Jurnal Keperawatan Global

JURNAL KEPERAWATAN GLOBAL Vol. 6, No. 1, June 2021

https://doi.org/10.37341/jkg.v5i2

Original Research / Systematic Review

Intervention Progressive muscle relaxation therapy for anxiety in CKD

undergoing hemodialysis patients
Holid Fauzi, Suningsih2, Setyo Adi Nugroho3
1
Department of Medical Surgery, University of Eirlangga, Indonesia
2
Faculty of Nursing University of nurul jadid, Indonesia
3
Department of medical surgery, Muhammadiyah University, Jakarta, Indonesia

ABSTRACTpatients with end-stage renal KEYWORDS

disease undergoing hemodialysis experience anxiety1; ckd2;
lifestyle changes that cause physiological hemodialysis3; progressive
problems. If psychological problems are not muscle relaxation 4;
addressed immediately, they can have negative
impacts that can aggravate the disease, one of CONTACT
which is a psychological problem, namely 082146578639
anxiety. Interventions that can be used to
reduce anxiety in patients with adversity failure E-mail
undergoing hemodialysis include progressive Ischaaratha99@gmail.com
muscle relaxation. Background: to see what Department of Nursing,
interventions are effective for reducing anxiety Faculty of Health, Nurul
in patients with chronic kidney disease (CKD) Jaded University, Paiton-
undergoing hemodialysis Probolinggo
Methods:database search includes Google
cindekia, Google scholar, Science direx with
keywords anxiety, kidney failure, hemodialysis.
The criteria for the journals chosen were
published in 2015-2020 with full text and in
Indonesian with experimental journal types, this
systematic review uses 25 journals that match
the criteria
Results:analysis of twenty-five journals showed
that. PMR intervention can have a positive
effect on reducing anxiety levels, blood
pressure and pulse rates. In addition, PMR
therapy has a complex physiological
mechanism of the sympathetic and
parasympathetic nervous systems. When PMR
therapy is carried out with the right steps, the
effect of the parasympathetic nerves reduces
muscle tension so that it can generate a
relaxation response so that a calm state is
achieved.
Conclusion:The literature review progressive
muscle relaxation intervention is more effective

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 Jurnal Keperawatan Global
JURNAL KEPERAWATAN GLOBAL Vol. 6, No. 1, June 2021
https://doi.org/10.37341/jkg.v5i2

in reducing anxiety in patients with chronic

kidney diseases (CKD) undergoing
hemodialysis.

INTRODUCTION
Chronic kidney failure is the main cause of public health problems in
the world. This is proven because this disease became the 27th leading
cause of death in 1990 and increased to 18th in the world according
toGlobal Burden of Disease the year 2010.In developed countries such
as the United States, chronic kidney failure affects approximately 26
million people. Whereas in Indonesia the prevalence of chronic kidney
failure continues to increase, namely 2% in 2013 and in 2018 it increased
to 3.8%. According to research by the Ministry of Health and
Development of the Republic of Indonesia in East Java, the prevalence
of chronic kidney failure according to basic health research reached
2.8% in 2018.
Patients suffering from chronic renal failure who undergo
hemodialysis therapy will experience psychological problems such as
anxiety, depression and sleep disturbances but even though the patient
is aware of the significant negative consequences on the patient's health,
the patient does not attempt to treat it. Anxiety itself occurs due to a lack
of knowledge of the amount of money that must be spent on patients with
chronic renal failure undergoing hemodialysis therapy, especially if the
action is carried out for life. Many factors cause anxiety in patients with
chronic kidney failure undergoing hemodialysis therapy, one of which is
gender and patients who experience anxiety in men are times greater
than that of women.
From the results of research on chronic renal failure patients
undergoing hemodialysis therapy, 156 respondents 54 patients
experienced moderate to severe anxiety. The results showed that there
were 190 patients with chronic kidney failure who experienced anxiety,
54% of the patients were male, ranging in age from 15-59 years. From
the results of the study stated that patients suffering from chronic kidney
failure, 43 respondents, 27 patients who experience anxiety undergo
hemodialysis therapy. Patients with chronic renal failure who undergo
dual treatment often experience psychosocial disorders such as anxiety.
Therefore, management of anxiety is very important for patients with
chronic renal failure to prevent and overcome this happening, so that
patients can manage their health better.
One of the psychological problems experienced in chronic renal
failure patients undergoing hemodialysis is anxiety. To reduce anxiety,
non-pharmacological interventions can be used, namely relaxation
techniques, including Progressvie Muscle Relaxation (PMR). From the
results of the study, there were 70 patients with chronic kidney failure
who experienced anxiety who used PMR therapy, 10,057 before using
therapy and 8,829 who experienced anxiety before using therapy.

