Effectiveness of Benson’s Relaxation Technique Vs Music Therapy on

Bio-Psychological Parameters of Haemodialysis Patients

Mrs. G. Maheswari¹, Mr. Edwin Sam²

¹PhD Scholar, Saveetha University, Chennai

²M.Sc (N), II year Student, Dhanvantri College of Nursing, Namakkal (Dt.)

*Corresponding Author Email: mahipraneeth@gmail.com

ABSTRACT:

Hemodialysis is the procedure to remove waste and excess fluid from the blood when the kidney cannot do so sufficiently through the process of diffusion, osmosis and ultra filtration using external dialyzer. Studies have revealed that, about one million people are undergoing haemodialysis worldwide. In haemodialysis patient there may be a chance for developing complications. To overcome the complications during procedure the researcher adopted the alternative therapies.

Objectives: To compare the effectiveness of Benson’s relaxation technique Vs Music therapy on bio psychological parameters among patient under haemodialysis.

Design: True experimental where Factorial design was used.

Setting: Government Head Quarters Hospital, Erode

Sample size: Total sample size was 30 patient under haemodialysis out of which 15 were experimental group I and 15 were experimental group II.

Sampling technique: Simple random sampling technique was used to select the sample.

Methods: Experimental group I received Benson’s relaxation technique and experimental group II received music therapy 30 minutes 3 times a week. Pre test was done by using Vital parameters observation tool and Spielberger State Anxiety Inventory (STAI-S) and post test was done by using the same scale on the 8^th day.

Results: From the findings of the study it can be concluded that Most (46% and 40%) of the patients under haemodialysis were in the age group of above 50 years. Most (60% and 53%) of the patients under haemodialysis were male. Most (47% and 40%) of the patients under haemodialysis were under less than 3 hours and 3 -4 hours duration of dialysis. Most (80% and) of the patients under haemodialysis had no previous history of dialysis. Most (47% and 53%) of the patients under haemodialysis had no/low trait anxiety and moderate trait anxiety. Most (94% and 100%) of the patients under haemodialysis were non medical profession. The paired‘t’ value for experimental group I was 18.21 and 13.62 15.8 whereas in experimental group II 23.52 and anxiety was 17.42 respectively. Unpaired t test value for vital parameters was 15.96 and anxiety was 6.42. No significant between association between post test scores of bio psychological parameters with their demographic variables like age, gender, previous history of dialysis and occupation, whereas significant association in experimental group I trait anxiety and experimental group II was duration of dialysis and trait anxiety.

Conclusion: Benson’s relaxation technique as well as Music therapy both can be used for bio psychological parameters among patient under haemodialysis. But music therapy was more effective than Benson’s relaxation technique on bio psychological parameters among patient under haemodialysis

KEY WORDS: Benson’s relaxation technique, music therapy, bio psychological parameters, haemodialysis patients.

INTRODUCTION:

Patients undergoing haemodialysis, besides the disease itself, accompanying modifications in the occupational, marital, familial, societal, and personal life provides a sufficient base to give rise to anxiety. The effect of illness, dietary constrains, time restrictions financial burdens, feeling of handicap, psychological strain of awareness of impending death, and many such factors impend the normal life and normal ways of coping. When people come to hospital seeking care for their illnesses this truth is forgotten and ignored and they are cared only for their physical symptom. Over recent years, there has been increasing attention given to understanding the individual’s interaction of psychological factors with medical outcomes (Kohli S, Batra P, Aggarwal HK.2011).

The incidence of ESRD has increased by almost 8% per year for the past five years. In the united states, more than 280,000 patients with chronic renal failure (65%) are receiving hemodialysis; more than 120,000 (28%) have functioning renal transplants, and more than 24,000 (7%) are receiving peritoneal dialysis (United States Renal Data System, 2004).

