The Effect of Distraction and Relaxation Techniques toward Pain
Intensity Changes in Postoperative Patients
Dewi Tiansa Barus
1
, Rostiodertina Girsang
1
, Mutiara Dwi Yanti
1
, Rentawati Purba
1
, Herri Novita
Tarigan
1
, Friska Ernita Sitorus
1,
Iskandar Markus Sembiring
2
1
Institut Kesehatan Deli Husada Delitua Jalan Besar Delitua No.77 Deli Serdang
2
Institut Kesehatan Medistra Lubuk Pakam Deli Serdang
Keywords: Pain Intensity, Distraction Technique, Relaxation Technique.
Abstract: Postoperative pain belongs to acute pain category with characterized by having fast, sudden and lasting
onset for short time. This research was conducted with Quasi Experiment method with "pre test-post test
design", the sample selection used purposive sampling. Samples were 52 respondents. Data collection is
carried out by using observation sheets, the data were processed by using the Wilcoxon Test with
significance level α = 0.05 (95%), from 52 respondents divided into 2 namely distraction technique of 26
respondents before doing mild pain intensity as many as 9 respondents (34.6%), mild pain as many as 17
respondents (65.4) after doing there was no pain as many as 9 respondents (34.6%), mild pain as many as 10
respondents (38.5%), and moderate pain as many as 7 respondents (26.9%). Furthermore, the relaxation
technique of 26 respondents before doing mild pain intensity as many as 10 respondents (38.5%), mild pain
as many as 16 respondents (61.5) after being done there was no pain as many as 11 respondents (34.6%),
mild pain as many as 8 respondents (38, 5%), and moderate pain as many as 7 respondents (26.9%). The
study results showed that there was significant influence between distraction technique of listening to music
with pain intensity change in postoperative patients (p value = 0.003 <α 0.05), and the existence of
significant influence between deep breathing relaxation techniques with pain intensity changes in
postoperative patients (p value = 0.002 value <α 0.05).
1 INTRODUCTION
Real pain is one signal for individuals about body
damage (Hadjam, 2011). The pain intensity often
shows the damage or injury level which is
experienced by individuals. Complaints about pain
or pain are often reasons for individuals to get
medical treatment. According to American Pain
Society (APS), 50 million Americans are partially or
totally paralyzed due to pain, 2 and 45% of
Americans need pain treatment that is persistent for
the rest of their lives. Approximately 50-80% of
patients in the hospital experience pain in addition to
other complaints that cause patients to be
hospitalized (Ivan, 2013).
Based on data obtained from WHO (World
Health Organization, 2014), in some developing
countries have a high prevalence such as Singapore
amounting to 15% in children 16.5% in adults, while
Thailand 7% in children and adults 10% While
Indonesia in the Central Bureau of Statistics data
(BPS2014) states the incidence rate of appendicitis
cases is from 140 people with appendicitis cases per
100,000 people. In the post-operation the patient
feels severe pain and 75% of sufferers have
unpleasant experiences due to inadequate pain
management (Sutanto, 2004 in Pinandita et al,
2012).
Provision of regional anesthesia is given to the
operation; anesthesia will affect the functioning of
body's system in terms of pain responding. Pain will
occur if anesthesia effects have disappeared. The
classification of pain felt varies which can be
affected by several factors. The Royal College of
Surgeons (RCS) reports that postoperative pain is
found in 30-70% of patients with moderate to severe
degrees. Other studies have shown that although the
incidence of postoperative pain has decreased by 2%
each year over the past 30 years, 30% of patients
still experience moderate pain and 11% of other
Barus, D., Girsang, R., Yanti, M., Purba, R., Tarigan, H., Sitorus, F. and Sembiring, I.
The Effect of Distraction and Relaxation Techniques toward Pain Intensity Changes in Postoperative Patients.
DOI: 10.5220/0009463300510057
In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 51-57
ISBN: 978-989-758-460-2
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
51

patients complain of severe pain (Anita Holdcroft,
2005).