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 Jurnal Keperawatan Global
JURNAL KEPERAWATAN GLOBAL Vol. 6, No. 1, June 2021
https://doi.org/10.37341/jkg.v5i2

Several studies show that there is a decrease in the anxiety level of

hemodialysis patients between before and after giving progressive
muscle relaxation therapy. Provision of progressive muscle relaxation
techniques is effective in reducing anxiety levels in patients with chronic
renal failure due to the long duration of hemodialysis. The aim of this
review system is to see which interventions are effective for reducing
anxiety in patients with chronic kidney dies (CKD) undergoing
hemodialysis.

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MATERIALS AND METHOD
The research method we use here is literature review using electronic
databases through international and international journals such as
Google cindekia, Google scholar, Science Rex, publisher and pro quest.
The inclusion criteria used by the author was to limit the articles or
journals published in the last five years from 2015 to 2020. The keywords
used to search were intervention, anxiety, chronic renal failure,
hemodialysis. The journal has a title and content in accordance with the
research objectives, full text, and is related to nursing. The search for
journals began on 11-22 September 2020 with keywords that have been
determined by journal researchers found by researchers selected
according to the inclusion criteria.
.

RESULTS
Based on the results of literature search through duplication of
sciendirect, pubmed and proquest. By using the keyword "progressive
muscle relaxation and anxiety or hemodialysis", the researchers found
8258 journals that match these keywords. A total of 1280 journals were
excluded due to the publication of 2015 and below. 369 journals that did
not fit the inclusion and exclusion criteria. Then the abstract identification
was carried out there were 36 so that the 20 journals that would be
reviewed were listed in Figure 1.

Figures, Tables and Schemes

Picture 1

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 Search using keywords through the
database proquest, science direct, and
pubmed
N = 8258

The selection of journals for the

Excluded (223)
Problem / population
-not on the topic (n = 85)
Intervention
-intervention is not progressive
muscle (n = 27)
Title selection
Out come N = 269
-No relationship with hemodialysis
(n = 36)
Study design
-Book capters (63)
-Conference abstract (11)

Abstract identification
Excluded (16)
N = 36
- Interventions were
given in addition to
anxiety hemodialysis
(n = 6)
- Research objectives
Selected articles (n = 20)
are not appropriate
(6)
Figure 1. Flow diagram of article selection
The results of 20 journals show that in patients with Chronic Kidney
Disease (CKD) who undergo a hemodialysis program there are
complaints of anxiety intervention which show a decrease in anxiety in
patients with chronic kidney disease (CKD), including therapy using
progressive muscle relaxation, benson relaxation, relaxation. dzikirdan
aromatherapy inhalation as listed in table 1.

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 Table 1. Anxiety reduction interventions in renal failure patients with
hemodialysis
No. Title Researc Sample Variable Instrum Analys Result
h design ent is
1 Effect of In this 100 The Questio The The results
Progressi double- hemodia indepen nnaires collect showed that
ve Muscle blind lysis dent for ed PMR function
Relaxatio clinical patients variable anxiety, data was better
n and trial, conveni s are sleep were than aerobic
Aerobic ence Progres quality, analyz exercise in
Exercise samplin sive and ed improving
on g and Muscle fatigue using symptoms of
Anxiety, randoml Relaxati were Stata anxiety,
Sleep y on and complet versio sleep
Quality, assigne Aerobic ed by n 13 disturbances,
and d were participa softwa and fatigue in
Fatigue in divided The nts re hemodialysis
Patients into depend before using patients
with three ent and ANOV
Chronic groups: variable after the A, chi-
Renal PMR, is intervent square
Failure aerobic Anxiety, ion. and t-
Undergoi exercise Sleep test.
ng , and Quality,
Hemodial controls and
ysis. Fatigue
(Amini et
al., 2016)
2 Effek Of This From The Data Data There is a
Progressi researc 234 indepen were were significant
ve h is a people dent collecte analyz effect of
Muscular quasi- with a variable d using ed by progressive
Relaxatio experim sample is the univari muscle
n On ental of 78 Progres HARS . ate, relaxation in
Anxiety study people sive question bivaria reducing
Levels In with were Muscula naire te and anxiety in
Patients pretest selected r analyti chronic
With posttest using Relaxati cal, kidney
Chronik with simple on data disease
Kidney control random presen patients
Disease group samplin The ted in undergoing
Undergoi design g depend the hemodialysis
ng ent form. . The results
Hemodiali variable  Mean, of this study
sis inthe is media are expected
General anxiety n, to be a
Hospital deviati reference in
Of on making
Tugerejo progressive
Semaran muscle
g relaxation a
,Indonesi nursing
a.(Astutik intervention
et al., in reducing
2017), anxiety in
patients
undergoing

