The Relationship of Spiritual Level and Patient Anxiety in the

General Ward

Merina Widyastuti, Iis Fatimawati, Siti Fatimah

STIKES Hang Tuah, Surabaya, Indonesia

Keywords: Spiritual Level, Adult, Anxiety Level.

Abstract: Spiritual state has a wide and strong influence on health. Spiritual level can decrease anxiety, depression,

anger, and improve the life quality of the patient. Anxiety is one of many psychological problems experienced

by patients in hospital. The purpose of this research was to define the relationship of spiritual and anxiety

levels in patients. The research design was used correlational observation. Simple random sampling was used

to obtain sample consisting of 52 respondents. The independent variable was the spiritual level, whereas the

dependent variable was the level of anxiety. Instruments using questionnaires. Data were analyzed using

Spearman's Rho (α < 0.05). Out of 52 respondents, 57,7 % were indicated to have high spiritual level. In

addtion to 30,8% were medium level, 17,3 % of whom were indicated low. There was a significant

relationship of spiritual and anxiety levels of the patient in general ward. The Spearman rho test results

obtained by value ρ = 0.01 with a level of trust <α = 0.05. The role of nurses is very important in providing

nursing care holistically, especially on the fulfillment of spiritual needs.

1 BACKGROUND

Anxiety is one of the many psychological problems

experienced by patients during their stay in the

hospital. Anxiety is a common human experience that

is the basic human emotion with anxiety, discomfort,

uncertainty, or fear of a danger (Varcarolis, Elizabeth

M & Jordan, 2010).

Spirituality is one's belief in the existence of

God, and this belief becomes a source of strength in

times of illness that affects his beliefs about the cause

of illness, the process of healing illness and choosing

the person who will take care of it (Hamid, 2008). A

person's faith has a broad and powerful influence on

health. Wahyu (2012) mentions that spiritual factors

influence the likelihood of increasing life expectancy,

decreased anxiety, feelings of depression and anger

other than that affect the decrease in blood pressure,

and improve the quality of life for patients. Until now

research of spiritual level can affect anxiety has not

been studied further. The purpose of this research was

to define the relationship of spiritual and anxiety

levels in patients.

Basic Health Research in 2013 showed that 14

million people in Indonesia aged over 15 years

experienced an emotional mental disorder shown by

symptoms of anxiety and depression (Kementerian

Kesehatan - Ministry of Health/Indonesia, 2014).

Survey of researchers in the month of September until

December 2017 in the hospital room dr. Ramelan

Surabaya showed 40% of patients experienced very

severe anxiety, 20% experienced severe anxiety and

20% experienced moderate anxiety and the rest did

not experience anxiety.

Asmadi (2008) states that anxiety experienced by

patients will affect the physiological system of the

patient This occurs through a series of actions

mediated by the pituitary adrenal hypothalamus,

anxiety will stimulate the hypothalamus to increase

the production of corticotropin releasing factor This

will stimulate the anterior pituitary hormone to

produce adrenocorticotrofic hormone

adrenocorticotrofic hormone will stimulate the

adrenal cortex to secrete cortisol. cortisol will

suppress the body's immune system

The spiritual dimension is an individual way of

maintaining harmony with the outside world in order

to maximize the power it has in itself to deal with

emotional stress, chronic, critical, terminal and death

physical illnesses (Utami, 2009). Spiritual approach

through praying will increase the autosuggestion that

can encourage someone to do according to the prayed,

ask for healing, optimism of hope for healing (Good,

2010). Therefore the role of nurses is very important

552

Widyastuti, M., Fatimawati, I. and Fatimah, S.

The Relationship of Spiritual Level and Patient Anxiety in the General Ward.

DOI: 10.5220/0008328405520556

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 552-556

ISBN: 978-989-758-336-0

to help patients in meeting spiritual needs such as

providing prayer equipment, always remind and

motivate to pray.

2 METHODS

This research was correlational analytic research with

cross sectional approach. The independent variable

was the spiritual level and the dependent variable was

the level of anxiety. The population of this study were

patients who were hospitalized in the hospital room

Dr. Ramelan hospital Surabaya during November

2017 – January 2018 with random sampling

technique obtained 52 respondents

The inclusion criteria such as 1) patients treated

in at ward room of internal disease in Dr. Ramelan

hospital Surabaya 2) the final adult age is 36 – 45

years 3) willing to be a respondent 4) all religion.

Exclusion criteria include 1) Patients experiencing

disorientation 2) Patients who experience a decrease

in consciousness. This study was conducted on 3 to 7

January 2018 at general ward in Dr. Ramelan hospital

Surabaya.

