Dwi Rohyani, Millya Helen | The Effect of Relaxation Techniques and Distraction Techniques ….

Journal Educational of Nursing (JEN) Article history:nyeri

Vol. 4 No. 2 – July – December 2021; page 98-107 Received: November 30th, 2021
p-ISSN : 2655-2418; e-ISSN : 2655-7630 Revised: December 5th, 2021
journal homepage: https://ejournal.akperrspadjakarta.ac.id Accepted: December 7th, 2021
DOI : 10.37430/jen.v4i2.97

The Effect of Relaxation Techniques and Distraction Techniques on

Reducing Pain Scale in Postoperative Patients at UKI Hospital East
Jakarta in 2020
Dwi Rohyani1, Millya Helen 2
1,2
Faculty of Nursing Science – National University, Jakarta
e-mail: dwinia0974@gmail.com1, millyahellen@gmail.com2

Abstract
The purpose of this study was to determine the effect of relaxation techniques and
distraction techniques on reducing pain scale in postoperative patients at UKI
Hospital in 2020. This study used a cross sectional study approach which aims to
determine the effect of relaxation and distraction techniques on postoperative
patients at UKI Hospital. Cross sectional is a method for approaching respondents
(point time approach) which is carried out at one time. the independent variable is
relaxation technique and the dependent variable distraction is the decrease in pain
scale in postoperative patients. The results of the study concluded that there were
differences in the results of the pain scale between the pre-test and post-test with the
Relaxation technique in postoperative patients. Most of the respondents had
moderate pain scale results as many as 77% of postoperative patients, the group after
intervention with Relaxation showed that most respondents had mild pain scale
results as many as 86% of postoperative patients. There is a difference in the results
of the pain scale between the pre-test and post-test with the Distraction technique in
postoperative patients. Most of the respondents had controlled severe pain scale
results as many as 88% of patients, the group after the distraction intervention
showed that most of the respondents had moderate pain scale results as many as 79%
of patients.

Keywords: Relaxation Techniques, Distraction Techniques, Pain Scale Reduction,

Post Surgery Patients

Introduction patient will experience discomfort and

Surgery or surgery is all treatment
measures that use invasive methods by
opening or displaying the body part to
be treated and is generally carried out
by making an incision and ending with
closure and suturing of the wound. The
resulting incision or wound is a trauma
for the sufferer and this can cause
various complaints and symptoms. As
a result of the surgical procedure, the
pain. Pain is a subjective sensory and
unpleasant emotional experience
associated with actual or potential
tissue damage or perceived in events
where the damage occurred.
During the postoperative period, the
nursing process is directed at
stabilizing the patient's physiological
equilibrium, relieving pain and
preventing complications. Careful

