Jurnal Ners

Vol. 15, No. 2, Special Issue 2020 This is an Open Access article distributed
under the terms of the Creative Commons
http://dx.doi.org/10.20473/jn.v15i2.18944 Attribution 4.0 International License

Original Research

The Effectiveness of Religious Music and Digital Storytelling on the Level of

Cooperativeness and Pain in Children During Invasive Treatment (Children’s Room,
Zalecha Local Hospital, Martapura)

Iis Pusparina, Insana Maria, and Raihana Norfitri

Stikes Intan Martapura, South Kalimantan, Indonesia

ABSTRACT
ARTICLE HISTORY
Introduction: The impact of invasive treatment procedure in children Received: Feb 27, 2020
undergoing healthcare in hospital is a trauma since the treatment brings Accepted: April 1, 2020
about an uncomfortable feeling. The study aimed at factors in the
application of atraumatic care in the form of religious music and digital KEYWORDS
storytelling given to patients. The study aims to find the difference of religious music; digital storytelling; level
effectiveness between religious music and digital storytelling in regard to of cooperativeness; pain
the level of cooperativeness and pain in children as they undergo invasive
CONTACT
treatment
Insana Maria
Methods: The design of research was quasi-experiment with time series  maria.insana82@gmail.com
design. There were two group treatments; the group of intervention 1  Stikes Intan Martapura, South
consisting of preschool children undergoing invasive treatment via Kalimantan, Indonesia
religious music and the group of intervention 2 consisting of preschool
children undergoing invasive treatment via digital storytelling.
Results: The statistical test shows p: 1.000 > 0.05, meaning that there is
no difference between religious music and storytelling in regard to the
level of cooperativeness and pain in children having invasive treatment
Conclusion: Religious music and digital storytelling have similar
effectiveness of influence in regard to the change of cooperativeness and
pain level in children having invasive treatment.

Cite this as: Pusparina, I., Maria, I., & Norfitri, R. (2020). The Effectiveness of Religious Music and Digital Storytelling on the
Level of Cooperativeness and Pain in Children During Invasive Treatment (Children’s Room, Zalecha Local
Hospital, Martapura). Jurnal Ners, Special Issues, 86-90. doi:http://dx.doi.org/10.20473/jn.v15i2.18944

and not cooperating with nurses and assuming that

INTRODUCTION
the actions of treatment procedures can threaten the
Hospital planning or emergency processes require integrity of their body (Zeinomar & Moslehi, 2013).
children to stay in the hospital undergoing therapy In the United States, it is estimated that more than
and treatment until return home. Illness and 5 million children are hospitalized and more than
treatment of children in hospitals is often the first 50% of that number experience anxiety and stress.
crisis that must be faced by children. This is because, (Fabric, 2014) (Sartika, 2013) . Every year, around 1.5
due to separation from the environment, children million preschool age children (aged three to six
experience unpleasant feelings, such as fear, tension, years) are hospitalized due to injury, chronic,
pain when treated in hospital and loss of control congenital or infectious diseases. In Indonesia, based
(Sartika, 2013). on research data on the islands of Java and
Children experience stress and their reaction to Kalimantan (Faradisi, 2012), 30% of 180 children
stressors varies according to the stage of growth and aged 3-12 years have experience with hospitals and
development. Reaction of pain, stress and trauma in an estimated 35 per 1000 children undergo
children due to invasive procedures is performed hospitalization.,
while in hospital. Anxieties of preschool children are Minimizing trauma is one of the basic principles of
shown with anger, regression or silence, bedwetting, child nursing, namely the principle of Atraumatic
rebellion, verbal expression by saying angry words Care or prevention of trauma to children and families.

