LITERATURE REVIEW: TREND AND ISSUE IN

COMPLEMENTARY CARE

NI WAYAN APRIYANTI, NI KADEK SEPTIA DEWI, NI

PUTU GITHA VERA ASTARI, PRAMA JUNIARTHA

Fakultas Keperawatan Stikes Wiramedika Denpasar

Jalan Kecak No 9A, Tonja, Kec.Denpasar Utara, Kota
Denpasar
Bali 80239

Abstract

Complementary therapies have recently become an issue in many countries. People use this
therapy for reasons of belief, finances, chemical drug reactions and cure rates. Nurses have the
potential to be involved in this therapy, but need support from research results (evidence-based
practice). Basically, complementary therapy has been supported by various theories, such as the
theory of Nightingale, Roger, Leininger, and other theories. Complementary therapy can be
used at various levels of prevention. The nurse can play a role according to the client's needs.
The increasing need and the development of the community towards complementary therapy is
an opportunity for nurses to participate according to the needs of the community. The nurse can
act as a consultant to the client in choosing appropriate alternatives or assisting direct therapy.
However, this needs to be further developed through research (evidence-based practice) so that
it can be used as a better treatment therapy.
 PRELIMINARY
Pain prevalence can be difficult to quantify based on the subjective variation of individual pain.
The US Department of Health and Human Services shows that pain affects more Americans
than heart disease, cancer, and diabetes combined. The National Center for Health Statistics
estimates that 1 in every 4 Americans has pain that lasts more than 24 hours. Research shows
25 million American adults get sick every day. The National Health Interview Survey found
that half of American adults (125 million) have pain identified as musculoskeletal. More than
40% of adults use complementary approaches in treating musculoskeletal pain. Overall out-of-
pocket spending on complementary health approaches is approximately $30 billion per year.
In addition to pharmacological therapy, pain can be overcome by pharmacological and non-
pharmacological therapy. Several pharmacological therapies are used as pain management such
as systemic analgesics, narcotic analgesic compounds, analgesic effect generating agents. Side
effects of such therapy are nausea, vomiting, dizziness. Some of the non-pharmacological
therapies that are often applied include breathing techniques, acupuncture, transcutaneous
electric nerve stimulation (TENS), audionalgesia, hot cold compresses, massage and
aromatherapy (Gondo et al, 2011).
Complementary therapy has recently become the center of attention in many countries, this is
because of the holistic philosophy of complementary therapy which means the existence of
harmony in oneself and the promotion of health in complementary therapy. The increasing
needs of the community and the development of research on complementary therapies are
opportunities for nurses to participate in providing complementary therapies. Nurses can act as
consultants to clients in choosing appropriate alternatives or help provide direct therapy. The
provision of complementary therapies in nursing care needs to be further developed in evidence
based practice so that it can be used as additional therapy in nursing care.
Aromatherapy is a complementary therapy in nursing practice and uses essential oils from
fragrant plants to reduce health problems and improve quality of life. Sharma (2009) said that
smell has a direct effect on the brain like analgesic drugs. For example, smelling lavender will
increase alpha waves in the brain and help you feel relaxed. In addition to providing
aromatherapy, music can also cure chronic pain, it works on the autonomic nervous system,
which is the part of the nervous system that is responsible for controlling blood pressure, heart
rate, and brain functions that control feelings and emotions. According to research, both
systems react sensitively to music (Muttaqin, 2008).
Based on the problems above, it is important to conduct a literature search to identify
complementary sensory therapies movement therapies in reducing pain, as a first step to
identify problems and determine appropriate interventions in overcoming pain that will have an
impact on improving the quality of nursing care in treating patients.

