The Effect of A Combination of Progressive Muscle Relaxation and Deep Breathing Techniques on Anxiety Levels in Preoperative Patients Under Spinal Anesthesia
Keywords:
Anxiety, Deep Breathing, Preoperative, Progressive Muscle Relaxation, Spinal Anesthesia.Abstract
Preoperative anxiety is common before surgery and may become more pronounced during spinal anesthesia because consciousness is maintained. Uncontrolled anxiety may affect physiological stability and readiness. This study aimed to analyze the effect of combining Progressive Muscle Relaxation (PMR) and Deep Breathing on anxiety levels among patients undergoing spinal anesthesia. A quasi-experimental pretest-posttest control group design included 44 patients at Permata Medika Hospital, with 22 respondents per group. The intervention group received combined PMR and Deep Breathing, whereas the control group received Deep Breathing alone. Anxiety levels were assessed before and after intervention and analyzed according to data distribution. Before intervention, both groups had identical anxiety distributions, with 68.18% experiencing severe anxiety and 31.82% experiencing panic. After intervention, the intervention group showed 45.45% mild and 54.55% moderate anxiety, while the control group showed 4.54% mild, 63.64% moderate, and 31.82% severe anxiety. Within-group analyses showed significant reductions in anxiety in both groups (p = 0.000). Between-group analysis demonstrated a significant posttest difference (p = 0.000), with a mean difference of 4.73 points. The combination of PMR and Deep Breathing was more effective than Deep Breathing alone and may be considered a simple non-pharmacological intervention for reducing preoperative anxiety among patients undergoing spinal anesthesia.
Downloads
References
Alifiani, A. P., Sukmaningtyas, W., & Utami, T. (2024). Implementasi relaksasi otot progresif terhadap penurunan tingkat kecemasan pasien pre sectio caesarea. Jurnal Pengabdian Masyarakat - PIMAS, 4(3). https://doi.org/10.35960/pimas.v4i3.1860
Arvela, A., Wulandari, A., & Susanti, N. I. (2025). The effect of progressive muscle relaxation techniques on anxiety levels in preoperative patients with general anesthesia techniques at Amanda Cikarang South Hospital. Journal of Indonesian Anesthesiology Nursing, 1(2). https://ejournal.unisayogya.ac.id/index.php/jian/article/view/4042
Bashir, A., Dewi, A., & Khoiriyati, A. (2019). Pengaruh teknik relaksasi nafas dalam dan terapi murottal Al-Qur’an terhadap tekanan darah dan respirasi pada pasien pre operasi. Journal of Health Studies, 3(1), 39–46. https://doi.org/10.31101/jhes.520
Casman, C., Hikmat, R., & Sulaeman, R. (2022). Pengaruh terapi relaksasi otot progresif terhadap kecemasan pada pasien pre operasi: Literatur review. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 8(1), 127–135. https://jurnal.stikep-ppnijabar.ac.id/index.php/jkk/article/view/507
Fatmawati, L., & Pawestri, P. (2021). Penurunan tingkat kecemasan pada pasien pre operasi sectio caesarea dengan terapi murotal dan edukasi pre operasi. Holistic Nursing Care Approach, 1(1), 25–32. https://doi.org/10.26714/hnca.v1i1.8263
Hamarno, R., Arif, T., Oktavia, D. A., & Supono. (2024). Manfaat teknik relaksasi napas dalam untuk menurunkan kecemasan pasien pre operasi general anestesi. Jurnal Keperawatan Muhammadiyah, 9(3). https://doi.org/10.30651/jkm.v9i3.22772
Hamasaki, H. (2020). Effects of diaphragmatic breathing on health: A narrative review. Medicines, 7(10), 65. https://doi.org/10.3390/medicines7100065
Hasanpour-Dehkordi, A., Solati, K., Salehi Tali, S., & Dayani, M. A. (2019). Effect of progressive muscle relaxation with analgesic on anxiety status and pain in surgical patients. British Journal of Nursing, 28(3), 174–178. https://doi.org/10.12968/bjon.2019.28.3.174
Hikmawati, F. (2020). Metodologi Penelitian. PT Rajagrafindo Persada.