According to national kidney foundation, approximately 80,000 people die from kidney disease in this country every year. In 2002 only 9% were free of co-morbid conditions. More than 65,000 patients with ESRD die annually, and 23% annual mortality rate reflects the degree to which ESRD affects mainly a severely ill geriatric population (White.L.et.al, 2005).

A descriptive study was conducted to assess the stress and coping mechanisms of 50 patients undergone haemodialysis at Holy Family Hospital and Research centre, Bandra, Mumbai. The stressor scores shows that 29.26% were experiencing physiological stress, 42.52% psychological stress; socioeconomic 16.72% and spiritual 6.66% . The highest level of stressors was identified in psychological area. The finding of the coping mechanisms scores were-factor I active coping (28%); Factor II avoidance coping (30%); Factor II Minimize the situation (42%) (Sr. Catherine, 2011).

The people who are undergoing heamodialysis may develop anxiety. Anxiety, an emotion characterized by feelings of apprehension and helplessness, is nearly always present in people undergoing medical procedures. Most patients would prefer to relieve anxiety because of the psychological discomfort it causes. The medical professionals are aware of the physiological complications of anxiety. Anxiety is known to cause increased blood pressure, heart rate and respiration rate, all of which lead to poor circulation, and can cause fluctuations in body temperature, urinary urgency, enlarged pupils, and loss of appetite .It has been found that anxiety leads to increased cortisol levels, which inhibit the immune system and blood clotting. Lastly, conditions that arouse anxiety increase pain. Thus, it is always a challenge to care providers to keep anxiety at a minimum for patient’s comfort and safety (Rachel L. Perlman , 2008).

Music is a wave, a vibration, which resonates with our nervous system and gives rise to emotions which can calm or stimulate. It modifies our mood and facilitates the body’s homeostasis. The action of music touches the limbic system where the key to our emotions is situated. The rhythm, tonality and intensity of sounds stimulate our emotional reactions and produce a state of well-being which in turn favours calmness, equanimity, and an improvement in our physical and psychological state (Maryam Didehdar 2010).

There are many relaxation techniques helps in reduction of stress and anxiety. Among these relaxation techniques the researchers selected the Benson’s relaxation technique and music therapy for evaluating their effectiveness on stress and its changes in haemodialysis patients.

STATEMENT OF PROBLEM:

“A study to compare the effectiveness of Benson's relaxation technique Vs music therapy on bio psychological parameters among patients under haemodialysis in government head quarters hospital, erode”

OBJECTIVE:

To compare the effectiveness of Benson's relaxation technique Vs Music therapy on bio psychological parameters among patients under haemodialysis in experimental I and experimental group II

OPERATIONAL DEFINITIONS:

Benson’s Relaxation Technique:

It consists of 5 steps

1. Prepare to relax:

· Make sure you will be warm. Use a blanket or extra clothes if need be.

· Sit quietly in a comfortable position.

· Close your eyes.

· Think about letting go of the tension in all your muscles, beginning at your feet and moving up to your face.

· Keep the muscles loose.

2. Focus on your breathing:

· Breathe through your nose.

· Become aware of your breathing.

· As you breathe out, say the word 'one' silently to yourself (or another word, such as 'calm'., 'peace', or 'easy'.)

· Breathe easily and naturally.

3. Don't try too hard:

· Do not worry about it if you are not good at reaching a deep level of relaxation – let it happen at its own pace.

4. Deal with distractions:

· Distracting thoughts will probably occur. Do not dwell on these. Just return to repeating 'one' (or your own word).

· If you start to feel a little dizzy or breathless this will be caused by over-breathing because you are feeling anxious about doing it right. Just breathe out when your body naturally wants to and concentrate on saying your word.

· If you notice a slight tension in your 'favourite spot' - your jaws, neck or scalp - this will be because you are trying too hard. Just let go - this type of relaxation comes when you are not thinking about it!

5. Bring your relaxation to an end:

· After relaxing for 10-20 minutes, begin to bring your relaxation to an end.