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 Dwi Rohyani, Millya Helen | The Effect of Relaxation Techniques and Distraction Techniques ….
assessment and prompt intervention
help patients return to optimal function
as quickly, safely, and comfortably as
possible.
Pain is a stressor that can cause
stress and tension in which individuals
can respond biologically and
behaviorally that causes physical and
psychological responses. Almost all
pain experienced by patients with
fractures will be treated with
analgesics. Analgesic is a type of
medicine that relieves pain. Although
analgesic drugs are very easy to
administer, many patients and doctors
are not satisfied with long-term
administration. This situation
encourages the development of non-
pharmacological techniques to treat
pain.
Acute pain after major surgery has
at least a positive physiological
function, serving as a warning that
special care must be taken to prevent
further trauma to the area. Pain after
surgery is normally predictable for only
a limited duration, shorter than the time
required for natural repair of damaged
tissues. Postoperative pain is most
likely due to the surgical wound, but
other possible causes must be
considered. Prevention of pain before
surgery should be planned so that the
patient is not disturbed by pain after
surgery. How to prevent it depends on
the cause and location of the pain and
the condition of the sufferer. According
to The International Association for the
study of pain (IASP), pain is the main
reason people seek health care
assistance.
Individuals who feel pain feel
depressed or suffering and seek efforts
to relieve pain. Nurses use a variety of
interventions to relieve pain or restore
comfort. The nurse cannot see or feel
the pain that the client feels. Pain is
subjective, no two individuals
Journal Educational of Nursing (JEN) Vol. 4 No. 2 (2021)
experience the same pain and no two
events of the same pain produce
identical responses or feelings in
individuals. Pain is a source of
frustration for both clients and health
professionals. Unrelieved pain poses a
physiological and psychological danger
to health and healing. Overcoming the
problem of pain can be done by non-
pharmacological methods.
Postoperative nursing action is pain
management. Pain management can be
done in the form of breath relaxation
techniques which are non-
pharmacological management. Non-
pharmacological pain relief methods
usually have a very low risk. Although
they are not a substitute for medication,
they may be necessary or appropriate to
shorten episodes of pain lasting only a
few seconds or minutes. The effective
way to relieve pain is relaxation and
distraction techniques. One of the
relaxation techniques that are most
often used in every pain situation is the
deep breathing relaxation technique.
The deep breathing relaxation
technique is done by teaching and
encouraging the client to take a good
breath, take a deep breath and exhale
while releasing the feeling of pain that
is felt. The mechanism that occurs
when the patient takes a deep breath is
that there is relaxation in the skeletal
muscles, causing the lungs to enlarge,
the supply of oxygen to the lungs
increases, thereby opening the Kohn's
pores in the alveoli, thereby increasing
the concentration of oxygen to be
carried to the pain center. Perfect
relaxation can reduce muscle tension,
boredom, and anxiety so that it can
prevent an increase in pain intensity.
The three main things needed in a
relaxation technique are the right client
position, a rested mind, and a calm
environment.
The distraction method consists of
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 Dwi Rohyani, Millya Helen | The Effect of Relaxation Techniques and Distraction Techniques ….

several techniques, one of which is respondents (point time approach)

visual distraction. Visual or visual which is carried out at one time. the
distraction is a diversion of attention independent variable is relaxation
other than pain that is directed into technique and the dependent variable
visual actions or observations. distraction is the decrease in pain scale
Distraction is a method to relieve pain in postoperative patients.
by diverting the client's attention to This research was conducted at UKI
other things so that the client will General Hospital in May – July 2020
forget the pain experienced. using primary data through
From the data from the preliminary questionnaires and observations. The
study on the medical records of the research instrument used was
UKI General Hospital in the last 3 postoperative patient observation data
years, the number of operations has and also questionnaires given to
increased, namely as many as 654 postoperative clients. This
people in 2017, in 2018 as many as 705 questionnaire consists of 10 questions
people and in 2019 to 670 people. where each question is assessed based
Surgery has an impact on the patient, on a Likert Scale, for correct answers
the pain that goes away due to surgery are given a value of 1 and incorrect
at the surgical site in just one day has answers and do not know are given a
an impact such as limited mobilization, value of 0. Data collection in this study
the Activity of Daily Living (ADL) is is primary data using postoperative
disrupted in the patient as a result it patient observation data at UKI
gives discomfort and female patients General Hospital. Researchers also use
face physical and psychological secondary data. The sample in this
impacts. surgery, that is, most (70%) study used total sampling with the
have difficulty with activities, which assumption that the respondents were
are related to spinal anesthesia and less than 30 respondents.
finding a comfortable position during
pain. Result
Based on the above background, the 1. Univariate Analysis
researchers wanted to find out whether Frequency Distribution
there was an effect of relaxation Table 1. Description of Respondents
techniques and distraction techniques Characteristics
Characteristics Amount %
on reducing pain scale in postoperative Age 30 – 40 year 17 57%
patients at UKI Hospital, East Jakarta. 41 – 50 year 10 32%
> 50 year 3 11%
The purpose of this study was to Sex Woman 20 68%
determine the effect of relaxation Man 10 32%
techniques and distraction techniques Education Finished Middle School 10 32%
Finished high school 20 68%
on reducing pain scale in postoperative Medical Minor surgery (excision
patients at UKI Hospital in 2020. Diagnosis of mammary tumor aff 21 70%
plate)
Moderate operation 9 30%
Method Source: Data processed by SPSS in 2020
This study used a cross sectional
study approach which aims to Research data were collected from
determine the effect of relaxation and 30 postoperative patients aged 30 to
distraction techniques on postoperative more than 50 years who were to be
patients at UKI General Hospital. Cross operated on. The assessment was filled
sectional is a method for approaching out by respondents to assess the age of

