
the pretest; sensation and distress were then measured at three post-tests during ambulation (post preparatory, post ambulation, post recovery), and once
following rest (post rest). Prep, preparatory (pretest) measure; Post-prep, after 5 min preparation for ambulation; Post-amb, after ambulation; Post-rec, after
10 min recovery from ambulation.
did not change differently over day 1 compared with day 2, but did
mm for sensation and 9.81 mm for distress on day 1 post
preparatory. Differences at day 1 post ambulation, were increase significantly from pretest to post-test during rest
5.08 mm for sensation and 8.13 mm for distress. At post rest,
differences were 7.98 mm for sensation and 7.89 mm for
on day 1, F(1)  22.97, P  0.000, and day 2, F(1) 
distress. Differences in pain were supported by signifi-
cantly lower radial pulse rate on day 2 at rest, P  0.004,20.35, P  0.000, and decreased significantly from post pre-
and observed respiration rate, P  0.001 – 0.004, in the
treat- ment groups compared to the controls after each test.

3.6. Mastery scores

Before surgery, mean mastery scores were 7.66 during

ambulation and 7.68 at rest, with 95 and 94% respectively,
achieving mastery. Postoperatively, the range during ambu-
lation was from 7.00 to 7.42 (SD  0.75 – 1.07) with 75
to
92% achieving mastery; at rest the range was from 7.27 to

7.47 (SD  0.77 – 0.88) with 84 to 92% achieving mastery.

Repeated measures ANOVA indicated that mastery scores
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paratory to post ambulation on day 1, F(1)  6.70,

P 

0.001, and day 2, F(1)  17.17, P  0.000. Paired t-

tests indicated that mastery scores returned
to pretest levels after the recovery from
ambulation period.

4.

is

si

In the first 2 painful days following major

abdominal surgery, patients in the three
treatment groups taken together had
significantly less post-test pain than those in
the control group at all data points during
ambulation and rest. Further, multivariate
analysis showed that each intervention resulted
in less pain than the control group at every
point except after ambulation for the
relaxation group on both days, and for the
music group on day 2 (Table 3). There
were, however, some univariate effects for
relaxation and music after ambulation, and
pain in these two groups was effectively
reduced during the pre- paration (5 min) and
recovery (10 min) phases of ambula- tion,
and during rest (15 min). In contrast,
the combination group showed MV and UV
effectiveness in
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2 their multimodal proposition that non-pharmacological

a
adjuvants along with analgesic medications reduce pain

Day 1 combination reduced pain more than PCA at ambulation and

Contrast 1: multivariate and univariate analysis of covariance (N  500) rest on more
the first 2 postoperative days. The mechanism of this
Post-tests F df than medications alone. Relaxation, music and their
effect can probably be best explained by the gate control
Multivariate – pain
theory: the perception of pain is decreased via ‘gates’, which
Ambulation
preparatory 15.36 2, 333 394 are numerous and diverse points of filtration, abstraction
ambulation 5.63 2, 333 394 and modulation of noxious input in the central nervous sys-
recovery 5.43 2, 333 394 tem. The gates are influenced by cognitive and emotional
factors through descending inhibition systems (Melzack,
Rest
Post rest 11.19 2, 451 0.000 22.23 2, 436 0.000
1982; Noordenbos, 1984; Jones, 1992).
The effect may occur through distraction, reduction of
Univariate – sensation tension and sympathetic modulation. When relaxation and
Ambulation music distract the mind, the result is selective attention
preparatory 339 400 mediated by the thalamus that alerts the prefrontal cortex
ambulation 339 400
recovery 339 400
to the sound rather than to the painful input (Fuster and
Alexander, 1973; Willis, 1985), causing pain inhibition
(Fuster, 1980; Hardy, 1985). Relaxation and soothing
rest 457 442 music reduce muscular and mental tension and thereby,
reduce sympathetic stimulation of the hypothalamus
Univariate – Distress
(Beary and Benson, 1974; Melzack, 1982; Turner and Chap-
Ambulation
preparatory 339 400 man, 1982; Standley, 1986) which activates endogenous
ambulation 339 400 opiates in the central nervous system, reducing propagation
recovery 339 400 of pain impulses and modulating perception of the sensory
and affective components of pain (Vidal and Jacob, 1980;
Carr and Uysal, 1985; Goldstein, 1985; Tasher et al., 1987;
rest 457 442
Culhane and Carstens, 1988). Concurrent reductions in

a
Note, only contrast 1 is shown. It compares the three treatment groups pulse and respiration in this study indicate that
taken together to the control group. Contrasts 2 and 3 were not given
because only one of the tests was significant. Contrast 2 at Day 1 rest
relaxation or distraction reduces sympathetic
was significant on multivariate, F(2, 451)  2.96, P  0.027, and univari- activity as they reduce pain. In addition, music
ate post-hoc tests for sensation, F(1, 453)  3.01, P  0.042, and distress, is known to stimulate the sensory cortex and
F(1, 453)  5.60, P  0.009. the thalamus which have been found to inhibit
nociceptive neurons in the spinal cord (Vidal
all phases of ambulation and rest. In addition, there was a graded and Jacob,
effect at Day 1 rest with the combination group having 1980; Andy, 1983; Dickenson, 1983; Yezierski
significantly less pain than the relaxation and music
groups taken together. Mastery scores in this study et al.,
were related to activity, significantly increasing dur- ing
rest and decreasing during ambulation. Reminders to focus 1983), and has been found to increase immune
on the tape may improve effectiveness during ambulation.
Health care professionals who prepare patients for factors
surgery are encouraged to discuss the impor- tance of
managing the pain with relaxation, music and the (Lane and Olness,
combination, encouraging patient choice between the
modalities. We emphasize that all the interventions were 1991).
effective for sensation as well as distress, refuting the
notion that these methods reduce only distress (McCaffery Sears and Carroll (1998) have questioned
and Beebe, 1989). the clinical significance of small differences
between relaxation and control groups in pain
4.1. Support of theory studies. However, studies of acute pain have
large standard deviations due to differences in
patient responses to pain and analgesics
The Good and Moore (1996) pain management theory (Tamsen et al.,
comprises three propositions stating that multimodal ther- 1982); these tend to diminish the mean effect.
apy, attentive care and patient education are needed for Differences in pain of 4 – 0 mm found in this
control of acute pain. The results of this study support study are clinically signifi- cant, since
relaxation, music and the combination consis-
tently reduced both sensation and distress, two
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163–172

components of pain endured by patients; and

also reduced heart and respiratory rates
moderating sympathetic nervous system
activity. Therefore, listening to the tapes for
longer periods of time postoperatively may
have significant cumulative effects on stress
and recovery. The effect was not con- founded
by strong opioid analgesics or by memory
errors associated with a retrospective pain
measures; pain was appropriately measured at
the time it occurred (Feine et al., 1998).
However, after the last test on day 2, subjects
were asked to report the amount of relief
provided by the intervention, and 84% said it
reduced their pain a moderate
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Table 3

a
Post-hoc analysis of covariance (N  500)

