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2014 Riau International Conference
Poster Presentation
MUROTTAL AL-QUR`AN STIMULATION FOR REDUCING
ANXIETY LEVEL ON ACUTE CORONARY SYNDROME PATIENT :
A PRACTICE BASED ON EVIDENCE
Safri1, Elly Nurachmah2 ,Tuti Herawati3 dan Rita Sekarsari4
1
Nursing Programe University of Riau
2,3
Nursing Faculty University of Indonesia
4
Harapan Kita Hospital Jakarta
Email: [email protected]
Abstract
The need to get help (diagnostic of nursing) generally happened to patients, i.e.: decreased of cardiac
output, impaired gas exchange, ineffective airway clearance, risk of hemorrhage, acute pain, and risk
for infection. This scientific work is report from Implementation of nursing practical based on
evidence, has to done to reducing patient anxiety Acute Coronary Syndrome with Intervention was
done Al-Qur`an stimulation up to 30 minutes. This is quasi experiment study using pre and post test
non equivalent control group design. Sample of 10 Acute Coronary Syndrome patient recruited using
NNT (Number Needed to Treat). The result shows significant differentce on level of anxiety on
esperimental group before Murottal Al-Qur’an intervention (mean = 40,80 ) and after Murottal AlQur’an intervention (mean = 31,00 ), and different between level of anxiety before Murottal AlQur’an intervention in control groups (mean=34,60 ), and after intervention (mean=34,60). Murottal
Al-Qur`an stimulation gave positive influence in reducing level of anxiety on Acute Coronary
Syndrome Patient. Based on this study it is recommended to nurse? To apply Murottal Al-Qur`an
stimulation to Acute Coronary Syndrome Patient patient to improve level of anxiety. Implementation
of evidence based nursing practice at patient with Cardiovascular`s system disorder in cardiovascular
Hospital Harapan Kita Jakarta.
Keywords : Acute Coronary Syndrome (ACS), Al-Qur`an Stimulation, Anxiety
BACKGROUND
cardiovascular system (Price & Wilson,
Inability of the heart to perform its
2006).
function will cause damage anatomically
Risk factors that may affect the
and physiologically. This can be caused by
incidence of coronary heart disease are
problems with other body systems or vice
diabetes
versa so that ultimately interfere with the
hypertrigliseridimia, smoking and diabetes
function and adaptation of humans as a
disease in the family. Phenomena that have
system.Such
the
occurred since the 20th century, heart
emergence of various diseases of the
disease and blood vessels have replaced the
damage
triggers
371
mellitus,
dyslipidemia,
2014 Riau International Conference
Poster Presentation
role of pulmonary tuberculosis as a disease
bypass
epidemic in developed countries, especially
Corronary Artery Bypass Graft (CABG)
in males. At this time, heart disease is the
(Ignativicius & Work, 2010). The main role
number one cause of death in the world.In
of the author / nurse is to provide nursing
1999, at least 55.9 million, equivalent to
care that comes with the application of
30.3% of deaths worldwide are caused by
Evidence Based Nursing Practice. The
heart disease.According to the World
expectation is that through the application
Health Organization (WHO), 60% of all
of Evidence Based Nursing Practice nurse's
causes of death of heart disease is coronary
role as a provider of holistic care can be
heart disease (Soepriyono, 2008). The most
achieved and is able to be applied easily
frequent
and continuously.
cardiovascular
disease
are
surgery
through
intervention
hypertension, dysrhythmias, coronary heart
CRITICAL REAVIEW
disease (CHD) and ends in heart failure.In
Indonesia Cardiovascular disease is also
Implementation of Evidence Based
increasing, as evidenced by the data
Nursing is based on research conducted by
recorded by the Cardiovascular and Vessels
Dedi Supriadi, Elly Nurachmah and Dewi
Hospital Harapan Kita Jakarta is one of the
Gayatri. The study examined the effect of
national reference, so it can represent the
therapeutic interventions using murottal
incidence of cardiovascular disorders in
Qur'an to anxiety in patients with acute
Indonesia.In 2013, the highest figure being
coronary syndrome in the General Hospital
treated at the Cardiovascular and Vessels
Hasan Sadikin. While the purpose of the
Hospital Harapan Kita Jakarta was the ACS
study was to identify the effect of
as many as 3186 people where the data is
therapeutic interventions murottal Qur'an to
coming in through the ER, with details of
anxiety in patients with Acute Coronary
UAP in 1206 cases, 719 cases of NSTEMI,
Syndrome (ACS). The method used is
STEMI APS 896 and 456 cases, followed
quantitative research that uses experimental
by failure heart consisting of CHF 662
design quasy pre-post test with control
cases then ADHF 1932 cases.