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 hemodialysis
.
3 Effect of The Nonrand indepen Data analysi The results
progressi study omized dent is were s using of the study
vemuscler was a evaluati Progres collecte confid indicate that
elaxatione nonrand on with sive d using ence PMR has an
xerciseon omized intervent Muscula a visual interva effect on pain
postopera evaluati ion (n r analog l and vital
tiveepain on with 31) and Relaxati scale levels
Level in intervent control on (VAS) signs in the
patients ion and (n 30) question patient after
undergoin control groups.s The naire. open kidney
gopen groups. Nonrand depend surgery are
Renal omized ent indicated by
Surgery: evaluati variable nonrandomiz
anonrand on with is ed evaluation
omized intervent postope studies. The
evaluation ion (n rative results show
31) and mastery that PMR
control decrease in
(n 30) mean
groups. postoperative
VAS pain
score,
systolic blood
pressure,
and
breathing
and heart
rate among
patients on
compared to
the control
group.
4 The effect This 70 The The Data The results
of study samples indepen data analysi showed that
progressi used a were dent uses the s using progressive
ve muscle pre- recruited variable impleme paired muscle
relaxation experim using is ntation t-test relaxation
interventi ent with purposiv Progres with the can reduce
on on a one e sive control anxiety levels
decreasin group samplin Muscle experim in
g anxiety pretest- g Relaxati ental hemodialysis
level posttest on control patients.
among design group Nurses need
hemodialy approac The to consider
sis h depend this
patients in ent intervention
Sidoarjo variable as an
hospital is alternative to
(Kusnanto Anxiety reduce
, Arif, M., associated
Herawati, psychological
& problems
Hidayat,
A. (2019).
5 Effectiven This The The Data Data It showed
ess of researc data indepen collectio were that the

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 Progressi h is a were dent n with analyz mean scores
ve Muscle quasi obtained variable patients ed by for
Relaxatio researc by 60 (free) is who met resear depression,
n in h eligible Progres the ch anxiety and
Reducing Experim respond sive require using stress
Depressio ent ents Muscle ments in the chi differed
n , dengan who Relaxati the square significantly
Anxiety metode underwe on hemodia test before and
and non nt Depend llysis after the
Stress equivale hemodia ent room at intervention
among nt lysis and variable the between
Haemodia control were = Central groups and
lysis group randoml Anxiety Java within the
Patients pre test y general intervention
attending and post allocate hospital group (p
a Public test d to the using <0.05). PMR
Hospital design intervent the is effective
at Central ion and Depress for reducing
Java waiting ion, psychological
Indonesia list Anxiety symptoms in
(Hudiyaw control and patients
ati, D., groups. Stress undergoing
Muhlisin, Scale- hemodialysis
A., & 21
Ibrahim, (DASS-
N. (2019) 21)
question
naire.