METHOD

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 This literature review aims to identify complementary sensory movement therapies in reducing
pain. Articles were collected through the Medline database, Google Scholar, Science Direct,
Pubmed using the keywords: HIV-related stigma, discrimination, health care worker consisting
of qualitative and quantitative studies. The selected articles are those that meet the criteria based
on the PICO, published in the 2009-2019 range, and are in English and Indonesian. The articles
are then evaluated using critical appraisal and PRISMA guidelines. Based on this evaluation,
there were 6 (six) articles reviewed. The PRISMA diagram for determining the literature is as
follows:
Diagram 1

RESULT

Table 1. Summary of Research Results

Author Purpose Design Intervention Outcome

and Population
Fidora, 2019 For Pre-experimental design 1. Measure scale the patient's The results of the
determine the effect of with a one-Group Pretest pain was measured. study identify
3
 classical music therapy on Posttest design with a 2. Given classical music that there are
post-section pain sample size of 28 therapy (treatment) by therapeutic effect
reduction respondents researchers for 15 minutes classical music
caesarea 3. Re-measured (post-test) to decrease pain
the patient's pain scale scale in post
4. Compared between scales sectio caesarea
5. pre-test pain with post-test. patients

Sri Utami, For 1. Quasi experimental Action The intervention

2016 knowing the effect of design al, pre-test and giving bitter orange (Citrus group showed a
bitter orange post-test with control Aurantium) aromatherapy is a decrease in pain
aromatherapy to reduce group. non-pharmacological therapy 3.44 (low pain)
postnatal pain sectio 2. Numerical rating scale which is an alternative non- with a pain
caesarea instrument to calculate pharmacological technique, reduction value
the intensity of it. which can be given to patients to of 1.47, and a
3. Engineering purposive reduce pain. mean value of
sampling, a sample of 4.82 in the
34 respondents and control group
divided into 2 groups (sufficient pain)
with a reduction
value of 0. The p
value (0.000) <
0.05. So that
bitter orange
aromatherapy
can be
recommended as
an intervention
for postnatal care
by cesarean
section.

Sri Karyati, The purpose of this number of samples 66 by comparing changes in pain there is a
Noor, 2015 study was to determine consisting of 33 people in level significant
the effect of religious the intervention group before and after religious difference in
music therapy on and 33 people in the music therapy in the control pain scale
reducing the level of control group. quasi- group between the
pain in spontaneous intervention (quasi- groups who
childbirth experimental), post-test received
design with control group religious music
therapy and
those who did
not get it with a
value of p =
0.00

Rahmawati & The purpose of this 1. This research analyzes measuring the pain scale lavender
Ina, 2010 study was to determine using a quasi- using a numeric Rating Scale aromatherapy
the effectiveness experimental method with before and after being given and lemon
between lavender a two-group pre-test and aromatherapy aromatherapy
aromatherapy and post-test design are effective in
lemon aromatherapy at 2. sample 56 respondents, reduce the post
Budi Rahayu Hospital, 28 respondents lavender sectio caesarea
Magelang City aromatherapy group pain scale, but
and 28 lemon
lemon aromatherapy aromatherapy
group respondents. is more
effective in
overcoming
post sectio
caesarea pain

4
 with an average
value of 4
greater
compared to
the average
lavender
aromatherapy
which is 2.15.

Andreas.,I analyzed differences in 1. This type of research is 1. Researchers give/hear 1. There is a

smonah., pain intensity in cancer "experimental" therapy difference in
& patients before and clinic” by using Mozart classical music using pain intensity
Wulandari., after classical music Pretest-Posttest One earphones in cancer
n.d.
therapy at Telogorejo Design research design. for 15-20 patients before
Hospital Semarang 2. The sample used is 16 minutes and and after
respondents. After the therapy ended, the classical music
Effect of lavender 3. pre-experimental with researcher again measured the therapy at
aromatherapy on pain one group pretest-posttest scale of the pain intensity felt Telogorejo
intensity in design form by the respondent. Hospital
postoperative patients 2. Respondents were asked to Semarang.
breathe normally, not to do 2. The results
other activities while inhaling of the statistical
aromatherapy, in a quiet test obtained a
room. Then one hour later the p value of
pain scale was measured 0.001 which
again. means that
there is a
difference in
pain intensity
between before
and after being
given lavender
aromatherapy.