· You may open your eyes to check the time but do not use an alarm, which will make you tense up again.

· When you finish, sit quietly for several minutes, at first with your eyes closed and later with your eyes open. Then sit comfortably in bed. This relaxation technique given to the patients during dialysis for 30 minutes for 3 times a week

Music therapy:

Music therapy refers to the administration of rhythmic instrumental music, which consists of 9 uninterrupted sequences with different effects.

Description of Selected Music:

The music was recorded in an I-pod and played for the patients through head phones. Therapy was given for 30 minutes for 3 times a week.

Bio-Psychological Parameters:

Bio-psychological parameters involves

Vital parameters.

Anxiety

1. Anxiety:

Anxiety refers to unpleasant and uncomfortable experiences during hemodialysis period among patients which is measured by Anxiety assessment scale.

2. Vital Parameters:

· Vital parameters include:

· Systolic blood pressure

· Diastolic blood pressure

· Heart rate

· Respiratory rate

· Which are assessed by vital parameters assessment scale

Hypotheses:

H_1:

There is a significant effectiveness of Benson's relaxation technique Vs Music therapy on bio psychological parameters among patients under haemodialysis in experimental I and experimental group II

THE FINDING OF THE STUDY:

Section A:

Assess the level of bio psychological parameters among patients under haemodialysis experimental I and experimental group II before and after Benson's relaxation technique and Music therapy

Frequency and percentage distribution of pre and post test scores on bio psychological parameters among patients under haemodialysis in experimental group I.

Frequency and percentage distribution of experimental group I and II post test scores of level of anxiety among patients under haemodialysis depicts that, In experimental group I in pre test similar percentage (47%) of them had low and moderate level of anxiety whereas in post test 67% 0f them had low anxiety and 27% of them had moderate levels of anxiety. It seems that music therapy on anxiety among patients under haemodialysis was more effective than benson’s relaxation technique.

Frequency and percentage distribution of experimental group I and II post test scores of level of vital parameters among patients under haemodialysis depicts that, In experimental group I in pre test most percentage (67%) of them had moderate level of vitals whereas in post test 80 % 0f them had moderate level of vitals. In experimental group II 80 % of them had moderate level of vitals whereas in post test 67% of them had normal vitals. It seems that music therapy on anxiety among patients under haemodialysis was more effective than benson’s relaxation technique. Section

B: Compare the effectiveness of Benson's relaxation technique Vs Music therapy on bio psychological parameters among patients under haemodialysis in experimental I and experimental group II

Table 1:

S. No	Name of the cd	Duration	Effects
1.	Peaceful hymns	3mins	Settles down troubled mind
2.	Peaceful hymns	2mins and 23secs	Brings inward relaxation to the mind
3.	Peaceful hymns	3mins and 12secs	Regulates the breathing pattern and awakens the deep thoughts
4.	Peaceful hymns	2mins and 56secs	Brings in a sense of joy
5.	Sound scopes-Music of the rivers	9mins and 53secs	Takes one to the imagery world
6.	Peaceful Hymns	3mins	Betrays the depth of loneliness and the feeling of deprivation
7.	Peaceful Hymns	3mins and 34secs	Relaxes the body
8.	Sound Scopes-Music of the Seas	54secs	Evokes thoughts
9.	Sound Scopes-Music of the Seas	1min and 4secs	Relaxes the mind and calms the soul

Table 2: Frequency and percentage distribution of pre and post test scores on anxiety among patients under haemodialysis in experimental group I and II (n₁=15) (n₂=15)

Level of anxiety	Experimental group I						Experimental group II
	Pre test		Post test		Pre test		Post test
	n	%	n	%	n	%	n	%
No/ Low anxiety	7	47	10	67	8	53	13	87
Moderate anxiety	7	47	4	27	5	33	2	13
High anxiety	1	6	1	6	2	14	-	-

Table 4: Paired “t” test value of pre and post test scores of experimental group I and II

