The effect of Dhikr therapy on anxiety levels in chronic kidney failure patients that have done hemodialysis therapy in Indonesia

Abstract

Anxiety is a psychological response that is often experienced by patients with chronic renal failure undergoing hemodialysis. The purpose of this study was to determine the effect of Dhikr therapy on anxiety levels in chronic kidney failure patients undergoing hemodialysis at RSUD Dr. Drajat Prawiranegara attack in 2019. This type of research is quasi-experimental without control, with 72 respondents selected using purposive sampling technique. The results of univariate analysis showed that in the first measurement before getting therapeutic intervention Dhikr most respondents condition that is anxious as many as 10 respondents (55.6%). After getting the Dhikr therapy intervention, the condition of the respondents’ anxiety level experienced a change to a mild anxiety level of 9 (50%). The result of bivariate analysis is p value 0.000 with α < 0.005, so it can be concluded that there is an effect of Dhikr therapy on the level of anxiety in patients with chronic renal failure undergoing hemodialysis at RSUD Dr. drajat prawiranegara attack in 2019. Further researchers are advised to examine the support of family relationships to the level of anxiety in patients with chronic renal failure in the hemodialysis room.

Introduction

Chronic kidney disease is a global health problem whose numbers continue to increase. Based on the 2013 Basic Health Research by the Indonesian Ministry of Health, 0.25 of the total population of Indonesia. Based on the Indonesia Renal Registry of kidney disease in Indonesia in 2016, more than 8000 patients with CKD were caused by diabetes (diabetic neuropathy), and are the most common cause in Indonesia. Followed by hypertension, which numbered nearly 4000 sufferers. Patients with CRF who are actively dialysis also continue to increase from 30 thousand in 2015, to more than 50 thousand in 2016. More and more patients with late stage chronic kidney failure who already understand the treatment. On the other hand is also a warning because of the lack of good management of chronic kidney failure so that it falls to the final stage so that it requires kidney replacement therapy. One of the main psychological problems that often arise in chronic renal failure patients undergoing hemodialysis is anxiety.¹

Anxiety disorders are one of the common mental disorders with a lifetime prevalence of 16%–29%.² It was reported that the estimated anxiety disorder in young adults in America is around 18.1% or around 42 million people living with anxiety disorders, such as panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder and phobia.³ While gender-related anxiety disorders are reported that the prevalence of lifetime anxiety disorders in women is 60% higher than men.⁴ In Indonesia the prevalence associated with anxiety disorders according to results.⁵

Anxiety experienced by patients with chronic renal failure undergoing hemodialysis can be caused by various stressors, including: complications of hemodialysis, dependence on others, difficulties in maintaining employment, financial, death threats, changes in self-concept, changes in participation, changes in social interactions.⁶ This is in line with the results of research that shows many anxiety phenomena in Chronic Kidney Failure patients undergoing hemodialysis. Previous research conducted at RSUD Dr. Congratulations Garut in the hemodialysis room obtained data from 61 respondents to get 1 patient (3%) experienced panic, 11 patients (18%) experienced severe anxiety, 43 patients (70%) experienced moderate anxiety and 6 Patients experience mild anxiety (9%).⁷

Stressors that cause anxiety in CRD patients tend to persist, therefore we need an effective, efficient, and easy strategy to be able to reduce anxiety so that patients are able to adapt to existing stressors. One effective strategy for overcoming anxiety is with relaxation techniques. Relaxation techniques that are combined with elements of religious beliefs as well as God can increase the relaxation response stronger than just relational techniques.⁸

The approach of spiritual belief in Islam is by the technique of remembering Allah or dhikr. Previous studies have shown the effectiveness of dhikr in reducing anxiety levels from the results of previous studies according to Ref. [9]. Shows before the recitation of dhikr: no anxiety 0 (0%), mild anxiety 3 (11.5%), moderate anxiety 15 (57.7%), severe anxiety 8 (30.8%), panic 0 (0%). After reading the Dhikr: no anxiety 2 (7.7%), mild anxiety 11 (42%), moderate anxiety 13 (50.0%), severe anxiety 0 (0%), panic 0 (0%). Dhikr is an act of remembering, mentioning, understanding, maintaining in the form of verbal utterances, movements of the heart or movements of limbs. Contains the meaning of praise, gratitude and prayer in the ways taught by Allah and His Messenger. To obtain inner peace, or get closer (taqarrub) to Allah, and to obtain salvation and avoid the punishment of Allah.¹⁰

