THE EFFECT OF SPIRITUAL NURSING CARE ON PREOPERATIVE PATIENTS’

ANXIETY LEVEL IN THE INPATIENT WARD (R.ZUMAR) OF AL-IHSAN

REGIONAL HOSPITAL, BALAENDAH, BANDUNG

Yulida.S1, Yosep Rohyadi2, Hotma Rumahorbo3.

1
Bandung Health Polytechnic – Ministry of Health
2
Bandung Health Polytechnic – Ministry of Health
3
Bandung Health Polytechnic – Ministry of Health

Email: youngyulida@gmail.com

ABSTRACT

It is known that 90% of preoperative patients experience anxiety before surgery. During this
time, spiritual care is very rarely given by nurses to the preoperative patients because the nurses
focus on physical care alone. This lack of spiritual care can cause anxiety in patients. The
purpose of this research is to determine the effects of spiritual nursing care on the anxiety level
of preoperative patients. The research used a quasi-experimental method with one-group pre-
test-post-test design (Notoatmojo S: 2010) without control group, which is an activity carried
out before an experiment in the form of a treatment of a variable and the treatment is expected
to change or influence the other variables. The population of this study covered 1,166
preoperative patients who were sampled with non-probability or incidental sampling technique
to result in 47 respondents. Data were collected with questionnaire distribution.
Results: The frequency distribution of respondents based on characteristics or types of surgery
is: moderate category (98.1%) and severe category (1.9). Respondents’ mean level of anxiety
before intervention was 42.46 with a standard deviation of 4.206 and after the intervention a
mean of 23.94 with a standard deviation of 5.51 was obtained. Hence, the mean difference
before and after the intervention was 18.519 with a standard deviation of 6.960 (pV = 0.000).
Conclusions: There was significant difference between before and after intervention
Background 2008). As the Word of God follows:
“Whosoever follows My Guidance surely
Nursing care is a form of service to
there is no concern for them and neither do
assist individuals, both healthy and sick,
they grieve” (Surah Al-Baqoroh, 2: 38
with activities that support their health or
trans. by Ghoffar, 2006).
recovery which is carried out without any
In the preliminary study (2015-2016) at
assistance if providers have the strength,
Al-Ihsan Balaendah Hospital, it was
will, and knowledge.
reported that, the nurses only focused on
Spiritual needs are concerned with
preoperative patients’ physical conditions,
one’s belief in his/her relationship with the
not their spiritual ones.
Almighty and the Creator. Pre-surgical
Based on the results of interviews with
nursing is the initial stage of perioperative
10 patients for the nursing spiritual care, 7
nursing. The success of surgery as a whole
of them reported the nurses explained the
is very dependent upon this initial phase.
patients’ condition and reminded them to be
This phase is the beginning that becomes
patient and draw closer to God for their
the foundation for the success of the next
healing, while 3 other patients said their
stages (Rohdianto, 2008).
spiritual needs were met by worshipping
The preoperative stages include
and praying alone or with family assistance.
integral assessment of physical, biological,
and psychological functions which is
indispensable for the success of surgery. Aim
Mental preparation is no less important in
The aim of this study is to analyze the
the process of preparing the operation. This
effect of nursing spiritual care on the level
is so because surgery is a stressor that can
of anxiety of preoperative patients in the
cause psychological stress (neuroendocrine
Zumar ward of Al-Ihsan Baleendah
response) and psychological stress that is
Hospital.
anxiety and worry (Baradero et al 2009, p.
6).
Design
Treatments to reduce the level of
anxiety include how to mentally prepare the The research used a quasi-experimental
patients (Poter & Perry, 2005), provide method with the pre-test-post-test-one-
moral assistance in dealing with critical group design (Notoatmojo S: 2010) without
situations, and raise the willingness to any control group. Data were collected
accept reality as God’s destiny (Hamid A., through questionnaires. The population in
this study consisted of patients who would score of <14 indicates no to moderate
undergo surgery in Zumar (the surgical anxiety, 28-41 severe anxiety, and 42 - 56
room). very severe anxiety.

Sample
Research Ethics Consideration
The number of patients undergoing surgery
This study has received ethical approval for
in the last 6 months (July to December
health research from the Health Research
2016) in Al-Ihsan Hospital Baleendah
Ethics Commission of the Bandung Health
Bandung was 1,166. A number of 47
Polytechnic of the Health Ministry. The
respondents were taken as the sample.
researchers guarantee that the principles of
Meanwhile, because according to Sugiono
ethical research, including privacy, respect,
(2011), for most studies there is an
autonomy, justice, beneficence, are
assumption of 10% lost to follow-up, then
followed.
the number of sample needed was (10% x n
+ 2) 47 + 7 = 54 respondents. Data Analysis

Research Instruments Univariate analysis used in this study

produced a frequency distribution with
The research used an instrument known as
percentages to see the characteristics of
Hamilton Rating Scale for Anxiety (HRS-
respondents. Meanwhile, for the level of
A). This instrument consists of 14 symptom
anxiety of the preoperative patients before
groups, in which each group is broken
intervention and after intervention, t-test
down into more specific symptoms. Each
was carried out. Finally, to corroborate the
symptom group is scored from 0-4, in
research results by looking at the difference
which 0 means no symptoms, 1 means mild
between before and after the intervention,
symptoms, 2 moderate symptoms, 3 severe
Wilcoxon test was conducted.
symptoms, and 4 very severe symptoms.
All scores of the 14 groups of symptoms are
Results
summed, and from the summation the
degree of one’s anxiety can be found out, 54 preoperative patients were sampled
with the following interpretations: a total within the period of 6 weeks.