Post-tests Relaxation versus control Music versus control Combination versus control

F df P F df P F df P

Multivariate post-hoc tests – Wilks F test

Day 1
preparatory 12.60 333 0.000 8.97 333 0.000 9.43 333 0.000
ambulation 2.15 333 n.s.* 5.36 333 0.003 4.33 333 0.007
recovery 4.57 333 0.006 3.78 333 0.012 3.20 333 0.021
rest 4.65 451 0.005 6.56 451 0.001 13.05 451 0.000

Day 2
preparatory 7.09 394 0.001 7.22 394 0.001 6.66 394 0.001
ambulation 1.03 394 n.s.** 2.17 394 n.s.*** 3.92 394 0.011
recovery 3.16 394 0.022 3.44 394 0.017 3.82 394 0.012
rest 15.32 436 0.000 14.44 436 0.000 15.57 436 0.000

Univariate – sensation

Day 1
ambulation 21.84 339 0.000 13.04 339 0.000 10.36 339 0.001
ambulation 0.90 339 n.s.**** 6.02 339 0.008 3.14 339 0.035
recovery 7.10 339 0.004 8.14 339 0.003 5.02 339 0.013
rest 8.02 457 0.003 14.93 457 0.000 22.63 457 0.000

Day 2
ambulation 12.77 400 0.000 14.99 400 0.000 11.86 400 0.001
†
ambulation 0.51 400 5.04 400 0.013 7.77 400 0.003
recovery 6.99 400 0.005 7.47 400 0.004 8.79 400 0.002
rest 19.13 442 0.000 24.27 442 0.000 25.73 457 0.000

Univariate – distress

Day 1
ambulation 20.79 339 0.000 16.05 339 0.000 18.12 339 0.000
ambulation 3.31 339 0.035 10.82 339 0.001 8.03 339 0.003
recovery 9.19 339 0.002 5.43 339 0.010 6.40 339 0.006
rest 7.66 457 0.003 6.31 457 0.006 21.32 457 0.000

Day 2
ambulation 11.71 400 0.001 9.42 400 0.001 10.95 400 0.001
†† †††
ambulation 1.58 400 2.71 400 6.84 400 0.005
recovery 4.13 400 0.022 5.13 400 0.012 2.85 400 0.046
rest 30.98 442 0.000 27.02 442 0.000 29.76 442 0.000
a
Note, only the differences between each treatment group and the controls are shown. Day 1 rest multivariate post-hoc differences were not significant
between the combination group versus the relaxation or the music group, F(2, 226)  1.88, P  0.08. Day 1 rest univariate differences did not confirm the
MV tests. Compared with the relaxation group, the combination group had significantly less sensation, F(1, 228)  3.75, P  0.027, and less distress, F(1,
222)  3.84, P  0.026. Compared with the music group, the combination had significantly less distress, F(1, 222)  4.06, P  0.023, but the lower sensation scores
were not significantly different.
† †† †††
*P  0.059; **P  0.147; ***P  0.058; ****P  0.172, P  0.238; P  0.105; P  0.051; n.s., not significant.
amount or a lot; this may have been an overestimation for some of
the four tests. However, these general perceptions of relief4.2.1. Ambulation
at the exit interview do add support to the high satisfaction
with the interventions, that is, nearly all (91%) said they These results are in sharp contrast to those of Good
would use a tape like this again if in pain, and 96% would
recommend it to others for surgery. (1995) (n  21), who found at initial ambulation that none

4.2. Comparison to other studies

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of these tapes reduced sensation, distress, or anxiety

of pain after return to bed, although they were
reported helpful during the next 2 days. In the
present study, with the same tapes and
comparisons, but with a larger sample at
subse- quent ambulations we found that the
combination on both days, and music on day 1
reduced pain, significantly more than usual
care at all three points: after preparation, after
ambulation and after recovery (Table 3), with
mixed results after ambulation for music on
day 2 and for relaxation on day 1.
In contrast to the present study, most
investigations of the effects of jaw relaxation
on pain during ambulation were
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Pain 81 (1999)
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conceptualized and analyzed univariately, therefore making

comparisons complex. Ceccio (1984) (n  10) found that We thank Richard Zeller, PhD, statistical consultant for
jaw relaxation reduced both components of pain after initial
turning, but Mogan et al. (1985) (n  40) found relaxation
reduced only distress after ambulation; two others had posi-
tive or negative results, respectively, but did not randomize,
or provide pretest control (Flaherty and Fitzpatrick, 1978;
n  21; Horowitz et al., 1984; n  15). Inconsistent results
may be due to small samples and methodological problems.

4.2.2. Rest

The three interventions together reduced multivariate

pain, significantly more than the controls at rest on both
days (Table 2). In addition, there was a graded effect: the
combination treatment was significantly more effective
than the individual interventions at day 1 rest. The post-hoc
UV findings at rest were similar to (Levin et al., 1987) who
used Benson’s relaxation technique, (Locsin, 1981, 1988)
who used preferred music to reduce pain behavior, and
Mullooly et al. (1988) (n  11), who used easy listening
music and found effects for both components of pain on
day 2, and only for distress on day 1. Group sizes of .100
(Table 1) were probably the reason the findings were more
positive than those in small preliminary studies. Several
investiga- tors found the interventions reduced only the
affective com- ponent of pain at rest (Mogan et al., 1985;
n  40; Wells,
1982; n  6; Wilson, 1981; n  18) or music reduced dif-
ferent pain components on different days (Good and Chin,

1998; n  16), or had no significant results for relaxation

(Voshall, 1980; n  15); or for music in the recovery room
(Heitz et al., 1992; n  20) (Heiser et al., 1997; n  5) or
following cardiac surgery (Zimmerman et al., 1996; n 
26). In future studies, relationships between duration of
use, relief and occurrence of side effects and complications
should be explored, along with effects of relief on stress
and immune responses. These interventions should be tested with
other kinds of pain: chronic, cancer and procedural pain
across age groups, and in the critically ill.
In conclusion, these data strongly support recommenda-
tions by the Acute Pain Management Guideline Panel
(1992) to add non-pharmacological interventions, such as
relaxation, music, or their combination to pharmacological
treatment of pain during ambulation and at rest on post-
operative days 1 and 2. Both sensation and distress were
significantly reduced, and these results were not
confounded by opioids. Greater effectiveness was
demonstrated for the relaxation and music combined over
the individual interven- tions at day 1 rest, but patient
preference may be important as well. Control of
postoperative pain with these interven- tions after major
surgery may also reduce opioid side effects and may hasten
recovery.