Postoperative pain can also cause an increase in
metabolic rate and cardiac output, no appetite and
tense expression. Pharmacological approach is a
collaborative approach between doctors and nurses
that emphasizes drugs administration that can
eliminate pain sensations, damage the insulin
response, increase cortisol production. Frustration
and anxiety that causes the client to experience sleep
disturbance, complaining of pain either moderate or
severe pain in post surgery. While non-
pharmacological approach is an approach to the
client to eliminate the sensation of pain due to post
surgery (Brunner & Suddart, 2006). Giving
analgesics and narcotics to relieve pain do not
recommend because it can obscure the diagnosis
(Sjamsuhidajat, 2005). Nurses play a role in
identifying patient needs and helping patients meet
those needs including pain management (Lawrence,
2002). Broadly speaking there are two managements
to deal with pain, namely pharmacological and non
pharmacological management. Pain management by
doing relaxation techniques is an external action that
affects an individual's internal response to pain. Pain
management with relaxation measures includes
diaphragmatic breathing exercises, progressive
relaxation techniques, guided imagery, and
meditation; several studies have shown that
relaxation techniques are very effective in reducing
postoperative pain (Brunner & Suddart, 2001).
The provision of music therapy can affect
physiological functions in the respiratory system,
heart rate, and blood pressure. Music can also affect
the release of endorphins, the body's hormones that
provide feelings of pleasure that play a role in
reducing pain so that music can be used to divert
pain so that patients feel less pain. But the reality is
that in hospitals there is still a small percentage
using non-pharmacological methods in pain
management, one of which is music therapy.
Hospitals emphasize pain management by
pharmacological methods, one of which is analgesic
administration, especially in post-operative patients.
Where the provision of analgesics on an ongoing
basis, not in accordance with the rules and the right
monitor will cause dependence (Sulistyo, 2014).
Pain interventions can be done with pain
management strategies, including both
pharmacological and non-pharmacological
approaches. This approach is selected based on the
client's needs and goals. Interventions will succeed if
the pain has not become severe, and the greatest
success is often achieved if several interventions are
applied stimulantly (Smeltzer & Bare, 2014).
Previously, several studies related to this pain
have been carried out by Endang Fourianalistyawati,
based on the pretest and postets results, it is known
to decrease the amount of pain. Release techniques
are effective in reducing pain in addicts or residents
at BNN Rehabilitation Unit. Nurhafizah Erniyati,
Coping strategies affect the pain intensity. People
who have good coping strategies experience
moderate pain intensity but people with poor coping
strategies experience high intensity even severe pain.
Cakrangadinata, Robert based on his research results
that therapy with Cognitive-Behavioral approach can
deal with psychological factors from the experience
of pain in chronic pain patients. The difference
between this study and previous research is that the
variables explained are more focused on expressing
pain that appears after surgery.
Based on preliminary data taken by researchers
at one hospital in Deli Tua, in one day, there are
approximately 10 patients who underwent surgery
with variety of different complaints, there are
patients who have performed surgery and in
recovery stage, female patients who have undergone
surgery Caesarean sectio and post operative
appedictomy, colostomy found that on average the
patients experienced pain several hours after surgery
and the next few days patient asked the nurse to give
pain relievers because the patient could not resist the
pain that arises due to surgery.
The difference between this study and previous
research is that the variables revealed are more
focused on expressing pain that appears after
surgery. Where this research was conducted to
control pain in surgery patients with distraction and
relaxation techniques, it can be practiced and does
not cause side effects. Record studies show that 60%
to 70% of patients with pain tension can reduce pain
at least 50% by relaxing deep breathing.
2 METHOD
The study design was Quasi Experiment method
with Pre Test-Post Test design in which this
researcher aimed to find out the presence or absence
of the distraction and relaxation techniques influence
on decreasing intensity by observing before and after
the intervention. The research conducted at Deli Tua
SEMBIRING GENERAL HOSPITAL Deli Serdang
Regency. The study population were all post-
operative patients who were hospitalized in
Edelweis Room Deli Tua SEMBIRING GENERAL
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
52

HOSPITAL. The study sample used non-probability
sampling technique with purposive sampling type
with total of 52 samples with inclusion criteria: male
and female patients who have aged over 18 years
who experienced post-surgery, entered 2 days after
surgery, compost mentis awareness, stable
condition, patients who have received treatment after
surgery> 1 x 24 hours, scaled mild and moderate
pain, willing to become respondents in writing.
