EFFECTS OF SPIRITUAL EMOTIONAL FREEDOM TECHNIQUES (SEFT) ON ANXIETY REDUCTION IN CHRONIC KIDNEY FAILURE PATIENTS UNDERGOING
HEMODIALYSIS AT DUSTIRA CIMAHI HOSPITAL
Rita Fitri Yulita*, Fifi Siti Fauziah Yani [email protected]
Department of Nursing, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia ABSTRACT
Background : Chronic renal failure (CRF) is a progressive disorder of kidney function where the body is unable to maintain metabolism and fails to maintain fluid and electrolyte balance resulting in an increase in urea. Based on WHO in 2015 CRF occupies chronic diseases with the 20th highest mortality rate in the world.
Whereas in Indonesia according to Indonesia Renal Registry data in 2015 the prevalence of chronic renal failure undergoing hemodialysis reached 15,424 with an increase of 10% each year. CRF patients need treatment for long periods of time, one of which is hemodialysis. Hemodialysis has physical side effects, this is a physical stressor that affects the patient's biopsychosocial. One of the main psychological problems that often arises is anxiety. One way to reduce anxiety is Spiritual Emotional freedom techniques (SEFT).
Objectives:The study aimed to determine the effect of Spiritual Emotional Freedom Techniques (SEFT) on anxiety reduction in chronic kidney failure patients undergoing hemodialysis. Methods : This study was conducted using pre-experimental, with a pre-test-post-test one group design research design. The sample in this study consisted of an intervention group (n = 22). Measurement of anxiety using the Hamilton Anxiety Rating Scale (.HARS). The statistical test used is the T-dependent test. Results : The results of the intervention group showed a significant decrease in anxiety scores (p = 0.001). Conclusion : That chronic kidney failure patients givent Spiritual Emotional Freedom Techniques (SEFT) decreased anxiety. Suggestions : for nursing are expected to increase nurses' knowledge about the benefits of providing Spiritual Emotional Freedom Techniques (SEFT) to anxiety in patients with chronic kidney failure undergoing hemodialysis.
Keywords:Chronic Renal Failure, Hemodialysis, Anxiety, Spiritual Emotional Freedom Techniques (SEFT)
INTRODUCTION
Chronic kidney failure is a progressive and irreversible disorder of kidney function, where the body is unable to recover and fails to restore fluid and electrolyte balance resulting in increased urea (Black dan Hawk, 2014). Chronic kidney failure is now a big problem because it is a difficult disease to cure which requires treatment in the form of kidney transplants, peritoneal dialysis, hemodialysis and outpatient care for a long time (Black & Hawk, 2014; Wahyuni et al, 2014).
According to Sasmitaet al (2015) the most used method is hemodialysis.
Based on WHO in 2015 CRF occupies chronic diseases with the 20th highest mortality rate in the world. The incidence of CRF worldwide reaches 10% of the population with an estimated increase of 8% each year. Meanwhile, chronic renal failure patients undergoing hemodialysis are estimated to reach 1.5 million people worldwide. In Indonesia, according to data from the Indonesia Renal Registry
in 2015 the prevalence of chronic renal failure undergoing hemodialysis reached 15,424 with an increase of 10% each year. The province that had the highest number of chronic kidney failure patients in 2015 was West Java, where 9,882 people were active in hemodialysis from 3,358 in the previous year.
Hemodialysis is a high-level technology as a substitute for kidney function to remove metabolic waste from blood circulation through a semi permiable membrane as a blood separator and dialysis fluid in artificial kidneys where diffusion, osmosis, and ultra filtration processes occur (Smelzer & Bare, 2008). Hemodialysis has side effects felt by patients such as muscle cramps, hypotension, headaches, nausea, and vomiting (Lewis et al, 2011). Other problems in the form of regulation as a result of kidney disease such as the impact of decreased hemoglobin which is common in patients with kidney failure, disruption of potassium, calcium, Fe, etc. This is a physical
stressor that affects the patient's biopsychosocial.
One of the main psychological problems that often arises in patients with chronic kidney failure undergoing hemodialysis is anxiety (Mahdavi et al, 2013).
Anxiety is a wake up signal, warns of a threatening danger and allows someone to take action to overcome the threat (Kaplan, et al dalam Tokala et al, 2015). Excessive anxiety, especially those that have become disturbances will hamper a person's function in carrying out his life. The results of research conducted by Aris (2011) about the picture of anxiety in patients with chronic kidney failure undergoing hemodialysis at RSUD dr.
Slamet Garut from 61 respondents found that 1 patient (3%) experienced panic, 11 patients (18%) experienced severe anxiety, 43 patients (70%) experienced moderate anxiety and 6 patients (9%) experienced mild anxiety.