Bio psychological parameter	Paired ‘t’ value		Table value	Level of significant (P)
Bio psychological parameter	Experimental group I	Experimental group II	Table value	Level of significant (P)
Systolic pressure	6.7	10.7	2.15	P < 0.05 significant
Diastolic pressure	6.65	2.8	2.15	P < 0.05 significant
Heart rate	5.82	11.9	2.15	P < 0.05 significant
Respiratory rate	2.8	13.41	2.15	P<0.05 significant
Total	18.21	23.52	2.15	P<0.05 significant
Anxiety scale	13.62	17.42	2.15	P<0.05 significant

Df =14 Table value=2.15 P<0.05 significant

Table 5: Mean, SD, and Mean percentage of experimental group I pre and post test scores on bio psychological parameters.

Bio psychological parameter	Max scores	Experimental group I						Difference in mean %
		Pre test			Post test
		Mean	SD	Mean %	Mean	SD	Mean %
Systolic pressure	4	2.1	0.316	53	1.6	0.42	40	13
Diastolic pressure	4	2.1	0.316	53	1.8	0.42	45	8
Heart rate	4	3.2	0.42	80	2.9	0.42	73	7
Respiratory rate	4	3.4	0.51	85	3.3	0.67	83	2
Total	16	10.6	0.965	66	9.4	1.15	59	7
Anxiety	80	36.33	8.96	45	34.33	8.06	43	2

Fig 1: Bar diagram showing mean percentage distribution of experimental group I pre and post test scores of Bio psychological parameters

Table 6:Mean, SD, and Mean percentage of experimental group II pre and post test scores on bio psychological parameters.

Bio psychological parameter	Max scores	Experimental group II						Difference in mean %
		Pre test			Post test
		Mean	SD	Mean %	Mean	SD	Mean %
Systolic pressure	4	2.8	0.52	70	1.05	0.22	26	44
Diastolic pressure	4	2.9	0.306	73	1.2	0.40	40	33
Heart rate	4	3.2	0.48	80	1.85	0.36	46	34
Respiratory rate	4	3.4	0.48	85	1.5	0.60	38	47
Total	16	12.4	0.725	78	8.6	0.68	54	24
Anxiety	80	35.67	7.78	45	28.07	5.54	35	10

Table 7: Unpaired ‘t’ test value of post test scores of bio psychological parameters in experimental I and II

Bio psychological parameter	Unpaired ‘t’ value	Table value	Level of significant (P)
Systolic pressure	10	2.05	P < 0.05 significant
Diastolic pressure	6.36	2.05	P < 0.05 significant
Heart rate	9.2	2.05	P < 0.05 significant
Respiratory rate	8.53	2.05	P<0.05 significant
Total	15.96	2.05	P<0.05 significant
Anxiety	6.42	2.05	P<0.05 significant

Df=28

Table value=2.05

P<0.05 significant

Table 8: Comparison of Mean, SD, and Mean percentage of experimental group I and II post test scores on bio psychological parameters.

Bio psychological parameter	Max scores	Post test scores						Difference in mean %
		Experimental group I			Experimental group II
		Mean	SD	Mean %	Mean	SD	Mean %
Systolic pressure	4	1.6	0.42	40	1.05	0.22	26	14
Diastolic pressure	4	1.8	0.42	45	1.2	0.40	40	5
Heart rate	4	2.9	0.42	73	1.85	0.36	46	27
Respiratory rate	4	3.3	0.67	83	1.5	0.60	38	45
Total	16	9.4	1.15	59	8.6	0.68	54	4
Anxiety	80	34.33	8.06	43	28.07	5.54	35	8

Fig 2: Bar diagram showing mean percentage distribution of experimental group II pre and post test scores of Bio psychological parameters

Fig 3: Bar diagram showing mean percentage distribution of post test scores of Bio psychological parameters in experimental group I and II