DISCUSSION

Based on the results of a literature review, it can be seen that complementary therapies that are
included in the category of Sensory Movement therapies are as follows:
1. Aromatherapy
Sharma (2009) said that smell has a direct effect on the brain like analgesic drugs. For example,
smelling lavender will increase alpha waves in the brain and help you feel relaxed.
The use of essential oils and aromatherapy are two complementary therapies dating back
thousands of years. These therapies, the fastest growing CAT, are popular and available for
patients to purchase at their local market or health food store. Essential oils and aromatherapy
products may not be available in hospitals or other health care settings, and nurses may have
limited training or knowledge about their use. Essential oils are made from various parts of
plants, herbs, or trees (i.e., bark, stems, flowers, bark, and roots), and are used for a variety of
therapeutic reasons by patients of all cultures and backgrounds. There are many types of
essential oils, and their indications are very wide. Essential oils may be used topically, diffused
through the air, inhaled, or added to liquids or foods for oral consumption. They can be
combined with other CAT modalities, including massage therapy. Essential oils have the ability
to prevent bacterial and fungal growth, support wound healing, prevent or reduce inflammation,
and provide comfort, and they have anesthetic and analgesic properties (Jopke K, et., al, 2017 &
Halcon 2014).

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Aromatherapy consists of using fragrant essential oils for a variety of healing and health
benefits. Aromatherapy is most effective when used as an adjunct to pain management. Jopke
K, et., al, 2017 & Halcon 2014). Once essential oils are absorbed into the circulatory and
nervous systems, it is thought that all body systems can be affected by aromatherapy (Halcon
2014). The administration of aromatherapy is important to consider when developing a specific
treatment plan for pain.
With regard to pain, various studies link the use of aromatherapy and essential oils with
pain control. The most commonly studied essential oil showing an analgesic effect is lavender.
Studies have shown that lavender is associated with reduced pain levels in patients after
cesarean section, after tonsillectomy, after arthroscopic knee surgery, and after breast biopsy.
Other essential oils that aid in pain management include German chamomile, sweet marjoram,
dwarf pine, rosemary, and ginger. This oil has been shown to improve pain management and
improve comfort in patients with rheumatoid arthritis, headaches, muscle aches, swollen joints,
and other pain complaints.

Combining aromatherapy with massage has been found to increase the efficacy of pain
management (Metin et., al 2016 & Nasiri et., al 2016). When considering the use of essential
oils as part of a treatment plan, the nurse should take into account the potential risks,
implications, demonstrated efficacy, and indications for therapy. Usually, essential oils should
not be used at a concentration of 100%. They need to be diluted to lower concentrations,
especially for patients younger than 2 years. Essential oils can have adverse effects, including
the risk of toxicity, skin irritation, photosensitivity, and severe allergic reactions. If there is
suspicion for a potential allergic reaction, skin testing may be necessary before use. Proper
dilution minimizes the risk of reaction and sensitivity.
Essential oils and aromatherapy products are not regulated by the US Food and Drug
Administration (FDA). Only essential oils and unaltered products sold from reputable
companies that do not counterfeit products should be used. Nurses should not administer
essential oils without proper education and well-developed protocols. If used in a hospital or
outpatient setting, a material safety data sheet describing the properties and ingredients of the
oil should be available. Essential oils and aromatherapy should be used with caution by
pregnant women or women who are breastfeeding. Some essential oils should be avoided
because of the risks to infants, young children, and elderly patients. Lavender aromatherapy is
beneficial for relaxation, anxiety, mood, and post-surgery shows a decrease in anxiety, mood
improvement, and an increase in the strength of alpha and beta waves which indicate an
increase in relaxation. Alpha waves are very beneficial in a relaxed state encouraging the flow
of creative energy, giving a fresh and healthy feeling.