6 The This Data The Collectio Resea The results

Comparis researc obtained indepen n in rch showed that
on Of h is a by 70 dent hemodia analysi the level of
Progressi quasi- respond variable lysis s using anxiety in the
ve Muscle experim ents is ward t test intervention
Relaxatio ental using Progres Data group
n researc purposiv sive analysis decreased
Frequenc h with e Muscle was there was a
y on non- samplin Relaxati perform significant
Anxiety,Bl equivale g on ed and difference in
ood nt techniqu present the reduction
Pressure, control e and The ed in in anxiety
and Pulse group divided depend descripti levels
of pre-test into two ent ve between the
Haemodia and intervent variable statistics intervention
lysis post-test ion is and group and
Patients design groups Anxiety, significa the control
(Kusnanto methods and Blood nt errors group.
, Arif, M., . control Pressur were Interventions
Herawati, groups e, and abrogat in
& Pulse ed using progressive
Hidayat, paired t- muscle
A. (2019). test relaxation
can reduce
anxiety levels
in
hemodialysis
patients.

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7 Effect of This Total 20 The Intervie This The results
Progressi researc respond indepen ws were study of this study
ve Muscle h is a ents dent conduct used a indicate the
Relaxatio quantitat with variable ed by paired effect of
n on The ive purposiv is filling in T test. PMR with an
Level of researc e Progres the average level
Anxiety of h, samplin sive HARS of anxiety
Hemodial g Muscle question before and
ysis Relaxati naire to after the
Patients on see the intervention
at level of is 22.65 and
Muhamm The anxiety 16.30,
ad Sani depend before respectively.
Hospital ent undergo Of the 14
in variable ing PMR parameters
Karimun. is therapy. in the
(Sari, R., Anxiety questionnaire
& .
Muchtar, Based on
U. (2019) this study,
there is a
significant
effect of
PMR in
reducing
anxiety levels
so it is
advisable to
use PMR in
overcoming
anxiety
problems in
HD patients.

8 The effect The 20 The Data The During the

of design respond indepen collectio results pretest, all
progressi of this ents dent n used a of the respondents
ve muscle researc with variable standar analysi experienced
relaxation h is a samplin is d HARS s used mild anxiety
technique quasi g using muscle (Hamilto the as many as
s on the experim purposiv relaxatio n Wilcox 20 people
anxiety ent with e n Anxiety on (100%) and
level of a one samplin Variable Rating test. at the
hemodialy group g Scale) posttest most
sis pretest techniqu question of the
patients in and e naire. respondents
Wonosari posttest did not
Hospital approac experience
(Cahyo h, anxiety as
Promono, many as 14
Sat, S., & people
Yudha, M. (70%).
(2019)
9 The In this A indepen The Analyz research has
Influence researc sample dent is instrume e this shown that
Of h design of 55 Progres nt in this data this therapy
Progressi used is people sive researc using can increase
ve Muscle a Quasy was Muscula h uses a SPSS melatonin

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 Relaxatio experim taken by r BDI 20.0 production
n ent with simple Relaxati Questio softwa and
Techniqu pre-test random on nnaire re serotonin,
es On post-test samplin (Beck progra reduce the
Depressio control g The Depress mwilco stress
n Level Of group depend ion xon hormone
Chronic design. ent Inventor Signed cortisol. PMR
Kidney variable y) which Rank too, lowers
Disease is consists Test muscle
Patient depressi of 21 shows tension, do
Undergoi on question that p- positive
ng s value thinking so
Hemodial that, even
ysis though it is
Therapy an influence
to reduce
in
depression.
Regular
muscle
relaxation
distracts
everyday
stress
during
training
10 Progressi This is a The indepen The The The findings
ve muscle quasi number eden Brief data of this study
relaxation experim of adalah Pain analysi have shown
to ental samples Progres Inventor s that there are
reduces design was 100 sive y (BPI) emplo significant
chronic of time patients Muscula yed difference in
pain in series taken by r indepe pain levels
hemodialy design simple Relaxati ndent between
sis patient random on ttest. intervention
samplin and control
g. Variabel groups. PMR
depend therapy can
en adopted by
adalah nurses as an
painhem independent
odialysis intervention
for
hemodialysis
patients who
have
Pain. Non-
pharmacologi
cal therapy
using
progressive
muscles otot
Relaxation
has been
shown to
reduce pain
in
hemodialysis