This research has been ethical clearence with

number ND/09/I/2018/Diklat in Dr. Ramelan

Hospital Surabaya. The instrument used to measure

the spiritual level was the spiritual experience scale

which adapted from Underwood and Teresi (2002).

Hamilton Anxiety Rating scale was used to measure

anxiety level. The Statistical test used was Spearman

rho test

3 RESULTS

Based on table 1 the majority of respondents are

female 41 (78.8%). Related age, the majority of

respondents aged 38-39 years were 13 respondents

(25%) and 40-41 year olds were 13 respondents

(25%). Related to the level of education, the majority

of respondents last high school education as much as

24 respondents (46.2%). Regarding employment, the

majority of respondents who work private sector as

much as 23 respondents (44.2%). Related diseases,

the majority of respondents suffering from diabetes

mellitus as many as 19 respondents (36.5%). With

regard to health insurance, the majority of

respondents who are responsible for the cost of using

BPJS as much as 45 respondents (86.5%).

Based on table 2 majority of respondents have

high spiritual level as many as 30 respondents

(57.7%) followed by moderate spiritual level as many

as 13 respondents (25.0%), and the remaining

Table 1: Selected sociodemographic variables of study

participants.

Characteristic

(%)

n 52

Age

36-37

38-39

40-41

42-43

44-45

15,4

19,2

15,4

Sex

Male

Female

21,2

78,8

last education

No School

primary school

Junior high school

Senior High School

3-year diploma

Bachelor

9.6

3.8

21.2

46.2

9.6

Occupation

No job

Private

TNI/POLRI

government employees

Farmer

1.9

44.2

23.1

21.2

9.6

Disease

experienced

Diabetes Mellitus

Chronic Kidney

Disease

Gastroenteritis

Hypertension

Urinary Tract Infection

Gastritis

Hepatitis

36,5

21,2

5,8

9,6

3,8

19,2

Health

Insurance

Not using health

insurance

Social Insurance

Administration

Organization (BPJS)

13,5

86,5

Table 2: Spiritual levels on respondents in general ward

(n = 52).

Spiritual level

Frequency (f)

Percentage

(%)

Low

Medium

High

17,3

25,0

57,7

Total

100

The Relationship of Spiritual Level and Patient Anxiety in the General Ward

553

low spiritual level as much as 9 respondents (17.3%).

Based on table 3, The majority of respondents

experienced no anxiety as much as 28 respondents

(53.8%) followed by mild anxiety as many as 14

respondents (26.9%), severe anxiety 7 respondents

(13.5%), and anxious weight once 3 respondents

(5.8%). Result of analysis relation of spiritual level

with patient anxiety level through Spearman rho test

got value ρ = 0,01 with level of meaning <α = 0,05

and correlation coefficient -0,708.

It can be concluded that there is a relationship

between the spiritual level with patient anxiety. The

direction of the relationship is strong and the opposite

where the higher the spiritual value the lower the level

of anxiety

4 DISCUSSION

According to Mohammed (2017) that a mother's

spirituality is a form of maintenance by providing for

the needs of the child and her husband. It is used as a

symbol of the nature of divine providence, because

the point of spirituality is obedience and obedience to

God. But another thing that needs to be considered in

this study is the characteristics of respondents who

are not homogeneous because the number of female

respondents more than the number of male

respondents

Respondents with high spiritual level (30

respondents) comprised 56.7% were 40-45 years old

and 43.3% were 36-39 years old. Researchers argue

that early adulthood is a transitional period, in that

age a person is usually more concerned with work and

social pursuits, whereas the spiritual changes that

occur in late adulthood are characterized by maturity

in their diverse lives.

Mature spiritual development will help in the face

of reality, play an active role in life, formulate the

meaning and purpose of life (Monir, R., Kazemnejad,

A., & Mohammadi, 2014). Based on the results of

research related to age, the majority of respondents

(53.8%) did not feel anxiety. The data of 28

respondents are over the age of 40 years. According

to Nursalam (2014) young age more easily anxious

than individuals with older age.

According to the researchers' observation why the

anxiety of the late adult respondents is lower because

they are already taking a step and believe that God is

giving a trial. This appears in the phenomenon of

some respondents who have a good quantity of

worship show a calm attitude. The majority of them

believe that illness is a guidance to be able to reduce

some of their sins.

Another case in the respondents with low spiritual

level found the majority felt the severe anxiety as

much as 6 respondents (66.70%) followed by

respondents who felt very heavy anxiety as much as

3 respondents (33.30%).

The spiritual level when associated with age

according to Hamid (2009) that spiritual development

is divided into several levels seen from age. The

middle age group and the elderly have more time for

religious activities and seek to understand the value

of religion. In the elderly the feeling of loss due to

retirement, facing the death of another (brother,

friend) will cause a sense of loneliness and

introspection.