group and the measured results is the level
Management of Coronary Hart Disease
of anxiety in patients with acute coronary
can be through drugs to increase the supply
syndrome using the State-Trait assessment
of oxygen such as nitrate and antiplatelet,
instrument Anxiety Inventory (STAI). The
then the actions are invasive percutaneous
sample in this study using a non-probability
coronary intervention (PCI) and coronary
sampling technique with a consecutive
sampling
372
method.
There
were
30
2014 Riau International Conference
Poster Presentation
respondents
to
the
division
of
15
experimental design with an experimental
respondents in the intervention group and
group and a control group in which the
15 respondents in the control group.The
samples
results of the study showed that the Mean
Instruments of the State Trait Anxiety
anxiety in patients with ACS after the
Inventory (STAI) was used to measure the
intervention in the intervention group is
level of anxiety. If the calculation is done
20.67 with a standard deviation of 3.395
using the formula NNT (Number Needed to
and a standard error of 0.877.While the
Treat), it could be concluded that in the
Mean anxiety in patients with ACS after
application of this EBNP, minimum of 3
the intervention in the control group was
participants
46.40 with a standard deviation of 4.852
intervention. Patients in the implementation
and a standard error of 1.253.This study
plan Evidence Based Nursing Practice are
shows that the level of anxiety Acute
all clients who have Acute Coronary
Coronary Syndrome patients given murottal
Syndrome (ACS) who were treated in the
Qur'an stimulation decreased significantly
IWM, ICVCU observed since entry of
in the intervention group compared with the
Emergency Unit of the Cardiovascular and
control group with p-Value = 0.001.There
Vessels Hospital Harapan Kita. EBNP
is a significant difference in the Mean
Inclusion criteria were: Willing to be a
anxiety in patients with ACS after therapy
respondent, patients with acute coronary
using Qur'anic murotal in the intervention
syndrome (STEMI, non-STEMI, UAP)
group and the control group.
Non-PCI,
were
is
taken
required
Islamic
consecutively.
to
Religion,
get
the
Time
hospitalization in the first 24 hours,
METHODS
compost mentis awareness and cooperative,
Intervention is to provide stimulation
minimal level of pain 'moderate': 4-6
using Qur'anic murotal for 30 minutes
(assessment of pain intensity scale), good
using the earphones/mp3. This intervention
hearing function. While the exclusion
is very affordable and has effectiveness in
criteria Narcotic Analgesic therapy (such
itsapplication. These interventions are also
as: Morphine).
safe and convenient to do on patients with
Acute
Coronary
Syndrome
that
this
intervention is not a high-risk invasive
RESULTS
measures.The design used in the research
that
was
Evidence
fundamental
Based
to
Nursing
doing
is
Table 1
Characteristics of respondents by age in Cardiovascular and
Vessels Hospital Harapan Kita Jakarta
this
Quasi373
2014 Riau International Conference
Poster Presentation
Variable
Mean
SD
SE
Age
60,80
7,815
2,741
MinimumMaximum
50-76
before intervention was 89.80 min and after
95 %
CI
the intervention decreased to 86.80/min.