Acknowledgements
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Pain 81 (1999)
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163–172

the study, and Ada Jacox, PhD, pain management
consul- tant. We also thank Linda Schuler,
project manager, and her team of clinical
research nurses for clinical implementation of
the interventions: Vivian Balzar, Cynthia
DiFranco, Deb- bie Donohue, Carol Duber,
Jennifer Geras, Tonya Halfhill, Aisha Ja’far-
Bey, Jo Anne Rhoads, Barbara Sedenski,
Catherine Stiller, Sandra Siedlecki, Arleen
Sudyk, Suzanne Vendlinski, and Jane Wixted.
The study was supported by the National
Institute of Nursing Research, NIH, Grant
Number RO1 NR-03933 (1994 – 1998), to
M.G., principal investigator.
Everitt, B.S. and Dunn, G., Applied Multivariate Data Analysis,
Halstead
Press, New York, 1991.
Feine, J.S., Lavigne, G.J., Thuan Dao, T.T., Morin, C. and Lund, J.P.,
Memories of chronic pain and perceptions of relief, Pain, 77 (1998)
137–141.
Flaherty, G.G. and Fitzpatrick, J.J., Relaxation technique to increase com-
fort level of postoperative patients: a preliminary study, Nurs. Res., 27
(1978) 352–355.
Fuster, J.H., Prefrontal Cortex Stimulation Results in Pain
Inhibition, The
Prefrontal Cortex, Raven Press, New York, 1980.

Fuster, J.H. and Alexander, G.E., Firing changes in cells of nucleus med-
References ialis dorsalis associated with delayed response behavior, Brain Res., 61
(1973) 79–81.
Goldstein, A., Music/endorphin link, Brain/Mind Bull., 11
Acute Pain Management Guideline Panel, Acute pain management: opera- (1985) 1.
tive or medical procedures and trauma. Clinical practice guideline,
Agency for Health Care Policy and Research, Public Health Service,
US Department of Health and Human Services, Vol. AHCPR No. 92-
0032, Rockville, MD, 1992.

Andy, O.J., Thalamic stimulation for chronic pain, Appl.

Neurophysiol.,

46 (1983) 116–123.

Beary, B. and Benson, H., A simple psychophysiological technique which

elicits the hypometabolic changes in relaxation response, Psychosom.
Med., 36 (1974) 115–120.
Blankfield, R.P., Suggestion, relaxation, and hypnosis as adjuncts
in the
care of surgery patients: a review of the literature, Am. J. Clin. Hypn.,

33 (1991) 172–186.

Bonica, J.J., Current status of postoperative pain theory. In: J.Y.R. Dubner
(Ed.), Current Topics in Pain Research and Therapy, Excerpta Medica,
Tokyo, 1983, pp. 169–189.
Borkovec, T.D. and Sides, J.K., Critical procedural variables related to the
psychological effects of progressive relaxation: a review, Behav. Res.
Ther., 17 (1979) 119–125.
Carr, K.D. and Uysal, S., Evidence of supraspinal opioid analgesic
mechanism engaged by lateral hypothalamic electrical stimulation,
Brain Res., 335 (1985) 55–62.
Ceccio, C.M., Postoperative pain relief through relaxation in elderly
patients with fractured hips, Orthop. Nurs., 3 (1984) 11–14.
Chapman, C.R., Psychological factors in postoperative pain. In: G. Smith
and B.G. Covino (Eds.), Acute Pain, Butterworths, London, 1985, pp.
22–41.

Cook, T.D. and Campbell, D.T., Quasi-Experimentation: Design and Ana- lysis
Issues for Field Settings, Houghton Miller, Boston, MA, 1979.
Culhane, E.S. and Carstens, E., Medial hypothalamic stimulation sup-
presses nociceptive spinal dorsal horn neurons but not the tail-flick
reflex in the rat, Brain Res., 438 (1988) 374–381.

Dickenson, A., The inhibitory effects of thalamic stimulation on the spinal

transmission of nociceptive information in the rat, Pain (1983) 213–
224.
 Good
Good et /al.
et al. / Pain
Pain 81 (1999)
81 (1999) 163–172
163–172
 Good
Good et /al.
et al. / Pain
Pain 81 (1999)
81 (1999) 163–172
163–172

Good, M., A comparison of the effects of jaw relaxation and music on postoperative pain, Nurs. Res., 44 (1995) 52–57.
Good, M., Effects of relaxation and music on postoperative pain: a review, J. Adv. Nurs., 24 (1996) 905–914.
Good, M. and Moore, S.M., Clinical practice guidelines as a new source of
middle-range theory: focus on acute pain, Nurs. Outlook, 44 (1996) 74–

79.

Good, M. and Chin, C., The effects of Western music on postoperative pain in Taiwan, Kaoshiung Med. J., 14 (1998) 93–103.
Hanser, S.B., Larson, S.C. and O’Connell, A.S., The effect of music on relaxation of expectant mothers during labor, J. Music Ther., 20
(1983)
50–58.
Hardy, S.G.P., Analgesia produced by prefrontal stimulation, Brain Res.,

339 (1985).

Heiser, R.M., Chiles, K.C., Fudge, M. and Gray, S.E., The use of music during the immediate post-operative recovery period, AORN, 65
(1997)
777–785.

Heitz, L., Symreng, T. and Scamman, F.L., Effect of music therapy in the postanesthesia care unit: a nursing intervention, J. Post Anesth.
Nurs., 7 (1992) 22–31.
Henry, L.L., Music therapy: a nursing intervention for the control of pain and anxiety in the ICU: a review of the research literature,
Dimens. Crit. Care Nurs., 16 (1995) 295–304.
Horowitz, B., Fitzpatrick, J.J. and Flaherty, G., Relaxation techniques for pain relief after open heart surgery, Dimens. Crit. Care Nurs., 3
(1984)
364–371.

Johnson, J.E., Effects of accurate expectations about sensations on the sensory and distress components of pain, J. Pers. Soc. Psychol.
(1973)
261–275.

Jones, J.G., Historical overview of pain management: undermedication to state of the art. In: R.S. Sinatra, A.H. Hord, B. Ginsberg and
L.M. Preble (Eds.), Acute Pain: Mechanisms and Management, Mosby Yearbook, St. Louis, MO, 1992.
Lane, D. and Olness, K., Effect of music therapy on salivary immunoglo-
bulin A levels in children, Pediatr. Res., 29 (2) (1991) 11.

Lawlis, G.F., Selby, D., Hinnant, D. and McCoy, C.E., Reduction of post- operative pain parameters by presurgical relaxation
instructions for spinal pain patients, Spine, 10 (1985) 649–651.
Levin, R.F., Malloy, G.B. and Hyman, R.B., Nursing management of postoperative pain: use of relaxation techniques with female
cholecys- tectomy patients, J. Adv. Nurs., 12 (1987) 463–472.
Livingston, J.C., Music for the childbearing family, J. Obstet. Gynecol.
Neonatal Nurs., 8 (1979) 363–367.