The results of a preliminary study of secondary data on the medical record of Dradjat Prawiranegara General Hospital in 2018 the number of patients with CRF were 72 patients. The number of patients with chronic kidney failure at Dradjat Prawiranegara Hospital from August to October 2018 was 72 patients. The results of interviews with 5 patients with chronic kidney failure who will do hemodialysis at Dradjat Hospital Prawiranegara, said the patient's rest and sleep needs were not met properly, some also said when he slept often he woke up (difficult to maintain sleep). Based on the background of the research described, researchers are interested in conducting research on the effects of Dhikr therapy on anxiety levels in patients with chronic kidney failure undergoing hemodialysis at the Regional Hospital Dr. Drajat Prawiranegara in 2019.

Method

This research is quasi-experimental without control in that this design seeks to reveal the causal relationship with one group pre-test and post-test. In this case the researcher involved two variables namely the dependent variable (but Dhikr) and the independent variable (anxiety). The way to collect data is by using pre-test and post-test interview techniques. The location of the study was in the hemodialysis room of Dr. Drajat Prawiranegara Serang General Hospital in 2019. This study was conducted in January 2019. Sampling in this study used the nursalam 0.05 formula so that from 72 people became 16 and added 10% of the total sampling amounted to 18 respondents. The measuring instrument used in this study was a questionnaire.

Result

Univariate analysis

Based on Table 1 (A and B) the results after getting Dhikr therapeutic intervention in the hemodialysis room with the condition of respondents’ anxiety levels experiencing changes in the level of severe anxiety to 0 respondents (0%) and moderate anxiety 2 respondents (11.1%), mild anxiety 9 respondents (50%) and did not experience anxiety as much as 7 respondents (38.9%).

Table 1.

Results after getting Dhikr therapeutic intervention in the hemodialysis room.

	Frequency	Percentage (%)
(A): Anxiety pre-intervention
High	2	11.1
Partial	10	55.6
Low	4	22.2
Nothing	2	11.1
Total	18	100
(B): Anxiety post-intervention
High	0	0
Partial	2	11.1
Low	9	50
Nothing	7	38.9
Total	18	100

Bivariate data analysis

Effect of Dhikr therapy on anxiety levels in chronic kidney failure patients

Based on the results, Table 2, p value 0.000 with α < 0.005 and p value obtained is smaller than α, it can be concluded that there is an effect of Dhikr therapy on the level of anxiety in patients with chronic renal failure in Drajat Prawira Regional Hospital in Serang District in 2018.

Table 2.

Effect of Dhikr therapy on anxiety levels in chronic kidney failure patients.

No	Pre-test	Anxiety level post-test						Total		p-Value
		Sedang		Ringan		Tidak Ada
		F	%	F	%	F	%	F	%
1	High	1	50	1	50	0	0	2	100	0.000
2	Moderate	1	10	6	60	3	30	10	100
3	Light	0	0	2	50	2	50	4	100
4	Absence	0	0	0	0	2	100	2	100
Total		2	11.1	9	50	7	38.9	18	100

Discussion

Anxiety level of patients with chronic kidney failure before getting Dhikr therapy intervention

Based on the results of the study before getting the Dhikr therapy interventions in the hemodialysis room with the highest proportion of respondents’ conditions that is moderate anxiety level of 10 (55.6%).

In line with the results of previous research conducted by Ref. [11] shows the first and second measurements of respondents who experience moderate anxiety more than 60%. Of the four anxiety categories in either the first or second measurement, respondents in the control group were in the category of mild, moderate and severe anxiety.

Agreeing also according to Ref. [12] in general, people who suffer from pain can be overcome by a sense of anxiety and an uneasy soul, if the anxiety is prolonged. Symptoms also appear as chronic blood pressure increases, headaches, muscle weakness, and intestinal disorders, to the occurrence of severe tissue damage. Patient anxiety in patients with chronic kidney failure (CKD) can include fear of pain after physical changes (becoming ugly and not functioning normally), dying if not doing hemodalysis.^13,14

Anxiety can be caused by everyday events that can be experienced by humans and can also be experienced by anyone.¹⁵ Anxiety describes the state of being worried about something that will happen with a cause or object that is not clear and is associated with feelings of uncertainty, fear, and sometimes accompanied by physical complaints.¹⁶

Anxiety in patients with chronic kidney failure (CKD) can arise because psychological readiness for surgery has not yet occurred. Some people are sometimes unable to control anxiety constructively is a major cause of psychological behavior. Excessive anxiety and shock or a serious condition that occurs if the cardiovascular system is not able to circulate blood throughout the body in sufficient quantities, then in general can be accompanied by poor blood circulation and impaired perfusion of vital organs, such as the heart and brain. This will have bad consequences, because if not immediately addressed will increase blood pressure and breathing.