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 patients.
11 Progressi . This The indepen Using When According to
vemuscle study number eden the analyzi the results of
relaxation used a of adalah State ng the research
to pretest- samples Progres Trait differe conducted
decrease posttest was 80 sive Anxiety nce in that PMR
anxiety in experim patients Muscula Inventor the has the
clinical ental taken by r y (STAI) pre- potential to
simulation design simple Relaxati test reduce
s random on and anxiety levels
samplin post- and reduce
g. Variabel test anxiety
depend scores in doing so
en betwe can lead to
adalah en the clearer
anxiety two thinking and
groups communicati
on skills.
PMR
is a simple
strategy for
dealing with
anxiety-
provoking
situations
such as
simulations.
12 The This is a 64 indepen Generali Analys According to
paradox quasi- participa dent is zed es the results of
of experim nts were Progres Anxiety were research
relaxation ental female sive Disorder condu conducted
training: study and 32 Muscula Questio cted that
Relaxatio with participa r nnaire- using relaxation
n induced one- nts were Relaxati IV SPSS techniques
anxiety group, male. on (GAD- versio can reduce
and before Q-IV n 24. Generalized
Tmediatio and The anxiety
n effects after depend disorder
of design. ent (MDD) and
negative variable major
contrast is depressive
sensitivity anxiety disorder
in (GAD)
generaliz
ed anxiety
disorder
andmajor
depressiv
e disorder
13 Effect of This 90 indepen Generali Were According to
Muscle randomi patienpu dent is zed analyz the results of
Relaxatio zed rposive Muscula Anxiety ed research
n on controlle samplin r Disorder using conducted
Hemodial d clinical g based Relaxati Questio Chi- that
ysis trial on on nnaire- square Muscle
Patients’ inclusion IV , relaxation
Pain criteria The (GAD- indepe techniques
and depend Q-IV ndent can be used

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 randoml ent T and to reduce
y variable Mann- pain in
divided is Whitne hemodialysis
into Hemodi y tests patients.
control alysis by
and Patients’ SPSS
experim Pain 21
ental softwa
groups. re
14 The Effect This is a Using Sleep Analyz According to
of quasi- purposiv indepen quality e the the results of
Progressi experim e eden of statisti this study,
ve Muscle ental samplin adalah samples cal progressive
Relaxatio study g Progres was data, muscle
n on with method, sive assesse paired relaxation
Sleep one- 42 Muscula d by t-test has a
Quality of group, patients r Pittsbur and beneficial
Patients before Relaxati gh wilcox impact on
Undergoi and on Sleep on test sleep
ng after Quality were quality in
Hemodial design. Variabel Index used. patients
ysis depend (PSQI). undergoing
en hemodialysis
adalah and can be
sleep applied and
quality trained as a
useful
method to
improve
sleep quality
patients on
the
hemodialysis
ward.
15 Effect of This The The The resear The results
Progressi study number variable instrume ch showed that
ve uses a of in this nt in this analysi the average
Relaxatio pre- samples study is study s using patient
n (PMR) experim was 10 the was the statisti anxiety
Therapy ent with patients. indepen Zung cal test before PMR
on a one The dent Self- with therapy was
Reducing group samplin variable Rating paired 50.10, the
Anxiety in pretest- g (free) / Anxiety sampl average
Chronic posttest techniqu intervent Scale e t- patient
Kidney approac e used ion, (SAS/S test, anxiety after
Disease h. was namely RAS) PMR therapy
(CKD) Design purposiv the anxiety was 45.00.
Patients e variable measur
Due to samplin that ement
Length of g. affects, question
Time in this naire to
Undergoi study assess
ng the anxiety
Hemodial variable in CKD
ysis that patients.
Therapy affects
at RST is PMR
DR. therapy.