Locsin, R., The effect of music on the pain of selected post-operative patients, J. Adv. Nurs., 6 (1981) 19–25.
Locsin, R., Effects of preferred music and guided imagery music on the pain of selected postoperative patients, ANPHI Papers, 23 (1988) 2–4.
McCaffery, M. and Beebe, A., Pain: Clinical Manual for Nursing Practice,
CV Mosby, St. Louis, MO, 1989.
Melzack, R., The McGill Pain Questionnaire: major properties and scoring methods, Pain, 1 (1975) 277–299.
 Good
Good et /al.
et al. / Pain
Pain 81 (1999)
81 (1999) 163–172
163–172

Melzack, R., Recent concepts of pain, J. Med., 13 (1982) 147–160. Miaskowski, C., Current concepts in the assessment and
management of
acute pain., Med. Surg. Nurs., 2 (1993) 28–32.

Miller, K.M. and Perry, P.A., Relaxation technique and postoperative pain in patients undergoing cardiac surgery, Heart Lung, 19 (1990) 136–146.
Mogan, J., Wells, N. and Robertson, E., Effects of preoperative teaching on postoperative pain: a replication and expansion, Int. J. Nurs.
Stud., 22
(1985) 267–280.
Mullooly, V.M., Levin, R.F. and Feldman, H.R., Music for postoperative pain and anxiety, J. N.Y. State Nurs. Assoc., 19 (1988) 4–7.
Noordenbos, W., Prologue. In: P.D. Wall and R. Melzak (Eds.), Textbook of Pain, Churchill Livingstone, New York, 1984.
Sears, K. and Carroll, D., Relaxation techniques for acute pain manage- ment: a systematic review, J. Adv. Nurs., 27 (1998) 466–475.
Standley, J.M., Music research in medical/dental treatment: meta-analysis and clinical applications, J. Music Ther., 23 (1986) 56–122.
Stevenson, C., Non-pharmacological aspects of acute pain management, Compl. Ther. Nurs. Midwifery, 1 (1995) 77–84.
Tamsen, A., Hartvig, P., Fagerlund, C. and Dahlstrom, B., Patient-con- trolled analgesic therapy, part II: individual analgesic demand and
analgesic plasma concentrations of pethidine in postoperative pain, Clin. Pharmacokinet., 7 (1982) 164–175.
Tasher, R.A.R., Choiniere, M., Libman, S.M. and Melzack, R., Analgesia
produced by injection of lidocaine into lateral hypothalamus, Pain, 31 (1987) 237–248.
Turner, J.A. and Chapman, C.R., Psychological interventions chronic pain: a critical review. II. Operant conditioning, hypnosis, and
cognitive- behavioral therapy, Pain, 12 (1982) 23–46.
Vidal, C. and Jacob, J., The effect of medial hypothalamic lesions on pain control., Brain Res., 199 (1980) 89–104.
Voshall, B., The effects of preoperative teaching on postoperative pain. In:
Z.R. Wolf (Ed.), Topics of Clinical Nursing: Pain Management, Aspen

Systems Corporation, Frederick, MD, 1980.

Weis, O.F., Sriwatanakul, K., Alloza, J.L., Weintraub, M. and Lasagna, L., Attitudes of patients, housestaff, and nurses toward
postoperative analgesic care, Anesthesia and Analgesia, 62 (1983) 70–74.
Wells, N., The effect of relaxation on postoperative muscle tension and pain, Nurs. Res., 31 (1982) 236–238.
Willis, W.D., The Pain System, Basel, Karger, 1985.

Wilson, J.F., Behavioral preparation for surgery: benefit or harm? J. Behav. Med., 4 (1981) 79–102.
Yezierski, R.P., Gerhart, K.D., Schrock, B.J. and Willis, W.D., A further
examination of effects of cortical stimulation on primate spinothalmic tract cells, J. Neurophysiol., 49 (1983) 424–441.
Zeller, R., Good, M., Anderson, G.C. and Zeller, D., Strengthening experi-
mental design by balancing confounding variables across eight treat- ment groups, Nurs. Res., 46 (1997) 345 –349.
Zimmerman, L., Nieveen, J., Barnason, S. and Schmaderer, M., The effects of music interventions on postoperative pain and sleep
in cor- onary artery bypass graft (CABG) patients., Sch. Inq. Nurs. Pract., 10 (1996) 153–174.
 Good
Good et /al.
et al. / Pain
Pain 81 (1999)
81 (1999) 163–172
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ANALISA JURNAL

IDENTITAS JURNAL

Judul Asli : Relief of postoperative pain with jaw relaxation, music and their

combination

Penulis/ pengarang : Marion good

PICOT ANALISA
P (POPULATION The aim of this randomized controlled trial was to determine the
OR PROBLEM) effect of jaw relaxation, music and the combination of relaxation
and music on postoperative pain after major abdominal surgery
during ambulation and rest on postoperative days 1 and 2. Opioid
medication provided for pain, following abdominal surgery, does
not always give sufficient relief and can cause undesired side
effects. Thus, additional interventions such as music and
relaxation may provide more complete relief. Previous studies
have found mixed results due to small sample sizes and other
methodological problems. In a rigorous experimental design, 500
subjects aged 18–70 in five Midwestern hospitals were randomly
assigned by minimization to a relaxation, music, relaxation plus
music, or control group. Interventions were taught preoperatively
and tested postoperatively. The same amount of time was spent
with subjects in the control group. Pain was measured with the
visual analogue sensation and distress of pain scales.
Demographic and surgical variables, and milligrams of parenteral
or oral opioids in effect at the time of testing were not
significantly different between the groups, nor did they correlate
with pain scores. Controlling for pretest sensation and distress,
orthogonal a priori contrasts and multivariate analysis of
covariance indicated that the three treatment groups had
significantly less pain than the controls, (P = 0.028–0.000) which
was confirmed by the univariate analysis of covariance (P =
0.018–0.000). Post hoc multivariate analysis revealed that the
combination group had significantly less sensation and distress of
pain than the control group on all post-tests (P = 0.035–0.000),
and the relaxation and music groups had significantly less on all
tests (P = 0.022–0.000) except after ambulation. At post
ambulation those using relaxation did not have significantly less
pain than the controls on both days and those using music did not
on day 1, although there were some univariate effects. A
corresponding significant decrease in mastery of the interventions
from pre to post ambulation suggests the need for reminders to
focus on the intervention during this increased activity.
Physicians and nurses preparing patients for surgery and caring
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163–172

for them afterward, should encourage patients to userelaxation

and music as adjuvants to medication for postoperative pain.