Table 1: Frequency Distribution of Characteristics Freque Percentage

ncy
Respondents Based on Characteristics 1. Sex
Female 22 40.7
(n=54) Male 32 59.3
2. Level of Education interventions are planned to overcome
Elementary School 30 55.5
Junior High School 16 29.6 problems and meet expected outcomes
Senior High School 7 13
(Gruendemann and Frensebner 2006, p. 8).
College 1 1.9
3. Occupation Accordingly, the surgery performed on
6 11.1
Unemployed
19 35.2 patients is elective surgery that is planned
Housewife
21 38.9
Entrepreneur
5 9.3 and carried out only if there is an indication
Private Employee
3 5.6
Civil Servant that the problem will cause harm to the
4. Marital Status
7 13 patient. The previously planned surgical
Single
43 79.6
Married
4 7.4 procedure that will be performed on the
Divorced
5. Religion patient causes anxiety in the patient.
Islam 54 100
Protestant - - Anxiety about surgical procedures can be
Catholic - -
Hindu - - reflected in various psychological
Buddha - - symptoms in the preoperative and
6. Types of Surgery
Mild - - postoperative periods (Maward and Azar
Moderate 53 98.1
Severe 1 1.9 2004, in Becihe 2005, p. 60).
Preoperative patients experience
The results show that almost all feelings of anxiety and tension which are
preoperative patients, namely as many as 48 characterized by anxiety, fear, tension,
respondents (88.9%), had a very severe lethargy, and restlessness. These symptoms
anxiety/panic level before getting spiritual of anxiety are experienced by both male and
guidance from nurses. This is likely due to female patients, especially those who first
preoperative patients assuming that surgery experience surgery. For almost all patients,
is a frightening treatment because it uses surgery is a very severe medical procedure
special equipment, room, and nursing care. because it has to deal with operating table
This perception requires the process of and knives. Patients have no experience of
adaptation from patients both things that will be faced during surgery,
physiologically and psychologically. such as anesthesia, pain, physical changes,
The expected results are set for and immobility after the surgery.
identified problems and perioperative