Exclusion Criteria: male and female patients who
have aged less than 18 years who experienced post-
surgery, decreased consciousness, stable condition,
had communication disorder, patients who had
received treatment after surgery <1 x 24 hours, had
severe pain scale, and were not in post caesarean
section patients. Primary data is taken directly from
respondents by using observation sheets that have
been compiled refer to objective criteria. Secondary
data consists of general description of the study
location and data of patients who have undergone
surgery. The study instrument used informed
consent, questionnaires including client
demographic data and observation sheets to observe
changes in pain intensity with distraction and
relaxation techniques usage, distraction and
relaxation techniques SOP and measuring
instruments carried out to measure pain by using
Numeric Rating Scale. Data processing techniques,
coding, editing, data tabulation and data entry used
univariate and bivariate analysis. The data obtained
were analyzed with Wilcoxon SPSS computer
program test. The consent form is respondent
(Informed consent), anonymous, (Anonymity),
confidentiality.
The research process was carried out by nurse
observation firstly for Postoperative patients on the
second day. The nurse measured the pain scale in
patients who said pain by using Pain Scale
Measurement Instrument, Numeric Rating Scale.
Furthermore, nurse provided interventions to
determine changes in pain scale with relaxation and
distraction techniques. After the intervention is done
the nurse measures again the pain scale. It can be
seen on figure 1.
Figure 1: Research flow
3 RESEARCH RESULT AND
DISCUSSION
3.1 Distraction Techniques
The respondents’ numbers involved in this
distraction technique of listening music were 26
respondents; all of them were post-operative patients
both male and female. These respondents were
inpatients. Based on the age characteristics, the
majority of respondents who have aged> 61 years
were 9 respondents or 34.6%, and the minority of
respondents who have aged 31-40 years was 1
respondent or 3.8%. Based on sex characteristics, it
was found that the majority of male sex was 14
respondents or 53.8%, and the minority of female
sex were 12 respondents or 46.2. Based on the
Distribution of Respondents' Characteristics from
Operational Experiences, it was found that the
majority were first-time operations of 14 people
(54%) and the minority of operations more than
once were 12 people (46%). It can be seen in Table
1 below.
Table 1: Characteristics Distribution of Postoperative
Patients Given Distraction Techniques Based on Age,
Gender and Operating Experience.
Characteristics n %
Aged
19-30
31-40
41-50
51-60
> 61
5
1
6
5
9
19,2
3,8
23,1
19,2
34,6
Total 26 100
The Effect of Distraction and Relaxation Techniques toward Pain Intensity Changes in Postoperative Patients
53

Sex
Male 14 53,8
Female 12 46,2
Total 26 100
Operation
Experience
First time
More than once
14
12
54
46
Total 26 100
Based on the distribution of the surgery type, it
was found that the majority were sectio caesarean
based on the age as many as 18 people (69%), while
the minority type of colostomy surgery were 23
people (8%). It can be seen in Table 2 below.
Table 2: Respondents Distribution Based on Operation
Type
Operation Type n %
Appendectomy 6 23
Caesarea Sectio 18 69
Colostomy 2 8
Total 26 100
According to surgery type of the patient undergo,
most patients undergo Caesarean Sectio surgery. In
this study, besides being given relaxation and
distraction techniques, patients are also given
pharmacological therapy by using analgesics. The
analgesic type which is used is ketorolac. To avoid
data confusion from relaxation and distraction
resulting with pharmacological effects of analgesic
administration, the action is performed 4-6 hours
after drug administration and or 60 minutes before
drug administration.
3.2 Relaxation Techniques
Based on the age characteristics, the results show
that the majority of respondents are in the age group
31-40 years old as many as 9 respondents or 30.8%,
and the minority of respondents who have aged 41-
50 years old as many as 2 respondents or 7.7%.
Based on sex characteristics, it was found that male
and female had the same number, namely as many
as 13 respondents or 50.0%. Based on the
Distribution of Respondents' Characteristics from
Operating Experience, the results show that the
majority were first-time operations as many as 17
people (65%) and the minority of operations more
than once were 9 people (35%). It can be seen in
table 3 below.
Table 3: Distribution of Characteristics of Postoperative
Patients Given Relaxation Techniques Based on Age,
Gender, Operating Experience
Characteristic n %
Age
19-30
31-40
41-50
51-60
> 61
7
8
2
6
3
26,9
30,8
7,7
23,1
11,5
Total 26 100
Sex
Male 13 50,0
Female 13 50,0
Total 26 100
Operation Experience
First Time
More than once
17
9
65
35
Total 26 100
Based on the distribution of surgery types, it was
found that the majority were sectio caesarean at the
age of 22 people (85%), while the minority type of
colostomy surgery was 1 person (4%). It can be seen
in Table 4 below.