I No intervention
(INTERVENTION)
C in this study there is no comparison
(COMPARATION)
O (OUTCOME) These results are in sharp contrast to those of Good (1995) (n =
21), who found at initial ambulation that none of these tapes
reduced sensation, distress, or anxiety of pain after return to bed,
although they were reported helpful during the next 2 days. In the
present study, with the same tapes and comparisons, but with a
larger sample at subse- quent ambulations we found that the
combination on both days, and music on day 1 reduced pain,
significantly more than usual care at all three points: after
preparation, after ambulation and after recovery (Table 3), with
mixed results after ambulation for music on day 2 and for
relaxation on day 1.

T (TIME) 1999
 s s3 39 9( 2( 02 1031)31) 11011 0– 11 –1 1
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Available online at www.sciencedirect.com

jou r nal h o m e page: www.elsevier.com/locate/burns

The effects of relaxation breathing on procedural pain and

anxiety during burn care
a b, b
Eunok Park , Hyunjin Oh *, Taeim Kim

a
Bestian Burn Center, Daejeon, South Korea

b
Daejeon University, Daejeon, South Korea

a r t ic l e info a b s t r

a
Article history:
c
Accepted 4 January 2013
t

Keywords: Pain
Anxiety Introduction: Burn patients experience high levels of pain and anxiety during
Burn care dressing changes. Relaxation breathing is a simple behavioral intervention
Relaxation breathing to manage pain and anxiety. However, the information about the effects of
relaxation breathing on pain and anxiety levels for burn patients during
dressing changes is limited.
Methods: This study followed a quasi-experimental, pretest-posttest comparison
group design without random assignment to groups. A total of 64 burn
patients from Daejeon, South Korea were recruited by a convenience
sequential sampling approach. With institu- tional approval and written
consent, the experimental group practiced relaxation breathing during
dressing change procedures. Data were collected from June to September
2011 using a VAS for pain and a VAS-A for anxiety.
Results: The homogeneity test was used to detect any significant group differences
in the demographic data and pretest measures. The pain scores significantly
differed between the
2 groups after intervention (RB group vs. control group, P = .01) and over time
(pretest vs. posttest, P = .001). The anxiety scores significantly differed
between the 2 groups (P = .01) and over time (P = .02).
Conclusion: Relaxation breathing is a simple and inexpensive technique nurses can
use to help burn patients manage pain and anxiety during dressing
changes.
# 2013 Elsevier Ltd and ISBI. All rights reserved.

1. Introduction Those who experience severe burns suffer from physical and
psychosocial sequelae. Along with background burn pain,
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daily wound care procedures such as dressing changes and healing process [4–6]. Management of procedural pain
debridement produce extreme pain and are described as a and anxiety is an important issue for nurses in
‘‘living hell’’ by burn patients [1]. Since the dressing changes should practice. Nurses should focus on both relief and
be repeated daily, burn patients experience psychoso- cial prevention of pain and anxiety [7,8].
distress such as depression and anxiety because of the Relaxation breathing (RB), or diaphragmatic
procedural pain [2,3]. Moreover, the anxiety level of patients breathing, is one of the easiest and oldest
during this procedure may increase the pain, while pain relaxation techniques that are beneficial for
itself augments the anxiety. Patients thus become trapped stress-related events [9,10]. By slowing down
in a one’s breathing and reducing the use of
vicious circle of emotional and physical distress during the shoulder, neck, and upper chest muscles, RB
allows one to breathe more efficiently and
reduces physiological tension and arousal.
During relaxation practice, neuromuscular
activity is reduced, result- ing in decreased
activation of the sympathetic nervous system
and a reduction in the cerebral cortex’s state of
excitability.
Relaxation techniques address cognitive diversion

and the

* Corresponding author at: Department of Nursing, Daejeon University, 96-3 Youngun-dong, Dong-gu, Daejeon 300-716, South Korea.
E-mail address: hyunjino@dju.kr (H. Oh).
0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved.
http://dx.doi.org/10.1016/j.burns.2013.01.006
 s s3 39 9( 2( 02 1031)31) 11011 0– 11 –1 1
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restructuring of harmful stimuli such as pain and anxiety [11–

The RB program developed by the authors was based on the
13]. Sympathetic nervous system response may be decreased by abdominal breathing methods from Mason and Ahn [21,22].
slowing down one’s physical and mental activity with the
practice of RB [14]. In addition, relaxation breathing enhances
brain function, sufficient air flow through the nasal passages,
diaphragmatic movement, light vagal stimulation, and
increases CO2 changes [11].
Researchers have found that relaxation breathing reduces
anxiety, emotional distress, pain, and aversion to chemother- apy in
cancer patients receiving invasive procedures such
hematopoietic stem cell transplantation, orthopedic surgery,
and preterm labor [9,13,15–18]. De Jong and Gamel (2006)
suggested RB as a simple, inexpensive, and useful nursing
behavioral intervention [19]. However, we have not found
studies testing the effect of RB on procedural pain as
experienced by burn patients. The purpose of the present
study is to evaluate the effects of RB on pain and anxiety in
patients who underwent burn-dressing changes.

2. Method

The aim of the study was to examine the effect of RB on

procedural pain and anxiety during burn dressing changes.
The study design was a quasi-experimental, pretest-posttest
comparison group design without random assignment to
groups. In the study planning stage of the quasi-
experimental design, randomization was not met. Therefore,
after the data collection, we tested the homogeneity for
both group participants.
The sample size was calculated by power analysis, based
on a power of .80, an alpha of .05, and a medium effect size
(ES) of .65, and a targeted sample size was predicted for a
study involving 30 subjects in each group [20].

2.1. Participants

Burn patients admitted to a burn center in Daejeon, South Korea

were asked to participate in this study between June 1 and
September 30, 2011. Inclusion criteria of participants were
those who (1) were aged 18 years or over at the time of
recruitment; (2) had no intellectual disability; (3) were able
to communicate verbally and had no hearing disability; (4)
had a second degree burn or worse; (5) had burn injuries
ranging from 5 to 25% of total body surface area (TBSA); (6)
received daily burn care; and (7) had suffered from a
chemical or flame, scald or electrical burn wound. A total of
64 adult burn patients who agreed to participate in the
study conformed to the inclusion criteria, of which 30 in
the BR group and 30 in the control group completed the
pre- and post-test measures. In order to avoid interaction of
treatment effects, 30 participants meeting the inclusion
criteria were assigned to the control group first, and then 34
were assigned to the experimental group according to the
order of sequential admission to the hospital. Table 1
illustrates the process of this study design.