Like wise, the Mean respiratory rate before
From the above table it is known that the
stimulation 27 x / min is to be 20.60 x/min
Mean patient age 60.80 years or 61 years
after the intervention. It is not much
with a minimum age and maximum age is
different in the comparison group or a
76 years.
comparison group that Mean systolic blood
Table 2
The mean hemodynamic (BP, MAP, HR, RR) of respondents in
the intervention and comparison groups before and after
intervention in the Cardiovascular and Vessels Hospital Harapan
KitaJakarta
Variable
Systolic
(mmHg)
 Pre
 Post
Diastolic
(mmHg)
 Pre
 Post
MAP (mmHg)
 Pre
 Post
HR (x/minute)
 Pre
 Post
RR (x/minute)
 Pre
 Post
Intervention
(n=5)
Comparison
(n=5)
139,00
131,20
127,60
126,00
80,80
77,20
87,80
79,80
95,20
90,60
95,60
92,80
89,80
86,80
93,60
89,20
27,40
20,60
24,40
24,00
pressure
was
intervention
127.60
mmHg
decreased
after
before
the
intervention to 126 mmHg.The Mean
diastolic blood pressure was 87.80 mmHg
before intervention becomes 79.80 mmHg
after the intervention. While blood pressure
MAP before intervention was 95.60 mmHg
be 92.80 mmHg after the intervention.
Mean heart rate of the respondents before
intervention was 93.60 x / minute to
89.20/min. Similarly, the Mean respiratory
rate before intervention was 24.40 x/min to
24/min. In other words, given stimulation
Hemodynamic
physiological
between groups using Qur'anicmurottal and
responses (BP, MAP, HR and RR) obtained
those
from 10 patients with ACS vary although
management interventions in the room
granting equal treatment of the ACS
equally
patients. Based on the data obtained in the
MAP, HR and RR).
intervention group, the Mean systolic blood
murottal was 139 mmHg, decreased after
becomes
131.20
Level of
Anxiety
 Pre
 Post
mmHg.
Diastolic blood pressure before intervention
was
80.80
mmHg
after
obtained
decreased
the
appropriate
hemodynamic
(BP,
Table 3
The mean level of anxiety of the respondents in the intervention
and comparison groups before and after intervention in the
Cardiovascular and Vessels Hospital Harapan Kita Jakarta
pressure before stimulation with Qur'anic
stimulation
who
Intervention
(n=5)
40,80
31.00
Comparison
(n=5)
34,60
33,40
stimulation
The above table illustrates the changes
decreased to 77.20 mmHg. While MAP
in the level of anxiety among respondents
before intervention was 95.20 mmHg
who received the intervention before
decreased to 90.60 mmHg. Mean pulse rate
374
2014 Riau International Conference
Poster Presentation
stimulation is 40.80 and decreased after
research by Li et al (2001) in Smeltzer,
stimulation
the
Bare, Hinkle, & Cheever (2010) states that
comparison group prior to the intervention
the elderly (age> 65 years) will report less
of anxiety level of the respondents was
pain than younger people. Pain is a
34.60 and dropped to 33.40 after the
subjective complaint associated with an
intervention.
unpleasant sensory system of emotional
becomes
31.00.While
experience accompanied by tissue damage
DISCUSSION
actual or potential (Perry & Potter, 2006).
Evidence Based Nursing Practice
concluded
that
stimulation
using
respondents pain on a scale of 4 (1-10).
Qur'anic murottal affect physiological and
However, the pain is not the only variable
psychological responses in patients with
affected by age, but rather the management
Acute Coronary Syndrome. Physiological
of patients with Acute Coronary Syndrome
responses include systolic blood pressure,
in the Cardiovascular and Vessels Hospital
diastolic blood pressure, MAP, pulse and
Harapan Kita Jakarta have been very good,
respiration.
psychological
especially in the emergency room where
response is anxiety in patients with Acute
the patient's continuing treatment prior to
Coronary
the next unit patients with acute coronary
While
the
Syndrome.