Table 4: Respondents Distribution Based on Operation
Type
Operation Type N %
Appendectomy 3 11
Caesarea Sectio 22 85
Colostomy 1 4
Total 26 100
Based on bivariate analysis based on pain
intensity before doing distraction technique of
listening music in postoperative patients, it was
found that the majority of moderate pain intensity
were 17 respondents or 65.4%, and the minority of
pain intensity was no pain as many as 0 respondents
or 00.0%. Based on bivariate analysis based on pain
intensity after performing distraction technique of
listening music in postoperative patients, it was
found that the majority of mild pain intensity were
10 respondents or 38.5%, and the minority had no
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
54

pain intensity as many as 7 respondents or 26.9%. It
can be seen in the table below.
Table 5: Respondents Distribution Based on Pain Intensity
Before and After the Distraction Technique of Listening
Music in postoperative patients.
Pain
Intensity
Pre test Post test
N % N %
No Pain 0 0 9 34,6
Mild Pain 9 34,6 10 38,5
Moderate Pain 17 65,4 7 26,7
Total 26 100 26 100
Based on bivariate analysis of pain intensity
before doing postoperative patient relaxation
techniques, it was found that the majority of
moderate pain intensity were 16 respondents or
61.5%, and minority of pain intensity was no pain as
many as 0 respondents or 00.0%. Based on bivariate
analysis of intensity pain after doing relaxation
techniques for postoperative patients showed that the
majority had no pain intensity as many as 11
respondents or 42.3%, and minority with moderate
pain intensity were 7 respondents or 26.9%. It can be
seen in table 6 below
Table 6. Respondents Distribution Based on Pain Intensity
Before and After Relaxation Technique Done.
Pain
Intensity
Pre test Post test
N % n %
No Pain 0 0 11 34,6
Mild Pain 10 38,5 8 38,5
Moderate Pain 16 61,5 7 26,9
Total 26 100 26 100
Based on bivariate data, willcoxon statistics
results on pre-test distraction technique were
performed on 26 respondents and obtained mean of
1.65 and std, deviation of 0.485 which took
minimum of 1 and maximum of 2, then in the post-
test distraction technique was carried out on 26
respondents and obtained mean of 0.92 and std
deviation 0,796 which is minimum 0 and maximum
2 then get p-value 0,003 <α 0,05 then Ho is rejected
and Ha is accepted, which means there is significant
influence between distraction technique of listening
music with pain intensity changes in postoperative
patients. It can be seen in table 2.
The comparative analysis of pain intensity results
before and after relaxation technique done. Based on
bivariate data, willcoxon statistics results on
relaxation technique pre test were conducted on 26
respondents and obtained mean of 1.62 and std
deviation of 0.496 which took minimum of 1 and
maximum of 2, then on distraction technique post-
test was carried out on 26 respondents and obtained
mean of 0.85 and std deviation 0.834 which is
minimum 0 and maximum 2, then p-value of 0.002
<α 0.05 so Ho is rejected and Ha is accepted, which
means there is significant influence between deep
breathing relaxation techniques with pain intensity
changes in postoperative patients.
3.3 Distraction and Relaxation
Technique
The research results conducted on 52 respondents
before distraction and relaxation techniques
performing, it obtained respondents results with mild
pain intensity totaling 19 respondents or 36.5% and
moderate pain intensity totaling 33 respondents or
63.5%. And after the distraction technique
performing, it obtained the respondents results with
painless intersity were 20 respondents or 38.5%,
mild pain 18 respondents or 34.6%, and moderate
pain as many as 14 respondents or 26.9%. Results
obtained after being distraction and relaxation
techniques given, respondents stated that there were
pain intensity changes.
Astuti and Merdekawati Research (2016) with
the title influence of classical music therapy on pain
scale reduction in postoperative patients at H.
Abdoel Madjid Batoe Hospital Muara Bulian,
showed pain intensity before distraction technique
with 36 respondents, it is being known before classic
music therapy given, the average pain scale is 4.64
and after classical music therapy given, the average
pain scale is 2.92. There is an influence of
disrtaction technique on pain scale decrease in
postoperative patients at H. Abdoel Madjid Batoe
Regional Hospital Muara Buliand with p-value =
0.002. There are similarities in research results
conducted by Stania et al. The similarity is
significant effect of distraction technique action on
pain intensity changes.