Anxiety that is not handled properly can lead to several impacts including a person tends to have a negative assessment of the meaning of life, decreased quality of life, emotional changes such as chronic depression and psychosis, if this is like patients with chronic kidney failure will usually be lazy to do hemodialysis, while the consequences hemodilaisa from not doing this will cause various kinds of complications that cause death. Based on this, it is considered necessary for patients with chronic kidney failure undergoing hemodialysis under psychiatric evaluation and the role of dialysis nurses is very important to evaluate the psychosocial condition of the patient so that it can improve the quality of nursing services. The success of nurses in holistic care must be able to assess the level of anxiety experienced by patients and strategies to overcome them.
How to overcome anxiety in improving the psychological health of patients with chronic kidney failure can be given pharmacological and non- pharmacological therapy. Pharmacological therapy has a rapid effect to reduce anxiety in patients, but the administration of drugs will aggravate the kidney's work. As for nonpharmacology therapy, one of the therapies that can be used is complementary therapy. One of the complementary therapies that can be used in reducing anxiety is Spiritual Emotional freedom techniques (SEFT).
This opinion is supported by Fone (2008) which suggests that therapy Spiritual Emotional Freedom Technique (SEFT) can calm the brain. After therapy Spiritual Emotional Freedom Technique (SEFT)
found some respondents said they felt calmer and more sincere.
Based on the background above, researchers are interested in researching. "Influence Spiritual Emotional Freedom Techniques (SEFT) of anxiety reduction in Chronic Kidney Failure Patients Underwent Hemodialysis at the Hospital Dustira Cimahi ".
Objectives
a. Knowing the average anxiety of chronic kidney failure patients who undergo hemodialysis before administration of Spiritual Emotional Freedom Techniques (SEFT) on anxiety reduction in chronic kidney failure patients undergoing hemodialysis.
b. Knowing the mean anxiety of patients with chronic kidney failure who undergo hemodialysis after being given of Spiritual Emotional Freedom Techniques (SEFT) on anxiety reduction in chronic kidney failure patients undergoing hemodialysis.
c. Knowing the difference in the average anxiety of chronic kidney failure patients who undergo hemodialysis before and after.
RESEARCH METHODS
This research uses this type of research pre experimental with research design pre test - post test one group design. This measurement is done before and after treatment. The second difference in measurement results is considered as an effect of the treatment. The method used in sampling is by Purpossive Sampling which is done by taking a subject that matches the inclusion and exclusion criteria of the researcher. The sample size in this study was 24 patients intervention group. This research was conducted at the hospital Dustira Cimahi and the time the study was conducted in July - September 2019. Data collection tools in this study were instruments to measure anxiety scores, namely the Hamilton Anxiety Rating Scale (HARS) and guidelines on Spiritual Emotional Freedom Techniques (SEFT). Furthermore, from the data collected, data processing is carried out through the stages of editing (re-checking), coding (coding), data entry (data entry) and cleaning (data cleaning).
Univariate analysis was carried out to describe all the variables studied. The univariate analyzed variables are anxiety scores which are numerical data by calculating the mean, standard deviation, maximum and minimum values with a
95% confidence interval. Bivariate analysis was performed to prove the research hypothesis by looking at differences in anxiety scores before and after Spiritual Emotional Freedom Techniques (SEFT) were given to the intervention group. The bivariate statistical test used the dependent T test
and Wilcoxon test.
RESULT
1. Average Anxiety Score Before and After Intervention in the Intervention Group
Table 1. Average Anxiety Score Before Intervention in the Intervention Group at Dustira Cimahi Hospital in 2019 (N = 24)
Variable Group Measurement Mean SD 95% CI Anxiety score Intervention Before 28,33 6,644 25,53
-31,14
After 25,46 6,541
Based on table 1 shows the average anxiety score in the intervention group before given Spiritual Emotional Freedom Techniques (SEFT) of 28.33 (95% CI: 25.53-31.14) with a standard
deviation of 6.644 and the average anxiety score after being given Spiritual Emotional Freedom Techniques (SEFT) of 25.46 with a standard deviation of 6.541.
2. Difference in Anxiety Score in Chronic Kidney Failure Patients Underwent Hemodialysis Before and After Being Given Spiritual Emotional Freedom Techniques (SEFT) In Intervention Groups
Table 2. Difference in Anxiety Score in Chronic Kidney Failure Patients
Before and After Intervention in the Intervention Group at Dustira Cimahi Hospital in 2019 (N = 24) Variable Measurement Mean (SD) Difference in mean (SD) 95% CI P Value Anxiety score Before 28,33 (6,644)
2,875 (3,579) 1,364-4,386 0,001
After 25,46 (6,541)
Based on table 4.3, the results show that the average anxiety score in kidney failure patients before being given Spiritual Emotional Freedom Techniques (SEFT) is 28.33 with a standard deviation of 6.644. While the average anxiety score in patients with chronic kidney failure after being given Spiritual Emotional Freedom Techniques (SEFT) is 25.46 with a standard deviation of 6.541. The average difference between anxiety scores before and after being given Spiritual Emotional Freedom Techniques (SEFT) was 2.875 with a standard deviation of 3.579 and 95% CI 1,364-4,386.