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the postoperative patient, gender, the postoperative pain scale results

education and the results of the pain after surgery. given treatment with
scale. Based on the age level, the Relaxation is 2.87 with a standard
postoperative patients were more deviation of 1.45 and the value ranges
dominant aged 30-40 years as many as from 1 to 6.
17 people (57%) and the sex of the Results of Pre-Test And Post-Test
postoperative patients were mostly Pain Scale With Distraction
women as many as 20 people (68%). Table 4. Distribution of Pre-Test and Post-Test
Education of postoperative patients Pain Scale Results with Distraction
Pain Scale Intervention With Distraction
mostly graduated from high school as Results
Pain
Before After
Scale
many as 20 people (68%). Based on the Average
(Pre Test) (Post Test)
n % n %
diagnosis, the most patients were minor Controlled
7,60 12 77% 2 14%
surgery as many as 21 people (70%). Weight
Currently 4,60 3 23% 13 86%
Pre-Test and Post-Test Pain Scale Amount 15 100% 15 100%
Results With Relaxation Source: data processing results, 2020
Table 2. Distribution of Pain Scale Results Pre-
Test And Post-Test With Relaxation
Pain Relaxation Intervention
Based on the table above, it can be
Pain seen that in the group before the
Scale Before After
Scale
Results (Pre Test) (Post Test)
Average
n % n %
intervention with distraction, it was
Currently 6,87 13 88% 3 21% found that most of the respondents had
Light 2,87 2 12% 12 79% controlled severe pain scale results as
Amount 15 100% 15 100%
Source: data processing results, 2020
many as 12 people (77%). While the
group after intervention with
Based on the table above, it can be distraction found that most of the
seen that in the group before the respondents had moderate pain scale
Relaxation intervention, it was found results as many as 13 people (86%).
that most of the respondents had
Table 5. Differences in Pain Scale Results
moderate pain scale results as many as Before (Pre) and After (Post) Postoperative
13 people (88%), the group after the Patients With Distraction at UKI Hospital
Relaxation intervention showed that Jakarta in 2020
most of the respondents had mild pain Pain scale
Std. Min-
results with Mean N
scale results as many as 12 people Distraction
Deviation Max
(79%). Pre-Test 7,60 1.24212 5-10
15
Table 3. Differences in Pain Scale Results Post-Test 4,60 1.12122 3-6
Before (Pre) and After (Post) Postoperative Source: data processing results, 2020
Patients With Relaxation at UKI Hospital
Jakarta in 2020
Pain Scale
Based on the data in the table above,
Std. Min-
Results With Mean
Deviation Max
N the average value of the pain scale
Relaxation
Pre-Test 6,87 1.12546 5-9
results for postoperative patients before
15 being given distraction was 7.60 with a
Post-Test 2,87 1.45733 1-6
Source: data processing results, 2020 standard deviation of 1.24 and a range
of pain scores from 5 to 10. While the
Based on the data in the table above, average value of the results of the
the average value of the postoperative postoperative pain scale was surgery
pain scale results before being treated after being given a distraction of 4.6
with relaxation is 6.87 with a standard with a standard deviation of 1.12 and a
deviation of 1.12 and the value ranges range of pain scores from 3 to 6.
from 5 to 9. While the average value of Based on the data in tables 3 and 5.