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Atraumatic care services are focused on efforts to tested by comparing the condition of the dependent
prevent trauma that is part of child care by paying variable in treatment group 1 after being treated
attention to cognitive development in preschool age with religious music therapy treatment with the
children in the pre-conceptual and intuitive transition treatment group 2 after being treated with digital
phase where children begin to be given storytelling.
understanding, use many words, begin to be able to
understand wrong and right and begin to know Research Design Pattern as follows:
children's songs and use vocabulary to tell stories O1 x O2 x O3 x O4 x O5
combined with music therapy, because music has a O6 x O7 x O8 x O9 x O10
therapeutic aspect through stimulation, where the The population in this study was all children
music enters the mind through auditory sensations treated in the children's ward Ratu Zalecha
with a soft voice so as to reduce stress, pain Martapura Hospital and, the sampling technique used
perception, anxiety and feeling isolated (Musbikin, was purposive sampling, as many as 15 samples per
2009). group. Direct data collection by researchers was by
Religious music is music that has a calming effect direct observation of cooperative attitude using the
plus its poetry which contains da'wah and spiritual CBS (Children Behavior Scale) observation
guidance, especially in soft strains with beats 50-70 instrument sheet in which data were collected on
times per minute. Thus, anyone who listens to respondents who were given treatment in the form of
religious music will feel calm in their heart, and be religious music therapy or digital storytelling, and
encouraged in doing good according to the lyrics that observation using the Wong-Baker Faces Pain Rating
are heard (Vohra et al, 2008). Storytelling is also a Scale to measure the level of pain along with
therapy to reduce anxiety, intensity of nausea and physiological responses to pulse and respiration.
vomiting in children undergoing chemotherapy, Data collection tools used in this study were
Storytelling is recommended as a therapy to reduce cooperative level observation sheets compiled by
anxiety in school-age children during hospitalization. researchers referring to the theory and adoption of
Storytelling implies telling stories about fairy tales, instruments and observation sheets of the Wong-
which are events that did not really occur, especially Baker Faces Pain Rating Scale to measure pain levels.
the events of the past. Digital storytelling is the art of The distribution of data of each dependent
turning stories into multi-media forms that contain a variable was first tested for normality using the
combination of music, film and / or images that are Shapiro-Wilk test (number of respondents = 40).
colored with sound (Musbikin, 2009). Based on the results of the cooperative level
Research on religious music therapy and digital normality test, all cooperative value scores p> 0.05,
storytelling to improve cooperation and reduce pain which means cooperative values before and after
in children has not been greatly done. If the religious music and digital storytelling were normally
interventions of religious music therapy and digital distributed. Whereas, based on the results of the
storytelling can be applied, it is hoped that children normality test of the level of pain, pulse and breath,
will be more cooperative during invasive actions so as all scores of pain, pulse and breath values p <0.05,
to support the success of the principle of atraumatic which means the value of pain, pulse and breath
care during hospitalization. This will have an impact before and after religious music and digital
on speeding recovery and shortening hospital days. storytelling were not normally distributed. Then the
(Musbikin, 2009). data were transformed. After being transformed, the
pain, pulse and breath scores were p <0.05 (still
MATERIALS AND METHODS abnormally distributed).

The design of this study is quasi-experiment with RESULTS

time series design, because this study uses treatment
Table 1 shows the results of the study based on the
or treatment aimed at assessing the influence of an
responses of 20 children, giving the characteristics of
action when compared with other actions, so that the
respondents: Boy 60% and Girl 40%, has never been
effectiveness of the given treatment is known. The
in hospital 20% and ever been in hospital 80% and for
assessment is done before the treatment is given
age of the children, the majority already treated was
(pre), then the treatment is given four times with each
aged 6 years for the religious music treatment group.
of them being carried out four times (post), each time
20% and ever been in Hospital 80% and for age of the
giving an invasive injection schedule intravenous
children, the majority which already been treated was
injection through an IV tube in children.
aged 6 years for the religious music treatment group.
In this study, two treatment groups were used,
Table 2 shows the distribution of respondents
namely treatment group 1 and treatment group 2. The
based on cooperative level before and after religious
treatment group 1 was preschool age children who
music and digital storytelling were given, showing the
were given religious music therapy during an invasive
majority of changes in children's cooperative level.
action, while treatment group 2 was preschool age
Table 3 shows that there is a significant difference in
children who were given digital storytelling at the
the cooperative value of preschool children after the
time of the invasive action. From this design, the effect
of a treatment on the dependent variable will be

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I. PUSPARINA ET AL.

