Effect of Instrumental Music Therapy on Preoperative Anxiety Levels in Patients at Imanuel Hospital Bandar Lampung

. Anxietiy is ain uncoiimfortable feelinig of piowerlessness cauised byi unpleaisant niew experiiences, resultiing in teinsion, agitation, aind loss of cointrol due to subjecitive judgmient. Anxiety often ioccurs in patieints underigoing surgical proceidures. The pirevalence of anxiiety in Indoneiisia in preoperaitive paitients raniges from i45% to 75%. This piroves that the majiority of paitients undeiirgoing surgery expiierience anxieity. One way to allieviate anixiety is thriough relaxatiion distraction techiniques, such as instrumental miusic thierapy. The effects of instrumiental music theirapy include reduicing stress and ainxiety, as iwell as impiroving concientration. The staitistical itest resuilts obitained a signifiicance valuei oif 0.00 < p 0.0i5, inidicating a significiant diffeirence in tihe lievel of preopierative patieint ainxiety beifore iand iafter ibeing givien instrumentali music theriapy iintervention. Thius, iit cian ibe concludedi that insitrumental musici thierapy afifects thei level of pireoperative paitient ainxiety at Iimanuel Hosipital Banidar Lamipung. Suggestiions for Imaniuel Hospitali are to imiplement instirumental miusic tiherapy as one ofi the nuirsing intierventions ito rediuce anxiiety in preoperiative patiients. Wiith the proviision oif instrumentali music theriapy, iit is hopeid that patientsi undeirgoing siurgery will ifeel cailmer, alloiwing the suirgical pirocedure toi proceed simoothly aind efifectively.


INTRODUCTION
Surgery is a medical procedure with a procedure to make an incision to open or display the body part being treated and aims to treat or diagnose a disease (Alim Sigit Prasetyo et al., 2023).Surgery consists of three phases, namely pre-operative, intraoperative, and post-operative (Prasetyawati et al., 2022).Based on the initial survey conducted at RiS Imanuel Biandar Laimpung, health education and explanation of surgical preparation have been given to patients who will undergo surgery.Health education that is carried out is structured and uses interesting media, so that families get complete and interactive information.It still affects patients as well as being a manifestation of anxiety that is experienced.However, the provision of instrumental music therapy to reduce anxiety in pre-operative patients before being carried out by nurses in the ward.In the initial survey of this study, researchers observed 12 patients who were going to undergo surgery through interviews and observations.

Identification of the Problem
From the background of the problem that has been described, the identification of the problem that can be obtained is as follows: According to WHO (2020), in 2017 there were 140 million patients in hospitals around the world who underwent surgery, while in 2019 the data increased by 148 million people.In 2020, there were 234 million patients in all the hospitals in the world who underwent surgery.b.Based on data from the Maharibe (2024), surgical procedures in Indonesia in 2020 reached 1.2 million people.Surgical procedures are ranked 11th out of 50 diseases in Indonesia, 32% of which are elective surgical procedures.Based on the Lampung Provincial Health Service in 2012, there were 10,320 patients who underwent surgery, where 60% of patients experienced anxiety before the surgical process.

METHODS
This type of research is quantitative research.Quantitative research is a type of research that uses numbers and statistics in data collection, along with data analysis that can be measured (Alam, 2021).In this study, the data that has been collected is rechecked, then coded and analyzed using statistical tests.This study uses an experimental method with pre-and post-test without control group design.This research was conducted from December 24, 2023 to January 24, 2024 in the operating room of Imanueil Hospital Bandair Lamipung.The population includes all the characteristics or attributes possessed by the subject or object being studied (Megawati & Sutarto, 2021).The lamps that are sleeping 2i50 patients.The sample is a part of the number and characteristics possessed by the population (Harefa et al., 2023).The sampling technique in this research is purposive sampling.iIn this research, a sample has been taken that has the following characteristics:

Inclusion criteria
GCS i15 deniers patient, Physical status of AiSA I and ASA II.

Exclusion criteria
Operation go, Patients with hearing impairment, Patients who do not like music and instruments.A good sample is one that is able to represent the population.Therefore, the sample dispersion has been calculated using the Sloivin formula, namely in the following equation.

Research Variables
In this research, there are 2 variables, namely the independent variable and the dependent variable.

Independent Variables
Independent variables are variables that affect the dependent variables, and do not depend on other.The independent variable in this study was instrumental music therapy which only played musical instruments without vocals.

Dependent Variable
The dependent variable is a variable whose existence is influenced by the independent variable, always related and dependent on other variables.The dependent variable in this study is the patient's anxiety level.