2. Frequency Distribution of Anxiety Level Frequen Percent

cy age
Respondents Based on Their 1. Not anxious - -
2. Mild - -
(Preoperative) Anxiety Level 3. Moderate - -
4. Severe 6 11.1
 5. Very Severe/Panic 48 88.9 lethargy, and restlessness. These
symptoms of anxiety are experienced by
The table shows that almost all
both male and female patients, especially
preoperative patients, or as many as 48
those who first experience surgery. For
respondents (88.9%), had a severe
almost all patients, surgery is a very severe
anxiety/panic level before spiritual
medical procedure because it has to deal
guidance. This is likely due to preoperative
with operating table and knives. Patients
patients assuming that operative is a
have no experience of things that will be
frightening action because it uses special
faced during surgery, such as anesthesia,
equipment, room, and nursing actions. This
pain, physical changes, and immobility
situation requires the process of adaptation
after the surgery.
from patients both physiologically and
psychologically.
Table 3. Frequency Distribution of
The expected results are set for Respondents Based on Level of Anxiety
identified problems and perioperative after Intervention (postoperative).
interventions are planned to overcome
problems and meet expected outcomes Anxiety Level Frequen Percen
cy tage
(Gruendemann and Frensebner 2006, p. 8). 1. Not anxious -
2. Mild 1 1.9
Accordingly, the surgery performed on 3. Moderate 41 75.9
patients is elective surgery that is planned 4. Severe 9 16.6
5. Very Severe/Panic 3 5.6
and carried out only if there is an indication
that the problem will cause harm to the The table indicates that almost all
patient. The previously planned surgical preoperative patients, or 41 respondents
procedure that will be performed on the (75.9%), in the inpatient ward of Al-Ihsan
patient causes anxiety in the patient. Hospital Balaendah Bandung Regency had
Anxiety about surgical procedures can be a moderate anxiety level after spiritual
reflected in various psychological guidance. This is likely due to patients
symptoms in the preoperative and gaining confidence to adapt to the
postoperative periods (Maward and Azar postoperative state, after being given
2004, in Becihe 2005, p. 60). spiritual guidance.
Preoperative patients experience feelings Relaxation is achieved because of a
of anxiety and tension which are combination of one’s physiological,
characterized by anxiety, fear, tension, psychological, cognitive, and social
responses with relaxation techniques.
Psychological responses may include
anxiety, depression, insomnia, phobias,
and hallucinations. The most commonly
observed physiological response is
characterized as a decrease in: heart rate,
respiratory rate, oxygen consumption,
muscle tension and metabolic rate (Moser
et al, 2003 in Mardiyono and Songwathana
2009, p. 1). Islamic relaxation has been
used with: Islamic religiosity in the
treatment for anxiety and depression, night
prayer to increase immunity, and
religiosity to facilitate coping (Rezaei,
Adib-Hajbaghery, Seyedfatemi, & so that preoperative patients can reduce
Hoseini, 2008 in Mardiyono and
Songwathana 2009, p. 1).
Islamic relaxation techniques
include remembrance and prayer. Prayer is
used as a therapy. According to Islamic
beliefs, there are formal prayers, those
performed five times a day as compulsory
prayers, optional prayers which are mainly
performed before and after formal prayers,
and evening prayers in the very early
morning as well as morning prayer after
sunrise. Formal prayers performed
individually are intended to help a person
maintain his/her beliefs and restore physical
health (Rezaei et al., 2008 in Mardiyono
and Songwathana 2009, p. 4).
Prayer can foster confidence in
preoperative patients for healing that will
be achieved through the surgery that will be
performed. Prayer also provides strength
and can restore the physical condition of a
preoperative patient so that the patient is in
good condition before having the surgery.
This feeling of anxiety in the
preoperative patients is a psychological
response to the operative action that will be
performed on the patient. If this
psychological anxiety is not addressed
properly, it will affect physical conditions
such as motion coordination and reflex
movements that worsen the patient’s
condition before surgery. Prayer can reduce
hormones that are associated with anxiety,
anxiety and get a good physical condition
before surgery.
Table 4. Relationship between anxiety
level before (preoperative) and after
intervention (post-operative)
Variable mean SD SE p N
Value
Anxiety
Score 42.46 4.206 0.572 0.000 54
Before 23.94 5.510 0.750
After
The table demonstrates that the average
score before intervention was 42.46 with
a standard deviation of 4.206 and after the
intervention a mean of 23.94 with a
standard deviation of 5.51 was obtained.
The mean difference between before and
after the intervention was 18.519 with a
standard deviation of 6.960 (pV = 0.000).
So, it can be concluded that there was
significant difference between before and guidance. The researchers provided
after the intervention spiritual guidance in the forms of prayer
Table 5. The effect of spiritual nursing and remembrance to give the preoperative
care on preoperative patients’ anxiety patients relaxation and a sense of serenity.
level Almost all preoperative patients

N Mea Sum of p had moderate anxiety before the spiritual

n Rank Valu
Rank e guidance. After being given spiritual
Post
Total Negativ 5 27.50 1485.0 guidance in the forms of prayer and
Scor e Rank 4 00 0 0.00
e Positive 0 00 0 remembrance, the patient experienced a
Scor Rank 0
e Ties 5 decrease in their anxiety. Almost all
Total 4
preoperative patients who were given
spiritual guidance in the form of prayer had
Based on the results presented in
a mild level of anxiety, but there was a
Table 4, then Wilcoxon test was carried out
patient who had a moderate level of
with a ρ value of 0.000, which means H0
anxiety. This is because the patient’s
was rejected; hence, that there was an
anxiety level started heavy or in panic
effect of spiritual guidance on the anxiety
level. The power of prayer and
level of preoperative patients in the
remembrance can provide ease and
inpatient ward of Al-Ihsan Balaendah
freedom from illness and foster confidence
Hospital, Bandung Regency.
for patients in undergoing surgery.
According to Ghoffar (2006, p. 37),
prayer besides having the benefit as a form
of worship also greatly helps humans for
their survival in the world and the Research Limitations
hereafter. Prayer also transforms distress
This research did not assess the competence
into ease, sadness into happiness, and it
of disaster volunteers in normalizing the
can even change destiny.
physical problems of post-disaster victims
The results of research conducted
directly in the clinical setting. This research
at Al-Ihsan Balaendah Hospital in Bandung could only assess the competence of
Regency obtained data of preoperative disaster volunteers in simulation using
patients experiencing decreased levels of phantom and demonstrations by fellow
anxiety after being given spiritual volunteers. Nevertheless, the assessments
carried out for the first and second months
after training is expected to be able to show
consistency of the ability to perform the
skills that have been trained.
Conclusions
The level of anxiety of preoperative
patients before being given spiritual care
was in majority at a very high level, as
indicated by 48 respondents (88.9%)
having severe anxiety. The level of
preoperative anxiety after being provided
with spiritual care was mostly moderate, as
shown by 41 respondents (75.9%). There
was a significant effect of the provision of
spiritual care on preoperative patients’
anxiety (pV = 0.000).
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