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it shows that there is a difference in the

average value of the postoperative pain
scale results before and after being
treated with Relaxation and
Distraction. The lowest average value
of the postoperative patient pain scale
after being treated with Relaxation was
2.87 (mild pain category) and
distraction 4.60 (moderate pain
category). The results showed that the
relaxation treatment was more effective
in showing the results of the
postoperative pain scale in patients
compared to the distraction
intervention. Figure-1 PP Plot Normal Normal
Graph
2. Bivariate Analysis
Data Normality Analysis Test From the Normal P‐P Plot graph, it
There are two ways that can be used can be seen that the points spread
to detect whether the residuals are around the diagonal line, and the
normally distributed or not, namely by distribution follows the direction of the
graphical analysis and statistical tests. diagonal line. This means that the data
In this study, both methods will be used already meet the assumption of
used. Graph analysis can be used with normality, so the regression model is
two tools, namely histogram graph and feasible to use to predict the results of
P-P Plot graph. the postoperative patient pain scale
Good data is data that has a normal based on the input of the independent
distribution pattern. In the histogram variables. This is also shown through
graph, the data that follows or the Kolmogorov-Smirnov statistical
approaches the normal distribution is test, namely:
the data distribution with a bell shape.
Table 6. Normality Test Results One-Sample
In the P-P Plot graph, a data is said to Kolmogorov-Smirnov Test
be normally distributed if the data Variable Asymp. α=5% Conclusion
points are not skewed to the left or Sig. (2-
tailed)
right, but spread around the diagonal Pain scale Normal
Lebih
line. Decision making basis: results with 0.452 distribution
besar
Relaxation
a. If the data spreads around the Distraction Normal
Lebih
diagonal line and follows the pain scale 0,859
besar
distribution
results
direction of the diagonal line, then Sumber : Olah Data Komputerisasi, 2020
the regression model meets the
assumption of normality. From the table above, the results of
b. If the data spreads far from the the normality test after the
diagonal line and or does not follow transformation with the natural
the direction of the diagonal line, logarithm above, it can be concluded
then the regression model does not that the data in the regression model
meet the assumption of normality. has been normally distributed because
c. Normal P‐P Plot graph can b e seen the residual significance value is 0.452
in the following figure. or greater than 0.05, which means that

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H0 is accepted. After the data is From the table above, it can be seen
normally distributed, it is continued that the average value of the
with the Independent T test. postoperative pain scale after being
Differences in Pain Scale Results treated with relaxation is 2.87 with a
Pre-Test and Post-Test with standard deviation of 1.45 and a
Relaxation standard score of 1-6, while the
Table 7. Differences in Pre-Test and Post-Test average value of the postoperative pain
Pain Scale Results with Relaxation at UKI scale results after surgery. given
Hospital Jakarta in 2020
Hasil treatment with distraction is 4.60 with a
Std.
Skala
N Mean
Std.
Error
p- standard deviation of 1.12 and the
Nyeri Deviation value
Relaksasi
Mean value of the pain scale results from 3 to
Pre-Test
15
6,87 1.12546 0.29059
0,000
6.
Post-Test 2,87. 1.45733 0.37628 The results of the statistical test
Source: data processing results, 2020
obtained a p-value of 0.001, it can be
concluded that there is a difference in
The results of the statistical test
the results of the post-test pain scale
obtained a p-value of 0.000, it can be
between Relaxation and Distraction in
concluded that there is a difference in
postoperative patients at UKI Hospital
the results of the pain scale between
Jakarta Year 2020. Interventions with
before (pre-test) and after (post-test)
Relaxation and Distraction resulted in
the Relaxation intervention in
differences in the average post-test,
postoperative patients at UKI RSU
namely Relaxation having a mean
Jakarta in 2020.
value of 2.87 is more effective in
Differences in Pre-Test and Post-Test
showing the results of a better pain
Pain Scale Results with Distraction
Table 8. Differences in Pre-Test and Post-Test
scale compared to distraction with a
Pain Scale Results with Distraction at UKI mean of 4.60.
RSU Jakarta in 2020
Pain Scalee Std.
Std.
p- Discussion
N Mean Error
Distraction Deviation
Mean
value Differences in Pain Scale Results
Pre-Test
15
7,60 1.24212 0.32071
0,000 Pre-Test and Post-Test with
Post-Test 4,60 1.12122 0.28950
Relaxation
Source: data processing results, 2020
The results of the statistical test
The results of the statistical test obtained a p-value of 0.000, it can be
obtained a p-value of 0.000, it can be concluded that there is a difference in
concluded that there is a difference in the results of the pain scale between the
the results of the pain scale between pre-test and post-test with the
before (pre-test) and after (post-test) Relaxation technique in postoperative
the Distraction intervention in patients at UKI RSU Jakarta Year
postoperative patients at UKI RSU 2020.
Jakarta in 2020. The results showed that the group
Table 9. Differences in Post-Test Pain Scale before the intervention with Relaxation
Results Between Relaxation and Distraction in showed that most of the respondents
Postoperative Patients at UKI Hospital Jakarta had moderate pain scale results as
in 2020 many as 77% of postoperative patients,
Pain Scale Pain Std. Nilai p-
Results
N Mean
Category Deviation Skor value the group after intervention with
Post Test
15
2,87 Light 1.45733 1-6
0,001
Relaxation found that most respondents
Relaxation 4,60 Currently 1.12122 3-6
had mild pain scale results as many as
Source: data processing results, 2020
86% of postoperative patients.

