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The Influence of Sundanese Zither (Kacapi) Music Therapy on Anxiety Levels in Pre-Cardiac Catheterization Patients

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The Influence of Sundanese Zither (Kacapi) Music Therapy on Anxiety Levels in Pre-Cardiac Catheterization Patients Handayani, K.P., Johan, A., Ropyanto, C. B. Belitung Nursing Journal. 2018 April;4(2):256-262 Received: 6 August 2017 | Accepted: 20 March 2018 http://belitungraya.org/BRP/index.php/bnj/ © 2018 The Author(s) This is an Open Access article distriButed under the terms of the Creative Commons AttriBution 4.0 International License which permits unrestricted non-commercial use, distriBution, and reproduction in any medium, provided the original work is properly cited. ORIGINAL RESEARCH ISSN: 2477-4073 THE INFLUENCE OF SUNDANESE ZITHER (KACAPI) MUSIC THERAPY ON ANXIETY LEVELS IN PRE-CARDIAC CATHETERIZATION PATIENTS Kristiana Prasetia Handayani*, Andrew Johan, Chandra Bagus Ropyanto Magister Keperawatan, Fakultas Kedokteran, Universitas Diponegoro, Semarang, Indonesia *Corresponding author: Kristiana Prasetia Handayani Magister Keperawatan, Fakultas Kedokteran, Universitas Diponegoro Gedung Dekanat Lama FK Undip Lt.2 Zona Pendidikan RSUP Dr. Kariadi, Jl. Dr. Soetomo No.18 Semarang Jawa Tengah 50231 Email: [email protected] Abstract Background: Patients who will have cardiac catheterization mostly experience anxiety. Unresolved anxiety may have a harmful effect such as increasing frequency of heart, breathing and blood pressure as well as risks of complication. Music is considered effective in reducing anxiety. Objective: This study aims to examine the effect of Sundanese zither (kacapi) music therapy on anxiety level in pre-cardiac catheterization patients. Methods: This was a quasi-experimental study. Fifty-six respondents were selected using consecutive sampling technique, which 28 respondents assigned in the experiment group and control group. Anxiety was measured using Hamilton Anxiety rating Scale (HARS). Data were analyzed using Wilcoxon and Mann-Whitney test. Results: The results showed an average decrease in anxiety value in the experiment group of 10.28, and in the control group of 3.25. Mann-Whitney test results obtained p value <0.001, which indicated that there was a significant difference of mean decrease between the experiment group and the control group. Conclusion: This study proves that the intervention of Sundanese kacapi music significantly decreasing anxiety levels (p <0.001) in pre-cardiac catheterization patients. It is suggested that Sundanese kacapi music can be used as an alternative therapy in the independent nursing interventions. Keywords: anxiety; music therapy; Sundanese, zither; kacapi; cardiac catheterization BACKGROUND Cardiovascular disease is multifactorial catheterization is done to restore the flow to disease. The most common type of the blocked blood vessels, to open the stenotic cardiovascular disease is Coronary heart heart valve (narrow) and to repair congenital disease (CHD) as the leading cause of death in damage. However, patients who will have the next fifteen years. CHD is caused by cardiac catheterization mostly experience atherosclerosis. The ways to identify and anxiety (Bonow, Mann, Zipes, & Libby, 2011; diagnose the presence of CHD are from non- Mann, Zipes, & Peter Libby, 2014). invasive techniques, such as electrocardiography (EKG), to invasive Anxiety experienced by the patients is caused examination, such as coronary arteriography by lack of accompanying friend, delivery of (cardiac catheterization). Cardiac the first procedure, lack of satisfactory Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018 256 Editor’s Note: This article has been updated on 2 July 2020 in terms of minor changes in the reference format. The update is according to BNJ Policy on article correction. Handayani, K, P., Johan, A., Ropyanto, c.B. (2018). information and length of waiting time. If malleus, incus and stapes and proceed to the anxiety is not resolved, then it will have a house snail or cochlea then received by the harmful effect, such as extending cardiac auditory nerve (the cochlear vestibule nerve) catheterization time, increasing the risk of and will be received by the brain (temporal complications, increasing heart frequency, lobe) as a sound sensation. The sound breathing and blood pressure (Andri, 2007; produced by the music will stimulate the Safaria & Saputra, 2009). Thus, anxiety expenditure of endorphins that will affect the management of this patient need to be working mechanism of the limbic system in performed. the amygdala in the emotional setting and mood of feeling. If the regulation of emotions Anxiety management can actually be done by the amygdala can be well organized, then through pharmacological and non- one can control the emotions well and feel no pharmacological therapies. The proven and anxiety. Listening