Terapi musik efektif menurunkan kecemasan pada pasien penyakit ginjal kronis yang menjalani pemasangan akses vena
DOI: https://doi.org/10.33024/hjk.v19i12.2417
Kecemasan Pasien Penyakit Ginjal Kronis Pemasangan Akses Vena Terapi Musik
Abstract
Background: Anxiety in patients with chronic kidney disease (CKD) is not only a psychological problem but also a serious clinical threat because it triggers hemodynamic instability. When patients experience intense anxiety before an invasive procedure such as double-lumen catheter (DLU) placement, the sympathetic nervous system is activated, increasing blood catecholamine levels, leading to spikes in blood pressure and tachycardia. This condition is particularly risky for CKD patients who already have cardiovascular complications. Several factors can trigger anxiety and depression in hemodialysis patients, including frequent comorbidities, frequent hospitalizations, new experiences with invasive procedures, chronic pain, sleep disturbances, chronic inflammation, increased fatigue, decreased sexual function, uremia, and lack of family support in daily life.
Purpose: To determine the effectiveness of music therapy in reducing anxiety in patients with chronic kidney disease undergoing venous access placement.
Method: This study used an evidence-based nursing practice (EBNP) approach with a quasi-experimental pre-post-test design, conducted on 14 participants selected through purposive sampling based on inclusion criteria. Music therapy was administered during the venous access/CDL surgical procedure for 30 minutes. Anxiety was measured using the HARS and VAS questionnaires. Data were analyzed using univariate and bivariate tests, including paired t-tests and Wilcoxon tests.
Results: The prevalence of anxiety decreased from 60% to 40%, with HARS and VAS measurements decreasing from 48% to 43% after the intervention. The paired t-test and Wilcoxon test showed p-values of 0.01 and 0.00, respectively.
Conclusion: Music therapy can reduce anxiety in hemodialysis participants. Applied systematically and supported by scientific evidence, music therapy has a positive effect on anxiety in patients with chronic kidney disease (CKD) undergoing venous access.
Suggestion: Further exploration of the physiological and psychological mechanisms of music therapy is needed, as well as consideration of other factors, such as pain, sleep quality, depression levels, and medication adherence, which may influence anxiety levels in hemodialysis patients undergoing first-time venous access.
Keywords: Anxiety; Chronic Kidney Disease Patients; Music Therapy; Venous Access Insertion.
Pendahuluan: Kecemasan pada pasien Penyakit Ginjal Kronis (PGK) bukan sekadar masalah psikologis, melainkan ancaman klinis yang serius karena memicu instabilitas hemodinamik. Saat pasien mengalami kecemasan hebat menjelang tindakan invasif seperti pemasangan catheter dual lumen (CDL), sistem saraf simpatis akan teraktivasi, meningkatkan kadar katekolamin dalam darah yang berujung pada lonjakan tekanan darah dan takikardia. Kondisi ini sangat berisiko bagi pasien PGK yang sudah memiliki komplikasi kardiovaskular. Beberapa faktor yang bisa memicu kecemasan dan depresi pada pasien hemodialisis, antara lain penyakit penyerta yang sering timbul, seringnya dirawat di rumah sakit, pengalaman baru terhadap tindakan invasif, nyeri kronik, gangguan tidur, peradangan kronik, peningkatan kelelahan, penurunan fungsi seksual, uremia, dan kegagalan dukungan keluarga dalam kehidupan sehari-hari.
Tujuan: Untuk menerapkan terapi musik efektif menurunkan kecemasan pada pasien penyakit ginjal kronis yang menjalani pemasangan akses vena.
Metode: Penelitian ini menggunakan pendekatan evidence-based nursing practice (EBNP) dengan desain quasi-experiment pre-posttest, dilakukan pada 14 partisipan terpilih berdasarkan purposive sampling sesuai kriteria inklusi. Terapi musik diberikan selama proses operasi pemasangan akses vena/CDL selama 30 menit, kecemasan diukur menggunakan kuesioner HARS dan VAS. Data dianalisis menggunakan uji univariat dan bivariat dengan uji paired t-test dan uji Wilcoxon.
Hasil: Prevelansi tingkat kecemasan 60% menurun menjadi 40% dengan pengukuran HARS dan VAS 48% menurun menjadi 43% setelah intervensi. Uji paired t-test dan Uji wilcoxon menunjukkan nilai p=0.01 dan p=0.00.
Simpulan: Terapi musik dapat menurunkan kecemasan pada partisapan hemodialisis, diaplikasikan secara sistematis dan didukung oleh bukti ilmiah untuk menurunkan kecemasan terapi musik memiliki efek positif terhadap kecemasan pasien penyakit ginjal kronis yang menjalani pemasangan akses vena.
Saran: Perlu mengeksplorasi lebih jauh mekanisme fisiologis maupun psikologis dari penerapan terapi musik, serta mempertimbangkan faktor-faktor lain, seperti nyeri, kualitas tidur, tingkat depresi, dan kepatuhan terhadap pengobatan yang mungkin berpengaruh terhadap tingkat kecemasan pada pasien hemodialis yang akan menjalani pemasangan akses vena pertama kali.
Kata Kunci: Kecemasan; Pasien Penyakit Ginjal Kronis; Pemasangan Akses Vena; Terapi Musik.
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