The pain intensity change before and after
distraction technique of listening music was tested
by using Wilcoxon test at significance level of 95%
(α = 0.05), with p-value of 0.003 or in other words
p-value of 0.003 <α 0, 05. Therefore, Ho is rejected
and Ha is accepted. So, the study results show that
The Effect of Distraction and Relaxation Techniques toward Pain Intensity Changes in Postoperative Patients
55

distraction technique of listening music can reduce
the pain intensity in postoperative patients.
According to Smletzer and Bare (2010),
distraction which includes focusing the patient's
attention to others beside pain, it can be very
successful strategy and mechanism responsible for
other effective cognitive techniques. The
effectiveness of distraction depends on the patient's
ability to receive and generate sensory input in
addition to pain. According to Potter & Perry (2010)
this distraction technique can activate a reticular
system that will inhibit pain stimulus. This is causes
differences in pain intensity changes before and after
distraction technique.
According to Potter & Perry (2010) this
distraction technique can activate reticular system
that will inhibit pain stimulus. This is causes
differences in pain intensity changes before and after
distraction technique.
Research conducted by Aini, et al (2018) with
the title influence of relaxation techniques on the
pain intensity reduction in postoperative patients,
shows the pain intensity before relaxation techniques
performed by 30 respondents with mild pain scale of
8 respondents or 13.3%, while pain scale 22
respondents or 86.7%. The pain intensity after
relaxation techniques are done to get results with no
pain scale as many as 8 respondents or 13.3%, mild
pain scale 16 respondents or 66.7% and moderate
pain scale as many as 7 respondents or 20% .There
is the influence of relaxation techniques on pain
intensity decreasing in postoperative patients with p-
value = 0.001. There are similarities in the research
results conducted by Stania et al. The similarity is a
significant effect of distraction technique action on
pain intensity changes.
There was pain intensity change before and after
breathing relaxation techniques which were tested
by using Wilcoxon test at significance level of 95%
(α = 0.05), with p-value of 0.002 or in other words
p-value of 0.002 <α 0, 05. Therefore, Ho is rejected
and Ha is accepted. So, the study results indicate that
deep breathing relaxation techniques can reduce pain
intensity in postoperative patients.
There are similarities in research results where
there is change in pain intensity after deep breathing
relaxation techniques. This similarity is due to
repeated deep breathing relaxation techniques that
can cause comfort for the patient. This comfort sense
cause tolerance to pain that is felt. Pulling a deep
breath and filling the air in lungs can relax skeletal
muscles that experience spasms caused by tissue
incisions (trauma) at the time of surgery. Muscles
relaxing will increase blood flow to injured area and
accelerate healing and reduce (eliminate) pain
sensations.
The difference in the respondent's pain intensity
is caused by the administration of breathing
relaxation techniques itself, if breathing relaxation
techniques are done correctly it will cause pain
decrease that is felt to be reduced / optimal and the
patient feels are more comfortable than before,
otherwise if the breathing relaxation technique is
done incorrectly, the pain is felt little less but still
feels pain and the patient feels uncomfortable with
the situation. It can affect pain intensity, because if
deep breathing relaxation techniques are carried out
repeatedly, it will be able make a comfort sense that
will ultimately increase the tolerance of perception
in reducing the pain experienced. If someone is able
to increase their tolerance for pain, a person will be
able to adapt to pain, and also have good self
defense (Lukman, 2013).
4 CONCLUSIONS
Based on the research results conducted on 52
respondents who were given distraction and
relaxation techniques that decreased pain intensity in
post patients. And obtained p-value> α 0.05. Then
Ha is accepted, which means the influence of
distraction and relaxation techniques on the intensity
changes of postoperative pain.
Based on the above results, it cannot be
ascertained which actions are more effective in
dealing with the patient's pain, but it can be
ascertained that the administration of relaxation and
distraction techniques are equally effective at
reducing pain felt by postoperative patients.
ACKNOWLEDGEMENTS
This research was supported by Institut Kesehatan
Deli Husada Deli Tua, Institut Kesehatan Medistra
Lubuk Pakam, Sembiring Hospital Foundations and
Grand Med Hospital Foundation, Indonesia.
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