2.2. Relaxation breathing program

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Table 1
2.4.Pre-test Post-test
Proce
1st 2nd 3rd
Experimental 011 012 021 X 022 031 X 032 041 X 042
dures
Control 011 012 021 022 031 032 041 042
pretest before dressing, 012: pretest after dressing, 021: posttest
before dressing, 022: posttest after dressing, 031: posttest before
The study was approved by the Institutional Review
dressing, 032: posttest after dressing, 041: posttest before
dressing, 042:Board
posttest (djomc-80) of treatment
after dressing, X: Daejeon Oriental
Hospital, and Bestian burn center authorities in
Daejeon, Korea. The study was explained in
Breathing techniques from the Sophrology method detail to each eligible participant prior to
designed for women in labor were combined obtaining consent. Patients were approached as
with abdominal breathing exercises [21,22]. soon as possible after admission and informed
The ratio of inspiration and expiration that the study involved testing RB during burn
measured at 4:4 before the procedure, and care procedures and determining its effect
changed to 2:4 during the procedure. on pain and anxiety. Those who then agreed
to participate and gave informed consent
2.3. Feasibility took part in interviews to collect demo-
graphic data. On the second day after the
study
patients were

A feasibility study was conducted on five patients to

determine if breathing ratio measurement is
applicable for burn patients. The original RB
method recommended for women in labor
adopted the ratio of inspiration and expiration
at 4:6 [22]. The breathing ratio of 4:6 was
compared with the before-dressing
measurement of 4:4, and the 4:4 measurement
was deemed applicable when four patients
performed the breathing exercises successfully
without difficulties. During dressing changes,
patients were not able to follow the 4:4
method because the dressing procedure caused
severe pain. Therefore, the ratio of inspiration
and expiration changes to 2:4 during dressing.
Although the average pain score increased to 4.5
due to severe procedure pain, the authors
finalized the protocol since four participants
subjectively expressed ease of RB practice and
decreased pain. The anxiety scores decreased an
average of 5.0 during burn care after the
feasibility study.
The authors created an educational video
clip and documentation about the RB
program. Using video clips as an education
medium is effective and can provide consistent
educational intervention. Using the same
methods explained in the video clip, an
educational pamphlet was prepared that
included the purpose of the RB, as well as
how to prepare oneself, and implement the
process. This one-page document was created to
support the intervention, and participants were
able to practice the RB as they needed. The
contents of the video and pamphletwere
verified by three burn specialists, one midwife
certified in the use of Sophrology as a
childbirth preparation method, and one nursing
professor.
1103 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1103

Table 2 – Characteristics of participants in groups (n = 60).

Variable Group Exp. (n = 30) Cont. (n = 30) x2 or t p

Gender Male N (%), mean

17(56.7) SD N (%), mean
12(40.0) SD 1.67 .20

Female 13(43.3) 18(60.0)

ge mean SD 44.5 14.6 45.3 15.3 0.19 .85

Education Status Elementary 3(10.0) 7(23.3) 3.92 .27

Middle 4(13.3) 5(16.7)

High 16(53.3) 9(30.0)
College 7(23.3) 9(30.0)

Cause of burn Scald 13(43.3) 12(40.0) 3.19 .53

Flame 12(40.0) 14(46.7) Electric

2(6.7) 0(0.0)
Chemical 3(10.0) 3(10.0)
Others 0(0.0) 1(3.3)

Burn status (degree) 2 24(80.0) 27(90.0) 1.68 .43

2 or 3 5(16.7) 3(10.0)

3 1(3.3) 0(0.0)

(%) Mean SD 11.2 4.8 11.7 5.9 0.36 .72

Lesion Face + arm/leg 10(33.3) 10(33.3) 1.56 .46

Arm/leg 18(60.0) 15(50.0) Others

2(6.7) 5(16.7)

Background pain Mean SD 0.3 1.3 0.2 0.6 0.51 .61

admitted, data for pain and anxiety were collected at 5 min before Using the Visual Analog Scale (VAS), patients were asked to rate
and immediately after the dressing change procedures for the intensity and unpleasantness of their pain during
both the experimental and control groups. In the training debridement and dressing of various wound sites [23]. The
session, the PI first showed the video clip, then scale consisted of a 100 mm horizontal line with verbal
demonstrated the breathing method, and finally asked
the group to demonstrate the breathing method. It took
about 10 min for each participant to complete the
educational session, and the demonstration and drills were
repeated approximately 20 times each until the participants
could competently perform the breathing technique. Along
with video clip, an educational pamphlet was provided for
participants to practice RB as needed. The program was
provided between 3 and 5 days after admission. Dressing
changes proceeded as usual for patients in the control group.
All adult patients in both the experimen- tal and control
groups were routinely given the same standard dose of
morphine formulations such as intravenous morphine
sulphate (5 mg) and intramuscular tramadol (50 mg) for
procedure pain. No changes beyond RB intervention
were made to normal pain relief medication during the
study. Medication included a range of morphine formulations
such as morphine sulphate intravenous and tramadol
intramuscular.

2.5. Measurement
1104 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1104

anchors of ‘‘no pain’’ and ‘‘most painful’’ and was

measured from the left in millimeters to
provide interval scores. This scale is widely
used and has demonstrated reliability and
validity in acute pain measurement.
Anxiety is the experience of diffused fear and
its emotional status [24]. The Visual Analog
Scale – Anxiety was used to measure anxiety
related to the burn treatment procedures [25].
Similar to the VAS, the scale consisted of a
100 mm horizontal line with verbal anchors of
‘‘no anxiety’’ and ‘‘most anxiety’’ and was
measured from the left in millimeters to
provide interval scores.

2.6. Data

analysis

Data were analyzed using SPSS (Windows 18.0, SPSS

Inc., Chicago, IL, USA) software. Descriptive
statistics, including mean, median, and
standard deviation (SD), were obtained to
describe the sociodemographic and burn-
specific variables. The homogeneity test was
used to detect any significant group differences
in the demographic data and pretest
measures. The analysis focused primarily on
the effects of RB on procedural pain and
anxiety.

3.

Res

ults

A total 60 burn patients participated in the study; 30

people in the RB intervention group and 30
control participants
1105 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1105

Table 3 – Difference of pain scores between two groups.

Group Pre mean SD Post 1 mean SD Post 2 mean SD Post 3 mean SD Source F p
Exp. (n = 30) 4.8 0.3 3.4 0.2 2.9 0.2 3.1 0.2 G 7.36

.01

oup, T: Time, G*T: Group Time; **p < .01.

completed the pre- and post-test measures, with dropout rates of 3.2. Relaxation breathing effects on
11.8% and 0%, respectively. The main reason given for
dropping out from the experimental group was the pain anxiety
during dressing change. Those leaving expressed that they
felt tired and experienced too much pain to follow the RB.
The members of both participating groups were similar in The anxiety scores significantly differed between the 2
terms of age, gender distribution, educational level, cause of groups (P = .01) and over time (P = .02), and
burn, degree and extent of the burn injury, location of the there was an interaction effect between group
wound, type of pain control, and time (minutes) spent in and time (P = .001). The RB group had a greater
procedure. General demographic and wound-related factors decrease in anxiety than did the control group
are summarized in Table 2. The mean age of participants (Table 4).
was 44.9 14.8 (range 21–86) years. 41.7% had scald burns As shown in Fig. 2, anxiety ratings decreased
(n = 25), 43.3% had flame burns (n = 26), 10.0% had chemical in RB patients over the course of the study,
burns (n = 6), and electrical burns accounted for 3.3% (n = 2). indicating the least distress in the second
85.0% (n = 51) of participants had second-degree, 26.7% (n = 8) had treatment session.
second- or three- degree, and 3.3% (n = 1) had three-
degree burn injuries. The extent of injury ranged from 5 to
4.
25% of total body surface area (TBSA) (mean %TBSA of
Discus
11.42%).