Based
by
In this Evidence Based Nursing Practice
on
the
characteristics of the respondents, the mean
Syndrome has been confirmed free of pain.
age of patients with Acute Coronary
Syndrome
who
participated
in
Based on physiological responses, it
the
is known that all hemodynamic variables
implementation of Evidence Based Nursing
decreased
Practice was 60.80 years of age (61 years).
conducted by the intervention or not. This
These data showed that the mean age of the
suggests that the factors that influence the
respondents is the age group at risk of
physiological response of Acute Coronary
Acute Coronary Syndrome.Increased age at
Syndrome patients consisted of more than a
someone is one risk factor for Coronary
factor of which the main one is the
Heart Disease in which the signs and
management
symptoms of Coronary Heart Disease
Coronary Syndrome patients, especially
occurs commonly in people aged over 40
pain management in the acute phase.
toward
or
normal,
treatment
whether
of
Acute
years (Black and Hawks, 2009). The
With the good management of patients
youngest age of this Eviden Based Nursing
with Acute Coronary Syndrome, especially
Practice is 50 years. Age is also one of the
to pain, it is also affecting the patient's level
factors that affect pain, according to
375
2014 Riau International Conference
Poster Presentation
of anxiety. From the results of this
abandoned.Cardiovascular disorder patients
Evidence Based Nursing Practice, the level
indicates critical life-threatening condition
of anxiety in patients known to be at a
that certainly urgently need the highest
moderate level, whether or not who given
power (spiritual dimension).Optimization
intervention. Only, in the group given
of
stimulation using Qur'anic murottal decline
cardiovascular disorders can be realized by
better than the group who did not receive
having
stimulation
This
instruments such as the format of spiritual
suggests that such stimulation therapy
assessment and spiritual care plan format
using the Qur'an murottal can affect a
along with a guide.
Qur'anic
murottal.
spiritual
care
spiritual
in
care
patients
with
facilitation
person's level of anxiety or stress patients,
Stimulation using Qur'anic murottal is
especially patients with heart attacks. In
expected to be one of the policy as an
addition, they also feel the calmness when
independent
given a spiritual approach according to his
especially
own
this
Vessels Hospital Harapan Kita Jakarta.
to
Therapy with a spiritual approach can also
convictions,
Evidence
Based
especially
Nursing
in
Practice
Muslim patients.
nursing
in
the
interventions,
Cardiovascular
and
be given to patients with a religion other
than Islam, in a way adapted to the
CONCLUSION
religious beliefs and religious activities
The implementation of the best
respectively.
evidence-based nursing practice (EBNP)
stimulation using Qur'anic murottal to the
REFERENCES
ACS patients shows the effects in reducing
Baharudin & Sumari. (2011). Pengaruh
especially
Terapi Suara dalam Meningkatkan
patients.
Ketenangan dan Mengurangi Stres
Stimulation therapy using Qur'anic murottal
Kerja pada Muslim Wanita di
can effectively reduce the anxiety of
Malaysia
patient
anxiety
cardiovascular
disorders,
Muslim
patients suffering from Acute Coronary
Barnum, B. S. (2006). Spirituality in
Syndrome. This complementary therapy is
Nursing From Traditional to New
low cost and has a small risk and is easily
Age (2nd Edition ed.). New York:
integrated in the practice of nursing and
Springer Publishing Company, Inc.
holistic nursing care.
Black, J.M., & Hawks, J.H. (2009).
Spiritual care is an element of nursing
care
that
can
not
Medical surgical nursing : Clinical
be
376
2014 Riau International Conference
Poster Presentation
management for positive outcomes
Hua Ni, Her Tsai, et al. (2010). Minimising
(8th ed). Philadelphia : Saunders
preoperative anxiety with music for
Elsevier
day sugery patients – randomized
clinical trial. Journal of clinical
Brunner and Suddarth. (2002). Buku Ajar
Nursing, 21, 620-625
Keperawatan Medikal Bedah Edisi
8. EGC ; Jakarta, Indonesia
McSherry, W. (2006). Making Sense of
Spirituality in Nursing and Health
Bulechek, G. M., Butcher, H. K., &
Care
Dochterman, J. M. (2013). Nursing
Kingsley Publishers.
Mosby Inc.; Elsevier Inc.