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 Reksodiwi
ryo
Padang in
2016.
(Yolanda,
Y. 2017).
16 Thought This Giving The When The The results
Stopping study therapy indepen carrying analysi of the study
Therapy, uses based dent out the s of on the
Progressi experim on the variable assess the response of
ve ental package is ment, resear anxiety
Relaxatio design that has Thought the ch patients after
n and been Stoppin researc results receiving
Psychoed made by g, her was consist therapy were
ucation the Progres assisted ed of that the
Against author sive by the univari patient's
Anxiety consists Relaxati room ate perception
Reduction of three on And nurse and was
in CKD package Psychoe and bivaria widespread,
Patients s, ducation used a te the patient's
Undergoi namely predeter analysi physiological
ng the first The mined s, response
Hemodial package depend table to using was an
ysis. of ent make it percen increase in
(Wahyuni thought variable easier to tage, sleep and
ngsih, stopping is classify depen eating, the
2020) therapy, Anxiety the level dent t- patient's
the of test affective
second anxiety and response did
package in the indepe not feel
consists patient, ndent worried and
of which t-test. the patient
thought the was able to
stopping nurse socialize. In
therapy had conclusion,
and previous the
progress ly given implementati
ive an on of an
relaxatio explanat effective
n, the ion of by nursing
third the therapy
package researc package
consists her.'; given on a
of mild scale is
thought generalist
stopping therapy and
therapy, specialist
progress thought
ive stopping
relaxatio therapy,
n and progressive
psychoe relaxation
ducation and
. psychoeduca
tion with the
result that
the patient's
ability to

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 control
anxiety
increases
and has a
positive
impact on the
caregiver.
17 Progressi This The The This Data The result is
ve Muscle type of number indepen researc analysi that there are
Relaxatio researc of dent h s using differences
n h uses a samples variable instrume statisti before and
Reduces quantitat is 30 is nt uses cal test after being
Patient ive people Progres the given PMR
Anxiety quasi- using sive HARS therapy
Levels experim the Muscle (Hamilto intervention
Before ent Porposiv Relaxati n can reduce
Hemodial using a e on Anxiety anxiety levels
ysis pre-test Samplin Rating in patients
Therapy. and g The Scale) with chronic
(Silitonga, post-test techniqu depend anxiety kidney failure
2019) approac e. ent question before
h variable naire undergoing
is approac hemodialysis
Anxiety h. therapy, so
this therapy
can be
recommende
d as a
method in
reducing
patient
anxiety
before
undergoing
hemodialysis
therapy.

18 The Effect This On 90 indepen Data resear The results

of Muscle randomi hemodia dent is collectio ch of the
Relaxatio zed lysis Progres n using analysi research
n on controlle patients sive the s using carried out
Dialysis d clinical selected Muscula State- the are that the
Adequacy trial through r Trait chi- current
in conveni Relaxati Anxiety square method used
Hemodial ence on Inventor test to increase
ysis samplin y (STAI) the adequacy
Patients g and The question of dialysis in
assigne depend naire Patients
d ent include
To the variable increasing
control is pump speed,

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 groups dialysis using
educatio high flux
n filter, as well
as increased
number and
duration
hemodialysis
session.
About the
results
studies, the
adequacy of
dialysis can
be easily
increased in
hemodialysis
patients
through
simple and
inexpensive
beliefs
relaxation
techniques.
19 progressi The In 37 indepen Data resear The results
ve muscle design clients i dent is were ch of the
relaxation used in who Progres collecte analysi research
therapy in conducti experien sive d using s using carried out
anxiety ng this ced Muscula the the are that the
clients researc anxiety r HARS . chi- nursing
h is to in the Relaxati question square actions of
conduct commun on naire test nurses,
case ity. progressive
analysis Clients The muscle
are depend relaxation,
divided ent have an
into 2 variable effect on
groups. is decreasing
The first anxiety signs and
group symptoms of
as many anxiety and
as 23 increasing
clients the ability to
received control
nurse anxiety,
action
and
progres
sive
muscle
relaxatio
n
therapy.
The
second
group of
14
clients
received

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 nursing
action
therapy
for
nurses.
20 the An Populati indepen The resear The results
effectiven experim on dent is instrume ch of this study
ess of ental consists Progres nts used analysi showed that
progressi group of sive to s using after PMR
ve design 54 Muscula collect chi exercise was
relaxation dialysis r the data square carried out in
in chronic with Relaxati included test patients
hemodialy control on a undergoing
sis group demogr hemodialysis
patients The aphic for a duration
depend question of 30 minutes
ent naire that PMR
variable consisti exercise by
is ng of showing a
hemodia two PMR
lysis parts, exercise
personal movement
informati video could
on and improve BP
informati and muscle
on on function well
thedisea and could
se and reduce
its anxiety.
treatme
nt.