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This research can be confirmed by
the theory of Tamsuri (2012), that pain
is a subjective sensory and unpleasant
emotional experience related to actual,
potential, or perceived tissue damage in
the event of an event when the damage
occurs.
The results of this study are also
reinforced by research by Lukman
(2013), there is a difference in average
after relaxation techniques and
distraction techniques are carried out,
and the more effective the technique is
to increase pain tolerance, then a
person will be able to adapt to pain,
and will also have good self-defense.
also. The coping style of each
respondent in perceiving pain also
affects the pain experienced by the
respondent. The more respondents
adjust to the surrounding environment,
relaxation is compared to distraction
techniques in reducing pain intensity in
fracture patients because in the
distraction group, the action aims to
divert the respondent's attention to
other things so as to reduce awareness
of pain. However, the effectiveness of
the distraction technique (listening to
music) depends on the respondent's
ability to receive sensory input other
than pain, in this case whether the
respondent enjoys the music being
listened to, or whether the respondent
does not enjoy or does not like the
music.
The researcher's assumption is that
pain reduction after relaxation
techniques is also influenced by several
factors, such as gender, age, education,
coping style, cause of fracture, fracture
location and type of fracture. Gender
did not differ significantly in response
to pain. A person's age is an important
variable that will affect the reaction and
expression of pain. The higher the
education level of the respondent, the
better the respondent's response in
Journal Educational of Nursing (JEN) Vol. 4 No. 2 (2021)
working with researchers when given
relaxation and distraction measures will
help the process of reducing pain when
given action. In the relaxation group
(deep breathing), the respondent
carried out a period of regular
inhalation and exhalation according to
the researcher's instructions and could
provide a feeling of relaxation or
comfort which in turn would increase
the tolerance of the respondent's
perception in reducing the pain
experienced. If a person is capable of
pain due to difficulty in moving the
body.
Differences in Pre-Test and Post-Test
Pain Scale Results with Distraction
The results of the statistical test
obtained a p-value of 0.000, it can be
concluded that there is a difference in
the results of the pain scale between the
pre-test and post-test with the
distraction technique in postoperative
patients at UKI RSU Jakarta Year
2020.
The results showed that the group
before the distraction intervention
showed that most of the respondents
had controlled severe pain scale results
as many as 88% of patients, the group
after the distraction intervention
showed that most of the respondents
had moderate pain scale results as
many as 79% patients.
The results of this study are in line
with the theory which states that
distraction consists of several
techniques, one of which is visual
distraction. Visual distraction or vision
is a diversion of attention other than
pain that is directed into visual actions
or observations.
According to the researcher's
assumption, patients who have
undergone surgery will feel pain, this is
because the action taken is by
dissecting, causing pain felt by
postoperative patients. According to
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 Dwi Rohyani, Millya Helen | The Effect of Relaxation Techniques and Distraction Techniques ….

researchers, distraction therapy with Riset Kesehatan Dasar. (2013).

virtual reality media can be given to Profil kesehatan Indonesia 2014.
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