Moorhead, S., Johnson, M., Maas, M. L., &
Carron, R., & Cumbie, S. A. (2011).
nursing
a
model
conceptual
for
the
nurse practitioners. Journal Of The
Of
E.
(2013).
Nursing
Outcomes
Classification
(NOC)
Mosby Inc.; Elsevier Inc.
adult primary healthcare settings by
Academy
Swanson,
(fifth ed.). St. Louis, Missouri:
implementation of spiritual care in
American
Interactive
London and Philadelphia: Jessica
(sixth ed.). St. Louis, Missouri:
of
An
Approach (Second Edition ed.).
Intervention Classification (NIC)
Development
Practice
O'Brien, M. E. (2010). Spirituality in
Nurse
Nursing: Standing on Holy Ground
Practitioners, 23(10), 552-560. doi:
(Fourth
10.1111/j.1745-7599.2011.00633.x
World
Edition
ed.).
Headquarters,
Sudbury:
Jones
&
Bartlett Learning.
Draper, P. (2012). An integrative review of
spiritual assessment: implications
Parker, M.E (2005).Nursing Theories &
for nursing management. J Nurs
Nursing Practice. (2nd edition).
Manag,
Philadelphia,F.A Davis Company
20(8),
970-980.
doi:
10.1111/jonm.12005
Potter, P.A., & Perry, A.G. (2006) Buku
Fitzpatrick, J.J. & Whall, A.L. (1989).
ajar fundamental keperawatan :
Conceptual models of nursing. (2nd
Konsep, proses dan praktik (Edisi 4,
edition). California: Appleton &
Vol 2). (Yasmin, dkk, Alih Bahasa).
Lange
Jakarta : EGC
377
Poster Presentation
2014 Riau International Conference
Price & Wilson. (2006). Patofisiologi
Koroner
konsep
klinis
proses-proses
Akut
(SKA).
Jakarta.
FIKUI
penyakit (Vol 2). (Peter Anugrah,
Supriyono, Mamad (2008) Faktor-Faktor
Alih Bahasa). Jakarta : EGC
Risiko Kejadian Penyakit Jantung
Reed, P.G. (2004). Perspectives on Nursing
Koroner (PJK) Pada Kelompok
Theory (4th edition). Philadhelpia:
Usia < 45 Tahun. (Studi Kasus di
Lippincott Williams & Wilkins
RSUP Dr. Kariadi Semarang dan
RS Telogorejo Semarang). Jurnal
Rilantono, Lily I. (2012). 5 Rahasia
Epidemiologi
Penyakit Kardiovaskular (DVK).
Badan penerbit FKUI; Jakarta
Timmins, F., & Kelly, J. (2008). Spiritual
assessment in intensive and cardiac
Safri. (2013). Pengaruh stimulasi Al-
care nursing. Nurs Crit Care, 13(3),
Qur`an terhadap tingkat kesadaran
124-131.
kuantitatif pasien stroke hemoragik.
Tomey, A.M. & Alligood, M.R. (2006).
Smeltzer, S.C & Bare, B.G. (2008).
Nursing Theorists and their work.
Textbook of medical surgical nursing.
(6th edition). America: Mosby
Philadelphia : Lippincot Williams &
Wilkins
Villareal. (2003) Using Roy’s Adaptation
Model When Caring for a Group of
Sodikin. (2012). Pengaruh terapi bacaan
melalui
media
Young
audio
Contemlating
Nursing , 20(3).
operasi hernia di Rumah Sakit
Cilaca. Jakarta FIKUI
Yanti,
Nova.
efektifitas
Supriadi, Dedi. (2013). Pengaruh stimulasi
Al-Qur`an
Women
Quitting Smoking , Public Healt
terhadap respon nyeri pasien post
murottal
10.1111/j.1478-
5153.2008.00276.x
Jakarta. FIKUI
Al-Quran
doi:
(2012).
terapi
Perbandingan
dzikir
dengan
relaksasi Benson terhadap glukosa
terhadap
darah pasien diabetes mellitus di
tingkat kecemasan pasien Sindrom
Sumatera
378
Barat.
Jakarta
FIKUI