In vital parameters respiratory rate had the highest pre test mean score (3.4±0.48) which is 855% whereas the post test mean score for heart rate (1.85±0.36) which is 38% and the mean difference is 47%. Systolic pressure had the lowest pre test mean score (2.8±0.52) which is 70% and the post test mean score (1.05±0.22) which is 26% and the mean difference percentage is 44%. The overall mean of vital parameter, pre test was (12.4±0.72) which is 78% and the post test mean score (8.6 ±0.68) which is 54% and the mean percentage difference is 24%. In anxiety pre test score (35.67±7.78) which is 45% and the post test score (28.07±5.54) which is 35% and the mean percentage difference is 10%. It seems that music therapy was effective among patient under haemodialysis in reduction of bio psychological parameters.

The unpaired ‘t’ test score for vital parameters and anxiety was 15.96 and 6.42 respectively, which is found to be higher than the table value. It shows that there is a highly significant difference between the experimental I and II post test scores. So it can be concluded that music therapy was highly significant for patient under haemodialysis than Benson’s relaxation technique. In vital parameters respiratory rate had the highest pre test mean score (3.3±0.67) which is 83% whereas the post test mean score for heart rate (1.5±0.60) which is 38% and the mean difference is 45%. Systolic pressure had the lowest pre test mean score (1.6±0.42) which is 40% and the post test mean score (1.05±0.22) which is 26% and the mean difference percentage is 14%. The overall mean of vital parameter, pre test was (9.4±1.15) which is 59% and the post test mean score (8.6 ±0.68) which is 54% and the mean percentage difference is 4%. In anxiety pre test score (34.33±8.06) which is 43% and the post test score (28.07±5.54) which is 35% and the mean percentage difference is 8%. It seems that music therapy was effective among patient under

haemodialysis in reduction of bio psychological parameters than Benson’s relaxation techniques.

CONCLUSION:

From the findings of the study it can be concluded that,

· Most of the patients under haemodialysis were males, were in the age group of above 50 years, no/low anxiety and non medical profession.

· In experimental group I group most of them had less than 3 hours duration of dialysis and no previous history of dialysis

· In experimental group II group most of them had less than 3.1 – 4 hours duration of dialysis and had previous history of dialysis

· Music therapy was effective among patient under haemodialysis in reduction of bio psychological parameters than Benson’s relaxation techniques.

· There was a significant association between the post test scores of bio psychological parameters when compared with trait anxiety in experimental group I

· There was a significant association between the post test scores of bio psychological parameters when compared with trait anxiety and duration of dialysis in experimental group II

IMPLICATIONS FOR NURSING:

The findings of the study have implication in Nursing service, Nursing administration and Nursing research.

Nursing service:

· Therapies can be used by the Nursing professionals who are working in all hospital and clinical settings while doing various dialysis procedures.

· Nursing professionals can use Benson’s relaxation technique Vs music therapy as a non pharmacological intervention in case of various situation like pain, anxiety, depression, anger, frustration, etc.,

Nursing Education:

· The researcher educates the health professionals to utilize this therapy to improve the bio psychological parameters among patient under haemodialysis.

· Nurse educator should encourage the Nursing personnel to practice the Benson’s relaxation technique Vs music therapy in their clinical settings.

Nursing Administration:

· Nurse administer can review the policies to include Benson’s relaxation technique Vs music therapy as a protocol for non pharmacological intervention for prevention of complications during dialysis.

· Nursing administrator can organize conference, seminars, and workshop for nurses working in hospitals to encourage a positive attitude on music therapy on bio psychological parameters among patient under haemodialysis.

· Nursing administrator can support the nurses for conducting research on comparing various other complementary therapies.

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Level of vital parameters	Experimental group I				Experimental group II
	Pre test		Post test		Pre test		Post test
	n	%	n	%	n	%	n	%
Normal	-	-	3	20	-	-	10	67
Moderate	10	67	12	80	12	80	5	33
Unchanged vital parameters	5	33	-	-	3	20	-	-