Table 1 Characteristics of Respondents

Type of Treatment Total
Characteristics Religious Music Digital Storytelling
f % f %
Gender
Boy 12 60 11 55 23
Girl 8 40 9 45 17
Experience Cared
Has never been 4 20 13 65 17
Ever been 16 80 7 35 23
Age
3 year 4 20 3 15 7
3.5 year 2 10 7 35 9
4 year 4 20 6 25 10
4.5 year 1 5 0 0 1
5 year 3 15 1 5 4
6 year 6 30 4 20 10

Table 2 Distribution of Respondents Based on Cooperative Level Before and After Religious Music and Digital Storytelling
Were Given
Treatment Cooperative Pre Post1 Post2 Post3 Post4
Level
Religious Music Cooperative 5 (25%) 12 (60%) 14 (70%) 20 (100%) 20 (100%)
Not Cooperative 15 (75%) 8 (40%) 6 (30%) 0 0
Total 20 20 20 20 20
Digital Storytelling Cooperative 7 (35%) 12 (60%) 16 (80%) 20 (100%) 20 (100%)
Not Cooperative 13(65%) 8 (40%) 4 (20%) 0 0
Total 20 20 20 20 20

Table 3 Anova Test Repeated Measure Results of Cooperative Differences After Being Given Religious Music and Digital
Storytelling
Source Sum of Squares df Mean Square f p
Intercept 77106.645 1 77106.645 793.455 .000
Error 3789.955 39 97.178
Total 80896.600 40 77203.823

Table 4 Independent T-Test Results

Variable Treatment group Mean Sd t P
Religious Music 13.65 4.716 .681
Cooperative pre .414
Digital storytelling 13.00 5.201 .681
Religious Music 15.75 5.056 .042
Cooperative post 1 -2.108
Digital storytelling 19.25 5.437 .042
Religious Music 19.40 4.070 .592
Cooperative post 2 -.541
Digital storytelling 20.20 5.217 .592
Religious Music 22.65 3.200 .743
Cooperative post 3 .331
Digital storytelling 22.20 5.177 .743
Religious Music 25.05 4.124 .827
Cooperative post 4 .220
Digital storytelling 24.80 4.152 .827

Table 5 Pain Value of the Respondents

Average pain
Treatment group
Pre P1 P2 P3 P4
Religious Music 5,70 4,60 3.30 0,90 0,00
Digital Storytelling 7,60 5,20 3.60 1,90 0,20

Table 6 Distribution of Respondents Based on Pulse Before and After Being Given Religious Music and Digital Storytelling
Treatment Nadi Pre Post1 Post2 Post3 Post4
Religious Music Normal 8 14 17 20 20
Not Normal 12 6 3 0 0
Digital Storytelling Normal 7 12 16 20 20
Not Normal 13 8 4 0 0
Total 40 40 40 40 40

treatment of religious music compared with digital Table 4 shows at least one difference in
storytelling. f (1.39) = 793.455, p = .000. effectiveness in the treatment of religious music and

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Table 7 Mann Whitney Test Results The Effectiveness of Religious Music and Digital Storytelling on a Child's Pulse
Variable Treatment Group Mean Rank p
Religious Music 19.08
Pulse post 1 .436
Digital storytelling 21.93
Religious Music 20.23
Pulse post 2 .881
Digital storytelling 20.78
Religious Music 20.10
Pulse post 3 .828
Digital storytelling 20.90
Religious Music 20.23
Pulse post 4 .881
Digital storytelling 20.78

Table 8 The Mean Respiration Rate of Respondents

Rata – rata nafas
Treatment Group
Pre P1 P2 P3 P4
Religious Music 26,85 25,10 21,95 21,05 20,15
Digital Storytelling 30,95 26,65 22,80 21,80 20,35