An overview of the anxiety level of patients with chronic kidney failure after the intervention of Dhikr therapy in the hemodialysis room of Dr. Drajat Prawiranegara Regional Hospital, Serang Regency in 2018

Based on the results of the study before getting Dhikr therapy interventions in the hemodialysis room with the highest proportion of respondents’ conditions that are moderate anxiety levels of 10 respondents (55.6%), after getting Dhikr therapy interventions the condition of respondents’ anxiety levels experienced changes in mild anxiety levels of 9 respondents (50%).

Anxiety in patients with chronic renal failure (CRF) with hemodialysis therapy before the intervention is given at the first measurement without intervention from the questionnaire results most patients experience unable to rest calmly, cry easily, have nightmares to have bad feelings after being given an intervention and the second measurement has changed the patient just feels easy to cry, and seen from the condition after the intervention the patient is seen to experience changing anxiety from initially experiencing severe anxiety to not feeling anxious again.

Appropriate nursing interventions are needed to prepare clients both physically and psychologically before hemodialysis, the anxiety experienced by patients with chronic kidney failure (CRF), can actually find a solution. To reduce the level of anxiety, you can use good therapeutic media with humor therapy, prayer therapy, and Dhikr therapy.¹⁷

Dhikr therapy has a function that is quite effective in reducing one's anxiety level.¹⁸ Dhikr is an act of remembering, mentioning, understanding, maintaining in the form of verbal utterances, movements of the heart or movements of limbs. Contains the meaning of praise, gratitude and prayer in the ways taught by Allah and His Messenger. To obtain inner peace, or get closer (taqarrub) to God, and to obtain salvation and avoid the punishment of God.¹⁹

Effects of Dhikr therapy on anxiety levels in chronic kidney failure patients: based on the results of the study showed the effect of Dhikr therapy reduces the level of anxiety when pre-test moderate anxiety 10 results of the post-test being 1 respondent (10%), mild 6 respondents (60%), no 3 respondents (30%), and when compared to the p value of 0.000 with α < 0.005 and p value obtained is smaller than α, it can be concluded that there is an effect of Dhikr therapy on the level of anxiety in patients with chronic renal failure in the Drs in the Drama of the Republic of Serra in Serang Regency in 2018.

This is in line with researchers before Ref. [20] who stated that Dhikr therapy had an effect on reducing anxiety levels because Dhikr contained an effective psychotherapeutic element which obtained a p value of 0.000 <0.05, not only with the angle of edge mental health but also general health. Scientific evidence supports this, that Dhikr is a manifestation of one's religious commitment. A person's faith is a spiritual (spiritual) force that needs to be explored and developed for one's ability to overcome the problems (anxiety) suffered by patients.

The results showed that prior to the intervention, of the four categories of anxiety levels, respondents had mild, moderate and severe anxiety categories but after being given an intervention the respondent turned into a category of no anxiety, mild anxiety and moderate anxiety.

Dhikr therapy is the right way to calm and calm the heart in the face of this life, especially if it is associated with illness and illness. People who believe in Allah and certainly do not be careless and negligent from Dhikr to Allah SWT, which is always reminded and remembered of the greatness of the Almighty, the most merciful, the Merciful, as for one way to remember God is by “Dhikr” because Dhikr can draw closer to Allah, and can be used as an antidote for the hearts and souls that are chaotic, restless and restless with Dhikr, then our souls will be filled with inner wealth in the form of peace and tranquillity of the heart in facing this life.

Based on the results of research before and after the implementation of Dhikr therapy in patients with chronic renal failure undergoing hemodialysis, it was found that the significant Dhikr therapy was very influential in reducing anxiety levels.

Conflict of interest

The authors declare no conflict of interest.