2. Music Therapy
Music therapy is a complementary sensory therapy that has been used by various cultures for
thousands of years. Music therapy involves listening to music, writing music, or playing music.
The most common form of music therapy involves active listening to music. Patients can wear
headphones or listen through speakers. They can choose their music or listen to a predefined
playlist developed by a music therapist. From classical music to nature sounds, and country to
rock and roll, music can have different physical effects, including decreased anxiety and stress,
improved mood, decreased heart rate and blood pressure, increased circulation, and decreased
pain perception.
Research has shown that music therapy has a positive impact on the experience of pain.
Reducing pain levels, reducing muscle tension, and reducing opioid use have been observed in
obstetric patients in labor who participate in music therapy. Other diagnoses or conditions for
which music therapy has demonstrated efficacy include patients with neuropathic pain, cancer
pain, pain associated with burn debridement, procedural pain, postoperative pain, and pain
associated with palliative care.
Music therapy can be initiated in a patient care setting. Various studies show significant
differences in patient pain levels in hospitals, intensive care units, palliative care areas, and
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postoperative settings. Music therapy may be administered by a trained music therapist, but it
can also be initiated independently by nurses, patients, family members, or other members of
the health care team. To facilitate music therapy, the nurse should encourage the patient or
family to bring listening equipment (eg, iPod, MP3 player, CD, radio) or access listening
materials available through the health care facility. If the right equipment is available, there is
no cost for this therapy, and there are minimal or no adverse side effects. Studies have shown
that environmental manipulation and patient involvement enhance the efficacy of music therapy
when used for pain management. Allowing patients to choose their own musical style of choice
has shown a plus. Gutsgell et al (2013) In addition, making adjustments to the patient's
environment, such as dimming lights, providing blankets, turning off electronics and cell
phones, and placing a do not disturb sign, has increased overall effectiveness. Music can have
the effect of reducing chronic pain, affecting the autonomic nervous system, which is the part of
the nervous system responsible for regulating blood pressure, heart rate, and brain functions that
control feelings and emotions. According to research, both systems react sensitively to music
(Muttaqin, 2008). The emergence of a pleasant stimulus from outside the body such as music
therapy can stimulate the secretion of endorphins, so that the painful stimulus felt by the patient
is reduced. Pain relief in general is directly related to the active participation of the individual,
the number of sensory modalities used, and the individual's interest in stimulation, so that brain
stimulation will be more effective in reducing pain (Tamsuri, 2007).

CONCLUSION
The provision of complementary sensory therapies movement therapy for pain reduction with
aromatherapy and music therapy which has an effect on reducing pain intensity in patients is
characterized by a decrease in the average value of pain intensity before and after being given
aromatherapy and music therapy. These results provide an overview of aromatherapy and music
therapy in reducing pain. Further research can explore other types of complementary therapies
as well as the effectiveness of these complementary therapies in reducing pain.

BIBLIOGRAPHY

Andreas.,Ismonah., & Wulandari. (n.d.). PERBEDAAN INTENSITAS NYERI PADA

PASIEN KANKER SEBELUM DAN SESUDAH PEMBERIAN TERAPI MUSIK KLASIK
DI RUMAH SAKIT TELOGOREJO, 001(scale 6).
Rahmawati & Ina. (2010). LEMON TERHADAP INTENSITAS NYERI POST SECTIO
CAESAREA ( SC ) DI RUMAH SAKIT BUDI RAHAYU KOTA MAGELANG, 10–16.
Sharma, S. (2009). Aromaterapi. Jakarta: Karisma.

Sri, Karyati., Noor, H. (2015). University Research Coloquium 2015 ISSN 2407-9189
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Sri,Utami. (2016). EFEKTIVITAS AROMATERAPI BITTER ORANGE TERHADAP

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