Statistical test results obtained p Value = 0.001, it can be concluded that there are significant differences in anxiety scores before and after Spiritual Emotional Freedom Techniques (SEFT) were given to the intervention group.
DISCUSSION
1. Characteristics of Anxiety Scores in the Intervention Group
The average anxiety score in the group given Spiritual Emotional Freedom Techniques (SEFT) decreased to 2.87 after being given Spiritual Emotional Freedom Techniques (SEFT). This shows that Spiritual Emotional Freedom Techniques (SEFT) can reduce the average anxiety score in the intervention group.
This is in line with research conducted by Bakara, dkk (2012) rearata values obtained before intervention was 16.87 and after intervention was given 12.93. From the results of these averages there are different values that indicate the meaning of a decrease in anxiety scores.
Meeting spiritual needs is very important when you are experiencing physical pain. When the physical condition is disturbed there is a possibility of experiencing emotional changes.
In these conditions, one's spiritual component is very important to overcome these emotional
changes. Getting close to God, is believed to make it easier for someone to cope with emotional changes during illness (Luccenote, 1995 dalam Bakara, dkk 2012).
2. Difference in Anxiety Score in Chronic Kidney Failure Patients Before and After Spiritual Emotional Freedom Techniques (SEFT) were given to the Intervention Group Statistical test results showed anxiety scores in patients with chronic renal failure before and after Spiritual Emotional Freedom Techniques (SEFT) in the intervention group were significant differences with a p value of 0.001. The results of this study are supported by research Prabowo, dkk (2018) The parametric test results obtained are independent t-test regarding the effect of Spiritual Emotional Freedom Techniques (SEFT) on reducing anxiety obtained p value 0.001 (p <0.05) which means that there is an influence of giving Spiritual Emotional Freedom Techniques (SEFT) to anxiety.
The decrease in anxiety score is in line with research Bakara, dkk (2012) which shows the difference between the pre-post test in the treatment group with the results of p value 0.001 (p <0.05). While in the control group the results of p value 1,000 (p> 0.05) which means there is no difference between the pre-post test in the control group, because the control group was not given Spiritual Emotional Freedom Techniques (SEFT). The results of the study are in line with this study that there was a significant decrease in anxiety scores after being given Spiritual Emotional Freedom Techniques (SEFT) in the intervention group, but the use of the sample group was not the same as this study because the sample group in this study was only done 1 group (intervention group) while in the research conducted Bakara, dkk (2012) using 2 sample groups namely the intervention and control groups.
The SEFT technique has the basic principle of the spiritual aspect of including prayer as part of therapy. The prayer is contained in one of the stages of SEFT therapy, which is the Set-Up stage which contains neutralizing prayers that are useful for "Psychological Reversal", it affects psychological health (raises hope, fortitude, and wisdom) and on social aspects, namely neutralizing emotions and minimizing anxiety.
SELF also focuses on five things, namely faith, sincerity, solitude, submission, and gratitude.
This is very influential in reducing anxiety levels. When someone feels anxious, the body system will work by increasing the work of the sympathetic nerves in response to stress. The sympathetic nervous system works through the activity of the adrenal medulla to increase epinephrine, nonepinephrine, cortisol release and decrease nitric oxide. This situation will cause changes in the body's response such as increased heart rate, respiration, blood pressure, increased blood flow to various organs and an increase in body metabolism. To inhibit the work of the sympathetic nerve can be done by increasing the work activity of the parasympathetic nerve to cause a relaxation response.
The relaxation response caused by the parasympathetic nerves works by stimulating the adrenal medulla to decrease epinephrine, nonepinephrine, cortisol output and reduce nitric oxide. This situation will cause changes in the body's response such as decreased pulse, blood pressure, oxygen consumption, body metabolism, lactate production and someone feels comfortable. Relaxation techniques performed with spirituality techniques can cause a relaxation response so that it can reduce anxiety.
CONCLUSION
Based on the results of the research that has been done, the conclusions obtained are as follows :
1.
The average anxiety score in the intervention group before and after given Spiritual Emotional Freedom Techniques (SEFT) decreased.
2.
There are differences in anxiety scores before and after Spiritual Emotional Freedom Techniques (SEFT) were given to the intervention group
.SUGGESTIONS 1. For Nursing Services
It is hoped that nurses can apply Spiritual Emotional Freedom Techniques (SEFT) which are clinical parameters to reduce anxiety in patients with chronic kidney failure, by means of education and socialization of Spiritual
Emotional Freedom Techniques (SEFT) for nurses by explaining, demonstrating and evaluating Spiritual Emotional Freedom Techniques (SEFT) )
2. For Health Education
This research is expected to be used as an additional nursing knowledge, especially surgical medical nursing in the urology system related to independent nursing interventions in patients with chronic kidney failure.
3. For Further Researchers
It is recommended for future researchers that the study sample consists of 2 groups (control group and intervention group), so that they can compare the effect of Spiritual Emotional Freedom Techniques (SEFT) on anxiety in patients undergoing hemodialysis.
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