to music with slow rhythm useful non-pharmacological management is an will also reduce the release of catecholamines integrated therapy in the form of into the blood vessels, so the concentration of complementary and alternative therapies, catecholamines in the plasma becomes low. It especially in anxious management. Non- can also activate the sympathetic and cause the pharmacological management can make body release of stress hormones that result in more relaxed and make sleep better. This non- relaxing the body (Weeks & Nilsson, 2011). pharmacological therapy can be implemented by nurses independently, one of which is the There are several studies have been conducted intervention of music therapy, such as in regards to the use of Sundanese kacapi Sundanese zither (kacapi) music therapy music, such as Supriadi's research that (Andri, 2007; Mulidah & Triyanto, 2009; examined the influence of Sundanese flute Safaria & Saputra, 2009; Weeks & Nilsson, kacapi music in decreasing blood pressure in 2011). The use of Sundanese kacapi music as a elderly in Yogyakarta (Supriadi, Hutabarat, & therapy in cardiac catheterization patients can Monica, 2015). Some studies used different improve the meaning of transcultural nursing kind of music such as classical and Javanese and values in the application of nursing care to music to reduce anxiety in pre-catheterization patients so as to deepen the cultural values in patients (HATI, Wibowo, & FarK, 2010). society. Listening to Sundanese kacapi music However, lack of studies examines the impact in Central Java Indonesia can enhance the of Sundanese kacapi music in decreasing development of specific and universal culture- anxiety in pre-catheterization patients. oriented nursing practices, so that the wider community recognizes and accepts the cultural diversity in Indonesia as well as to improve METHODS local wisdom (Andri, 2007). Study design Music therapy can increase emotional coping This was a quasi-experimental study with and positive affective status, gain pretest posttest control group design. psychological satisfaction, improve well-being during surgery, and have an effect on Sample decreased blood pressure, pulse, breathing, Fifty-six respondents were selected using heart frequency, decrease hormones. Music consecutive sampling technique, which 28 can lower the stimulus of the sympathetic respondents assigned in the experiment group nervous system. When the music is playing, and control group. The inclusion criteria of the the music in the form of sound waves is sample were: 1) Patients who would have received by the earlobe and then will go into cardiac catheterization, 2) Aged 40-65 years, the external auditory canal and then the sound 3) Willing to follow research and listen to waves vibrate the tympanic membrane and Sunda kacapi music, 4) Already got continued to vibrate the hearing bones of explanation about pre -catheterization Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018 257 Handayani, K, P., Johan, A., Ropyanto, c.B. (2018). procedures, 5) Never have other relaxation recorded with a stereo system. There were R techniques such as deep breathing relaxation, and L mark to be easy for respondents to put reciting the Qur'an or any other techniques. on. The form of instrumental song using the The exclusion criteria were: 1) Patients who tempo of 129.1 beats per minute means it has got antidepressant therapy, and 2) Patients slow tempo with the overall tap of 731 with who had hearing loss. 128 kbps voice quality. The overall song Ayun Ambing did not use human voice, but using Instrument only the sound of Sundanese kacapi Anxiety was measured using Hamilton instruments (Supriadi et al., 2015). This Anxiety rating Scale (HARS) (Sulistiyo et al., musical intervention was given only to the 2017; Yazici, Demir, Tanriverdi, Karaagaoglu, experiment group, while control group was & Yolac, 1998), which was developed by Max only given a standard therapy from the Hamilton in 1959 with good validity and hospital. During therapy, the researchers and reliability. The scale consisted of 14 items nurses assure there would be no interruption. with 5 levels of score (between 0-4). The anxiety level was classified based the number Data analysis of scores summed. It refers to no anxiety if The data analysis of this research consisted of score <14, mild anxiety if score 14-20, univariate and bivariate analysis. Univariate moderate anxiety if score 21-27, and severe analysis was used to describe mean and anxiety if score > 28. Anxiety was measured median of the data. While bivariate analysis before and after given intervention. consisted of Wilcoxon and Mann-Whitney test to examine the effect of Sundanese Kacapi Intervention Music on anxiety levels, and compare the MP3 and headphones were used to listen the effect between the experiment and control music and each patient had the same brand. group. The music
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