Karangan, D. A., Endarwati, T., & Purwanti, N. S. (2024). The effect of the combination of deep breath relaxation 4-7-8 method and classical music on anxiety levels preoperative patients with spinal anesthesia. Jurnal Teknologi Kesehatan, 20(1), 9–16. https://doi.org/10.29238/jtk.v20i1.2355
Lizawati, L., Rahardiantini, I., & Agustina, A. (2022). Pengaruh terapi progressive muscle relaxation terhadap rasa cemas pre operasi sectio. Jurnal Keperawatan, 12(1), 37–43. https://doi.org/10.59870/jurkep.v12i1.136
Natosba, J., Jauhari, N. M., & Rizky, V. (2020). Pengaruh relaksasi otot progresif terhadap kecemasan pada pasien gagal ginjal kronik yang menjalani hemodialisis. Jurnal Keperawatan Silampari, 4(1), 164–173. https://journal.ipm2kpe.or.id/index.php/JKS/article/view/1290
Nursalam. (2020). Metodologi Penelitian Ilmu Keperawatan: Pendekatan Praktis (Edisi 5). Salemba Medika.
Orbach-Zinger, S., et al. (2012). Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery. British Journal of Anaesthesia. https://doi.org/10.1093/bja/aes313
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2020). Fundamentals of Nursing (10th ed.). Elsevier.
Rakasiwi, M. R., Hastusi, W., & Nurprastina, G. (2023). Pengaruh teknik relaksasi nafas dalam dengan tingkat kecemasan pada pasien spinal anestesi. Vitamin: Jurnal Ilmu Kesehatan Umum, 1(3), 31–39. https://doi.org/10.61132/vitamin.v1i3.944
Rihiantoro, T., Handayani, R. S., Wahyuningrat, N. L. M., & Suratminah. (2018). Pengaruh teknik relaksasi otot progresif terhadap kecemasan pada pasien pre operasi. Jurnal Ilmiah Keperawatan Sai Betik, 14(2), 129–135. https://doi.org/10.26630/jkep.v14i2.1295
Sahin, G., & Basak, T. (2020). The effects of intraoperative progressive muscle relaxation and virtual reality application on anxiety, vital signs, and satisfaction: A randomized controlled trial. Journal of PeriAnesthesia Nursing, 35(3), 269–276. https://doi.org/10.1016/j.jopan.2019.11.002
Shebl, M. A., Toraih, E., Shebl, M., Tolba, A. M., Ahmed, P., Banga, H. S., Orz, M., Tammam, M., Saadalla, K., Elsayed, M., Kamal, M., Abdulla, M., Eldessouky, A. I., Moustafa, Y. T., Mohamed, O. A., & Aiash, H. (2025). Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis. Journal of Clinical and Translational Science, 9, e33. https://doi.org/10.1017/cts.2025.6
Stuart, G. W. (2023). Principles and Practice of Psychiatric Nursing (12th ed.). Elsevier.
Utami, R., Karlina, N., Lestari, P. I., & Amila, R. (2026). The effect of deep breathing relaxation on anxiety levels among preoperative Caesarean section patients in the hospital. Jurnal Kesehatan Mahardika, 13(1), 395–398. https://doi.org/10.54867/jkm.v13i1.303
Wahyuningsih, N., Rahmasari, I., & Wahyudi, T. (2024). Pengaruh progressive muscle relaxation terhadap kecemasan pada pasien pre operasi. Jurnal Penelitian Perawat Profesional, 6(6). https://doi.org/10.37287/jppp.v6i6.3753
Widiyawati, W., Wardani, L. K., Rinawati, F., Widyastuti, B., Hidajaturrokhmah, N. Y., & Saputro, H. (2024). Effectiveness of finger hand relaxation and progressive muscle relaxation techniques on anxiety in pre-operative sectio caesarea patients. Journal of Nursing Practice, 8(1). https://doi.org/10.30994/jnp.v8i1.657
World Health Organization. (2020). WHO guidelines for safe surgery 2009: Safe surgery saves lives. World Health Organization. https://www.who.int/publications/i/item/9789241598552
Wulandari, N. E., et al. (2017). Pengaruh slow deep breathing terhadap penurunan tingkat kecemasan pasien pre operasi sectio caesarea. Jurnal Ners Lentera, 5(2). https://jurnal.ukwms.ac.id/index.php/NERS/article/view/1793
Yudanari, Y. G., Purnamasari, F., & Aini, F. (2026). Perbedaan tingkat kecemasan pasien pre operasi sebelum dan setelah diberikan intervensi teknik relaksasi otot progresif kombinasi nafas dalam. Jurnal Keperawatan Berbudaya Sehat, 4(1), 108–114. https://jurnal.unw.ac.id/index.php/JKBS/article/view/4846
Zhakia, L. P., Sepdianto, T. C., Supono, & Marsaid. (2025). Pengaruh relaksasi otot progresif dan slow deep breathing terhadap penurunan tingkat kecemasan pasien pre operasi Ca Mamae di RSUD dr. Soedono Provinsi Jawa Timur. Jurnal Keperawatan Muhammadiyah, 10(4). https://doi.org/10.30651/jkm.v10i4.23358