sion
3.1. Relaxation breathing effects on pain

This study examined the effects of an implemented

The pain scores significantly differed between the 2 groups (RB group relaxation breathing program on pain and
vs. control group, P = .01) and over time (pretest vs. anxiety in adult patients undergoing burn
posttest, P = .001), and there was an interaction effect dressing changes. The major finding of the
between group and time (P = .001). The results showed that present study is that RB had a significant impact
pain in the experimental group was decreased as the on pain and anxiety for burn patients during
intervention processed and the time passed (Table 3). dressing changes.
As shown in Fig. 1, pain ratings decreased in RB patients Patients in the RB group had a significant
over the course of the study, indicating the least distress greater decrease in pain than did the control
during the second treatment session. Pain levels group. This is consistent with results from
demonstrat- ed improvement from the first to the final data previous studies of relaxation techniques. Even
collection point under the experimental group’s conditions though there is a limited number of studies
(P = .001). Relaxa- tion breathing interventions changed examining the direct effect of RB or breathing on
patients’ scores consis- tently, demonstrating a statistically the management of procedural or acute pain,
significant decrease between T1 and T2 (Fig. 1). studies have found that relaxation therapies,
alone or in combination with progressive
muscle relaxation [26,27], relax- ation–
6.0
distraction [28], music [29], and jaw relaxation
[30–33], have been found to reduce pain in burn
5.0 patients. These studies show that using a
combination of other techniques with RB is
4.0 effective in reducing pain for patients
suffering from burns. However, Patterson
pointed out that progressive muscle
relaxation is limited to use in the burn fields
because it requires repeated and lengthy
sessions for training; instead, he recommended
the use of simple breathing methods for these
populations [34]. Since burn patients are too
1106 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1106

fatigued to learn the muscle relaxation, finding is congruent with the findings of
breathing technique rather may be beneficial previous studies examining the effect of
to control over the procedural pain [34,35]. relaxation techniques to relieve pain and
This study also showed that a simple RB anxiety: For various populations, such as
program can reduce the anxiety related to mothers in premature labor, patients with postoperative
dressing changes for burn patients. This
pain,

3.0 Exp and those undergoing chemotherapy, relaxation

2.0 Cont methods have been approved as an effective
behavioral treatment in reducing anxiety
1.0 [9,13,31–33,36]. In this study, anxiety levels
peaked on the day of the third treatment for the
B/L ED1 ED2 ED3
control group, indicating that daily recurrence
0.0
of wound care procedures increases a patient’s
anxiety level. This is a congruent result of
Fig. 1 – Changes of Pain over time B/L: baseline, ED1: Geisser et al. (1995) [4].
experiment date 1, ED2: experiment date 2, ED3:
experiment date 3, Table 4 differences of anxiety scores The authors used a Visual Analog Scale
between two groups. (VAS) to measure the intensity of patients’ pain
and anxiety. The instrument, designed to
measure pain and anxiety during burn dressing
1107 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1107

Table 4 – Differences of anxiety scores between two groups.

Group Pre Post 1 Post 2 Post 3 Source F p

mean SD
Exp. (n = 30)
mean SD
3.6 0.3
mean
4.4 0.3
SD mean
4.6 0.3
SD 4.4 0.3 G 6.49

.01

Group, T: Time, G*T: Group Time; **p < .01

(2.5) (3.0)
JR, Gibran NS, et al. Self-reports of anxiety in burn-injured
(3.5) hospitalized adults during routine wound care. J Burn Care
Res 2006;5:676.
[3] Latarjet J, Choine` re M. Pain in burn patients. Burns

(4.0) (4.5) [4] Geisser ME, Bingham HG, Robinson ME. Pain and anxiety
Cont during burn dressing changes: concordance between
(5.0) patients’ and nurses’ ratings and relation to medication

1995;2:164–71.
B/L ED1 ED2
[5] McCain D, Sutherland S. Nursing essentials: skin grafts
ED3
for

Fig. 2 – Changes of anxiety over time, B/L: baseline, ED1:

eferences
experiment date 1, ED2: experiment date 2, ED3:
experiment date 3.

[1] Iafrati NS. Pain on the burn unit: patient vs nurse

changes, needed be short and easy to use in a clinical setting perceptions. J Burn Care Res 1986;5:413.
because of the pain characteristics of burns. The use of a
VAS in measuring pain is reliable and valid [19], but for
anxiety, the literature reports the use of various tools for
measurement [4,37]. Previous studies frequently used the
State Trait Anxiety Inventory (STAI) [28,29,38], but Taal and
Farber (1997) argue that the STAI might not be the most
appropriate instrument since it is long for use among burn
patients [35]. Based on the recommendations of previous
studies [17,37], we used VAS-A for anxiety. Our study
shows that the VAS-A is a potential choice as a
measurement tool to capture the differences of anxiety in
patients with procedural pain.
In conclusion, relaxation breathing appears to be a
promising technique for pain and anxiety relief during burn
care. Out study shows that simple and easy relaxation
techniques can contribute to a decrease in distress and an
increase in relaxation levels during dressing changes. Nurses
are the ones in the field who are most confronted by pain
and anxiety, and relaxation breathing can be utilized as a
non- invasive independent nursing intervention in these
situations.

Acknowledgements

We express our sincere gratitude to the patients and staff who

participated in the study. We also thank Yoonchul Chang,
Hyunju Na, and Yangwhan Choi at the Bestian Burn
Center, Daejeon for their cooperation and support.
1108 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1108

patients with burns. Am J Nurs 1998;7:34.

[6] Sheridan R, Hinson M, Nackel A, Blaquiere M, Daley W,

Querzoli B, et al. Development of a pediatric burn pain and
anxiety management program. J Burn Care Rehabil
1997;5:455.

[7] Turner JG, Clark AJ, Gauthier DK, Williams M. The effect of
therapeutic touch on pain and anxiety in burn patients. J
Adv Nurs 1998;1:10–20.
[8] Ulmer J. Burn pain management: a guideline-based
approach. J Burn Care Res 1998;2:151.
[9] Janke J. The effect of relaxation therapy on preterm labor
outcomes. J Obstet Gynecol Neonatal Nurs 1999;3:
255–63.