Characteristics of Responden
This research is quantitative in nature, where data are expressed in numerical form, then analysis is carried out using the iSPSS program.This data was obtained by administering a questionnaire to 71 respondents before Dian after being given institutional music therapy.Based on table 4.1, the number of respondents in this research is at least 60 respondents, consisting of the diaries of 35 respondents with a male gender with a percentage of 49.3%, and another 36 respondents with a female gender with a percentage of 50.7%.Count the highest number of female respondents.In the period from 24 December 2023 to 24 January 2024, the number of patients who underwent surgery at the Imainuel Baindar Lampiung Hospital was 250 patients, with 140 patients (56%) being female and 110 patients being male.Based on table 4, the total number of respondents to this research was 71 respondents with various types of work held by each respondent.There are 24 respondents who do not work, with a percentage of i33.8%, while respondents who have jobs are i47 respondents with a percentage of 66.2%.It can be concluded that the largest number of respondents are respondents who have jobs.Respondents who did not work in this research consisted of students from the household, while respondents who worked consisted of workers, farmers, entrepreneurs, teachers, civil servants and TNI/police officers.Respondents who experienced mild levels of anxiety were 1 person, with a percentage of 1.4%.Based on table 8, it is known that the average score for the level of anxiety of respondents after being given instrumental music therapy is 1, i28.This shows that the average level of anxiety of respondents after being given music therapy is at the level of mild anxiety.In the data non-normality test with Kolmogo irov -Sm i i i mov , if the significance value is > 0.05, it indicates that the data is normally distributed, whereas if the significance value is < 0.05, it indicates that the data is not normally distributed.Based on the normality test of the data contained in table i4.9, a significance value of 0.000i was obtained at the pre-i anxiety level.intervention and i post intervention.i This value indicates that the diary data resulting from this research is not normally distributed.The test used to find out the effect of instrumental music therapy on the preoperative patient's anxiety level is the parametric ion test, namely the Wilcoxon test .Based on table 10, the number of respondents who experienced a decrease in the level of anxiety after being given instrumental music therapy was 68 respondents and 3 other respondents did not experience changes in the level of anxiety after being given the level of instrumental music therapy.There were no respondents who experienced increased anxiety after being given instrumental music ,000

Bivariate Analysis
Based on table 11, a significance value of 0.000 <i was obtained at an IP value of 0.05.It can be concluded that H0 is rejected and Ha is accepted so that there is a meaningful or significant influence on the provision of instrumental music therapy on the level of anxiety of pre-operative patients at Iimanuel Bandiar Laimpung Hospital.

Gender
The number of respondents with male gender was 35 respondents, with a percentage of 49.3% and the number of respondents with female gender was 36 respondents with a percentage of 50.7%.The largest number are respondents whose gender is female.

Age
In this study, the ages of respondents varied between 20 years to 60 years.From the age of 20 to 30 years, the number of respondents was as many as 19 respondents with a percentage of 26.8%.For those aged 31 years to 40 years, the total number of respondents was 14 respondents with a percentage of 19.7%.At the age of 41 years to about 50 years there were 20 respondents with a percentage of 28.1%.At the age of 51 years to 60 years there were 18 respondents with a percentage of 25.4%.

Education
The number of respondents to this research was 71 respondents with different levels of education, starting from secondary education, middle school, high school, up to tertiary education.There were 19 respondents who had only completed SiD education, with a percentage of 26.8%.There were 11 respondents who had only completed junior high school, with a percentage of 15.5%.

Workplace
There were 24 respondents who did not work with a percentage of 33.8%, compared to 47 respondents who had jobs with a percentage of 66.2%.

Level of Anxiety Before Providing Rumental Institution Music Therapy
The effects of surgery can cause stress and physical and physiological changes, resulting in anxiety (Ulfah, 2023) .The anxiety that arises in the respondents this research is related to their illness, and plans for medical action in the form of surgery.The respondents of this research faced the initial phase of surgery so that they were surrounded by fear, namely fear of not knowing the surgical procedure, death, fear of anesthesia, worry about losing work time, losing their job, responsibility for supporting their family, and permanent disability.Feelings of fear of having surgery arise because of fear of facing death and not being able to get up again after surgery (Barus et al., 2021) .

Level of Anxiety After the Delivery of Instrumental Music Therapy
This research took a sample of 71 respondents.Previously, respondents were given a questionnaire to assess their level of anxiety before being given instrumental music therapy.Then all the respondents who had been selected were given instrumental music therapy entitled Our Future by Peder B. Hellanid for 9 minutes using a headphone so that the respondents could listen to instrumental music without the disturbance of other sounds.

CONCLUSION
From the research objectives, it can be concluded that: It is known that the level of anxiety of pre-operative patients after being given instrumental music therapy is between mild anxiety levels of 51 respondents (71.8%), moderate anxiety levels of 20 respondents (28.2%).No respondents were found to experience severe anxiety and panic.

Table 2 .
Age CharacteristicsFor those aged 20 years to 30 years, the number of respondents was 19 respondents with a percentage of 26.8%.At the age of 31 years to 40 years, the number of respondents was 14 respondents with a percentage of 19.7%.

ISSN 2776-1169 (online) Copyright © 2024, Journal of Community Health Provision, Under the license CC BY-SA 4.0 | 4 EducationTable 3 .
Educational CharacteristicsBased on table 3, the total number of respondents paid for this research was 71 respondents with different levels of education, starting from elementary school, middle school, high school, up to higher education education diaries.Respondents who only completed elementary school education numbered 19 respondents, with a percentage of 26.8%.There were 11 respondents who had only completed junior high school education, with a percentage of 15.5%.

Table 4 .
Job Characteristics

Table 5 .
Anxiety Level Before Intervention

Table 6 .
Description of Anxiety Level Pre Intervention

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Based on table 6, it is known that the average score of the level of anxiety of the respondents before being given instrumental music therapy is 2.34.

Table 7 .
Anxiety Levels Post InterventionBased on table 7, 71 respondents in this study had varying levels of anxiety after being given intervention in the form of instrumental music therapy.The patient's level of anxiety after being given instrumental music therapy is different from the level of anxiety before being given instrumental music therapy.

Table 8 .
Description of Anxiety Levels After Intervention

Table 9 .
Normality Test D iata Intervention Anxiety Level < Pre -Intervention Anxiety Level.b.Post Intervention Anxiety Level > Pre Intervention Anxiety Level c. Post Intervention Anxiety Level = Pre Intervention Anxiety Level