DISCUSSION
Chronic kidney disease is one of the diseases that cannot be
cured and requires kidney replacement therapy that lasts a lifetime,
from the available literature to date. Hemodialysis therapy is a therapy
that is often applied to patients with chronic kidney disease in the final
stages, and often patients receiving hemodialysis therapy feel anxiety
ranging from mild to panic in facing the stages of dialysis.
The results of a journal review by researchers found that there
are several kinds of effective ways to reduce anxiety. Anxiety in chronic
kidney disease (CKD) patients can be reduced by progressive muscle
relaxation, the results of 20 review articles found that interventions with
progressive muscle relaxation were the most effective compared to
other interventions.
Anxiety or psychological problems often occur in healthy people,
especially in hemodialysis patients so that it can affect the quality of life.
Rizki Sari Utami Muchtar, Marlian explained in his research that
patients undergoing HD will experience anxiety caused by several
stressors, one of which is pain at the needle insertion site. Anxiety is
more experienced by women than men. The predisposing factors that
cause anxiety in patients are mostly found in the biological aspect due
to chronic disease, the psychosocial aspect of sadness and worry, and

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 the socio-cultural aspect, namely inadequate work. In addition,
psychological problems, one of which is stress can cause high blood
pressure.
One of the research results shows that one of the effective
approaches to treat HD pain patients is a non-pharmacological
approach, namely progressive muscle relaxation (PMR). This therapy
can increase the production of melatonin and serotonin so that it can
reduce the stress hormone cortisol. PMR therapy can also reduce
muscle tension therefore this therapy can divert stress attention to
positive thinking every day during training. PMR therapy is carried out
on patients undergoing hemodialysis for 30 minutes once every two
weeks or once a month by showing a video Or a nurse who gives
examples of progressive muscle relaxation movements in hemodialysis
patients, has an effect on reducing signs and symptoms of anxiety and
increasing the ability to control anxiety.
PMR therapy has a complex physiological mechanism from the
sympathetic and parasympathetic nervous systems. Which when PMR
therapy is carried out with the right steps, it can reduce the pulse rate,
decrease the respiratory rate and reduce muscle tension so that it can
elicit a relaxation response so that a calm state is achieved.
Progressive muscle relaxation can be done independently to deal with
anxiety before undergoing hemodialysis therapy according to the
recommendations and teachings of medical personnel, PMR also has
the potential to reduce anxiety levels so that it can lead to clearer
thinking and communication skills. PMR is a simple strategy to deal with
situations that are challenging. trigger anxiety like a simulation. dialysis
can be easily improved in hemodialysis patients through a simple and
inexpensive belief that relaxation techniques. Progressive muscle
relaxation also has a beneficial impact on sleep quality.
Based on several research results, it can be concluded that there
is a decrease in anxiety levels in hemodialysis patients between before
and after giving progressive muscle relaxation therapy.
CONCLUSION
Anxiety can increase the work of the sympathetic nerves in
response to stress. The sympathetic nervous system works to increase
the release of epinephrine, norepinephrine, cortisol and reduce nirit
oxide, this situation will cause changes in the body's response pattern.
such as increased heart rate, respiration, blood pressure, increased
blood flow to organs and increased body metabolism. The cause of
anxiety that is often experienced by CKD patients is due to the effects
felt when undergoing hemodialysis such as muscle cramps, chest pain,
headaches and hypotension. Patients also feel restless, weak, limbs
tremble and muscles feel tense. Therefore, PMR intervention can have
a positive effect on reducing anxiety levels, blood pressure and pulse
rate. In addition, PMR therapy has a complex physiological mechanism
from the sympathetic and parasympathetic nervous systems. Which
when PMR therapy is carried out with the right steps, there is a
parasympathetic nervous effect that can reduce pulse rate, reduce

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 respiratory rate and reduce muscle tension so that it can elicit a
response. relaxation so that a calm state is achieved
Based on the results of the literature review above, it shows that
before and after progressive muscle relaxation intervention once a
week in a month in patients who experience anxiety is very effective in
reducing anxiety in chronic kidney disease (CKD) patients undergoing
hemodialysis.
ACKNOWLEDGEMENT
From the results of this systematic review, further studies related
to interventions are still very minimal so that further researchers can
conduct research on chronic kidney disease (CKD) patients by using
other innovations to reduce anxiety.
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