[10] Benson H, Greenwood MM, Klemchuk H. The relaxation

response: Psychophysiologic aspects and clinical
applications. Int J Psychiatry Med 1975;1:87–98.
[11] Lichstein KL. Clinical relaxation strategies. Oxford,
England: John Wiley & Sons; 1988.
[12] Lee PS. Theoretical bases and technical application of
breathing therapy in stress management. J Korean Acad
Nurs 1999;6:1304–13.
[13] Kim SD, Kim HS. Effects of a relaxation breathing exercise
on anxiety, depression, and leukocyte in hemopoietic stem
cell transplantation patients. Cancer Nurs 2005;1:79.
[14] Kwekkeboom KL, Gretarsdottir E. Systematic review of
relaxation interventions for pain. J Nurs Scholarsh
2006;3:269–77.

[15] Carey MP, Burish TG. Providing relaxation training to

cancer chemotherapy patients: a comparison of
three delivery techniques. J Consult Clin Psychol

1987;5:732.

[16] Daltroy LH, Morlino CI, Eaton HM, Poss R, Liang MH.

Preoperative education for total hip and knee replacement

patients. Arthritis Rheum 1998;6:469–78.
[17] Shim JO, Chang SB. Effects of abdominal breathing on
preterm labor anxiety. Korean J Women Health Nurs
2006;2:106–14.

[18] Yu WJ, Song JE. Effects of abdominal breathing on state

anxiety, stress, and tocolytic dosage for pregnant women in
preterm labor. J Korean Acad Nurs 2010;3:442–52.
[19] De Jong AEE, Gamel C. Use of a simple relaxation technique
in burn care: literature review. J Adv Nurs 2006;6:710–21.
[20] Cohen J. Statistical power analysis for the behavioral
sciences. Lawrence Erlbaum; 1988.
[21] Mason LJ. Guide to stress reduction. California: Peace

Press

Culver City; 1985.

1109 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1109
1110 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1110

[22] An SE. Effects of abdominal breathing on anxiety and labor time in primipara women. Korean J Women Health Nurs
2008;3:196–204.

[23] Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg
Med 2001;12:1153–7.
[24] Mishel MH, Braden CJ. Finding meaning: antecedents of uncertainty in illness. Nurs Res 1988.
[25] Benotsch E, Lutgendorf S, Watson D, Fick L, Lang E. Rapid anxiety assessment in medical patients: evidence for the
validity of verbal anxiety ratings. Ann Behav Med 2000;3:199.
[26] Knudson-Cooper MS. Relaxation and biofeedback training in the treatment of severely burned children. J Burn
Care Res 1981;2:102.
[27] Wells N. The effect of relaxation on postoperative muscle tension and pain. Nurs Res 1982;4:236.
[28] Miller A, Hickman L, Lemasters G. A distraction technique for control of burn pain. J Burn Care Rehabil 1992;5:576.
[29] Ferguson S, Voll K. Burn pain and anxiety: the use of music relaxation during rehabilitation. J Burn Care Res 2004;1:8.
[30] Flaherty GG, Fitzpatrick JJ. Relaxation technique to increase comfort level of postoperative patients: a preliminary
study. Nurs Res 1978;6:352.
1111 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1111

[31] Good M, Stanton-Hicks M, Grass JA, Cranston Anderson G, Choi C, Schoolmeesters LJ, et al. Relief of postoperative
pain with jaw relaxation, music and their combination. Pain
1999;1:163–72.

[32] Good M, Stanton-Hicks M, Grass JA, Anderson GC, Lai HL, Roykulcharoen V, et al. Relaxation and music to reduce
postsurgical pain. J Adv Nurs 2001;2:208–15.
[33] Good M, Anderson GC, Stanton-Hicks M, Grass JA, Makii M.

Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs 2002;2:61–70.
[34] Patterson DR. Practical applications of psychological techniques in controlling burn pain. J Burn Care Rehabil
1992;1:13–8.

[35] Taal LA. The psychological aspects of burn injuries. Shaker

1998.

[36] Seers K, Carroll D. Relaxation techniques for acute pain management: a systematic review. J Adv Nurs 1998;3:
466–75.

[37] Taal L, Faber A. The burn specific pain anxiety scale:

introduction of a reliable and valid measure. Burns

1997;2:147–50.

[38] Good M. A comparison of the effects of jaw relaxation and music on postoperative pain. Nurs Res 1995.
1112 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1112

ANALISA JURNAL

IDENTITAS JURNAL

Judul Asli : The Effects Of Relaxation Breathing On Procedural

Pain And Anxiety During Burn Care

a b, b
Penulis/ pengarang : Eunok Park , Hyunjin Oh *, Taeim Kim

PICOT ANALISA
P (POPULATION The Effects Of Relaxation Breathing On Procedural
OR PROBLEM) Pain And Anxiety During Burn Care, Burn patients
experience high levels of pain and anxiety during
dressing changes. Relaxation breathing is a simple
behavioral intervention to manage pain and anxiety.
However, the information about the effects of
relaxation breathing on pain and anxiety levels for burn
patients during dressing changes is limited.
I The aim of the study was to examine the effect of RB
(INTERVENTION) on procedural pain and anxiety during burn dressing
changes. The study design was a quasi-experimental,
pretest-posttest comparison group design without
random assignment to groups. In the study planning
stage of the quasi-experimental design, randomization
was not met. Therefore, after the data collection, we
tested the homogeneity for both group participants.
The sample size was calculated by power analysis,
based on a power of .80, an alpha of .05, and a medium
effect size (ES) of .65, and a targeted sample size was
predicted for a study involving 30 subjects in each
group
C in this study there is no comparison
(COMPARATION)
O (OUTCOME) The pain scores significantly differed between the 2
groups (RB group vs. control group, P = .01) and over
time (pretest vs. posttest, P = .001), and there was an
interaction effect between group and time (P = .001). The
results showed that pain in the experimental group was
decreased as the intervention processed and the time
passed (Table 3).
1113 s s3 39 9( 2( 20 01 13 3) )1 1 10 01 1– –1 1 10 06 6 1113

As shown in Fig. 1, pain ratings decreased in RB

patients over the course of the study, indicating the
least distress during the second treatment session. Pain
levels demonstrat- ed improvement from the first to the
final data collection point under the experimental
group’s conditions (P = .001). Relaxa- tion breathing
interventions changed patients’ scores consis- tently,
demonstrating a statistically significant decrease
between T1 and T2
Results: The homogeneity test was used to detect any
significant group differences in the demographic data
and pretest measures. The pain scores significantly
differed between the
2 groups after intervention (RB group vs. control group,
P = .01) and over time (pretest vs. posttest, P = .001). The
anxiety scores significantly differed between the 2
groups (P = .01) and over time (P = .02).
Conclusion: Relaxation breathing is a simple and
inexpensive technique nurses can use to help burn
patients manage pain and anxiety during dressing
changes.

T (TIME) 4 JANUARY 2013