The more mature religious physiological

developments can often help the elderly to face

reality, play an active role in life and feel valuable,

and more acceptable to death as something that can

not be denied or avoided. High spiritual level when

attributed type of disease experienced shows the

majority of respondents who suffer from chronic

diseases such as DM, chronic renal failure, hepatitis

and hypertension as much as 27 respondents (90%)

Other types of acute diseases such as gastritis and

urinary tract infections are experienced by

respondents who have moderate and low spiritual

levels. When the anxiety level is associated with the

type of disease, the results showed 28 respondents

(58.3%) did not feel anxiety with the majority of

respondents 24 respondents (85.7%) suffered from

chronic diseases such as diabetes mellitus, chronic

renal failure, hepatitis, and hypertension.

According to the researchers that respondents who

have chronic diseases and often hospitalized majority

have a low level of anxiety compared with

respondents who first entered the hospital. This is

because the respondent has adapted to the hospital

environment. In addition there are other factors that

affect the anxiety of respondents is the length of care.

But researchers are not the focus of current research.

According to the researcher's analysis of

spirituality is also a force that the patient needs during

Table 3: Level of anxiety in respondents in the general

ward.

Anxiety level

Frequency

(f)

Percentage

(%)

No sense of anxiety

Mild anxiety

Medium anxiety

Serious anxiety

Very severe anxiety

53,8

26,9

13,5

5,8

Total

100

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

554

hospitalization. Spirituality can affect the process of

healing and self-reinforcement or coping of the

patient in the face of his illness.

Putri, S. (2013) mentions spirituality as one's

belief in the existence of God, and this belief becomes

a source of strength during illness and thus affects his

beliefs about the causes of illness, the process of

healing illness and choosing the person who will care

for him

According to Nursalam (2014) the anxiety

experience of each individual varies and depends on

the situation and interpersonal relationships. There

are two precipitation factors that affect anxiety that is

internal factors and external factors. External factors

include the threat of self-integrity including

physiological inadequacies to basic needs due to

physical illness and trauma.

Respondents with low spiritual level showed the

majority felt the severe anxiety as much as 6

respondents (66,70%), felt very heavy anxiety

counted 3 respondents (33,30%). According to Basofi

(2016) religious approach becomes one form of

coping in the face of anxiety. In this case spiritual life

has an important role, someone who is grateful for the

favors will feel more sincere in the face of life.

Researchers analyzing religious activities can

result in an increase in serotonin levels that affect

spiritual awareness by generating fun / excitement.

Pleasure and happiness brings the effects of

relaxation, so relaxation can suppress anxiety that

arises feeling relaxed. Researchers analyze mild

anxiety that occurs in patients with high spiritual

levels due to several factors that can affect a person's

spiritual culture, life experience, and religious

practice.

One's spirituality is also influenced by life

experience. A person's positive and negative life

experiences can affect a person's spirituality and are

also influenced by how one perceives spiritually the

experience. Hamid (2008) states events in a person's

life are regarded as a trial God gives humans to test

their faith

According to Iswara (2016) severe anxiety greatly

reduces the field of individual perception. Individuals

will tend to focus on something detailed and specific

and do not think about anything else. All behaviors

are shown to reduce tension. Individuals need a lot of

referrals so they can focus on other areas.

From the observation of the researchers that

respondents with severe anxiety have a low spiritual

level associated with spiritual support.

Spiritual support serves as the shaper of individual

coping mechanisms against life-threatening

situations, in this case a reference to healing (Riley et

al., 1998). The spiritual role in coping mechanisms is

as a spirit or motivation for life. The coping

mechanism that is formed depends very much on the

personality of the person and the extent to which the

pressure of a condition it faces.

Dr. Ramelan Hospital Surabaya has also provided

spiritual guidance on a regular basis. This is

illustrated by reminding of the prayer times

announced through the speakers in each treatment

room. The role of nurses in providing nursing care

holistically includes physiological, psychological,

sociocultural, and spiritual dimensions is very

important. Such spiritual support as bringing

religious leaders to the faith of the believer, giving

privacy to prayer, giving the patient the opportunity

to interact with others, family or friends

5 CONCLUSIONS

Based on the findings of the study, it was concluded

that the role of nurses is very important in providing

nursing care holistically, especially on the fulfillment

of spiritual needs For further research it is necessary

to note the gender homogeneity of the respondents so

that the results obtained are more representative and

also with the larger number of samples in addition to

the length of treatment is also an influential factor.

Subsequent research can be done by comparing

spiritual levels in hospital-based patients with

religious values with other private hospitals

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