Table 9 Friedman Test Differences in Breath Frequency Before and After Being Given Religious Music and Digital
Storytelling
Treatment Group df X2 P
Religious Music 3 34,508 0.000
Digital Storytelling 3 46,767 0.000

Table 10 Mann Whitney Test Results of The Effectiveness of Religious Music and Digital Storytelling on the Breath
Frequency of Children
Variable Treatment Group Mean Rank p
Religious Music 17.18
Breath post 1 .063
Digital storytelling 23.83
Religious Music 17.83
Breath post 2 .106
Digital storytelling 23.18
Religious Music 19.00
Breath post 3 .376
Digital storytelling 22.00
Religious Music 19.23
Breath post 4 .308
Digital storytelling 21.78

digital storytelling (post 1 variable), where p = 0.042 digital storytelling have the same effectiveness on the
and the average score of religious music is greater decrease in the frequency of the child's breath.
than the average score of digital storytelling, so that
religious music is more effective in increasing DISCUSSION
children's cooperation compared to digital
Child care shows that one way to make children more
storytelling.
cooperative is to prepare the psychological condition
Table 5 shows that there was a decrease in the
of the child before nursing action, as well as religious
pain value of the respondent after being given
music interventions in that the majority of changes
religious music and digital storytelling. From Table 6
occur in a cooperative direction after being given
it can be seen that the majority of changes in the
religious music. The p value is0.042 and the average
child's pulse are in the normal direction. Table 7
score of religious music is greater than the average
shows that, after the Mann Whitney test, the
score of digital storytelling, so that religious music is
significance value p> 0.05 was obtained so that
more effective in increasing the child's cooperative
religious music and digital storytelling had the same
level compared to digital storytelling. Therapy that
effectiveness on the decline in the child's pulse value.
aims to help preschool-aged children use good coping
Table 8 shows that the mean respiration rate of
mechanisms during the procedure of invasive
respondents indicated a decreased breath rate after
intravenous injections, includes using music therapy,
being given religious music and digital storytelling.
which is included in complementary therapy
Table 9 shows the Friedman test differences in breath
(Musbikin, 2009). The use of complementary therapy
frequency before and after being given religious
for pediatrics, according to Kemper et al., is highly
music and digital storytelling indicated a significant
recommended because it can support healing of the
pulse difference (X2 (3) = 34,508, p <.005) and (X2 (3)
disease, reduce stress and fear of the child
= 46,767, p <.005), thus there was a difference in
undergoing treatment programs (Vohra, Kemper, &
pulse before and after religious music and digital
Walls, 2008). Cognitive development in preschool age
storytelling were given. Table 10 shows the Mann
children is in the pre-conceptual and intuitive
Whitney test results on the effectiveness of religious
transition phase where children begin to be given
music and digital storytelling as regard the breath
understanding, use many words, begin to understand
frequency of children. The results obtained
wrong and right and begin to know children's songs
significance value p> 0.05, thus religious music and
and use vocabulary to tell stories (Musbikin, 2009).

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I. PUSPARINA ET AL.

Music therapy is part of complementary therapy ACKNOWLEDGEMENT

used in the health sector to evaluate and treat
patients with emotional, physical, cognitive and social The author of this study would like to thank the
functioning disorders (Wahyuni Sri N, n.d.). In her Respondents, Nurses and Doctors in the children's
book Holistic Nursing, Barbara Dossey (2007) room Ratu Zalecha Martapura Hospital. Finally, the
emphasized that music therapy is one of the scientific authors also thank INC 11th 2020 Surabaya for
branches of nursing used as nursing therapy because providing the opportunity to present and publish the
music has a therapeutic aspect by encouraging valuable findings from this study
stimulation, whereby the music enters the mind
through auditory sensation with sound softs so that it
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CONCLUSION
Based on the results of research, it can be concluded
that: The majority of respondents are male and the
majority have been hospitalized before, there is an
increase in the cooperative level of children after
being given religious music, There is an increase in
the cooperative level of children after being given a
digital storytelling, there is a decrease in the level of
pain in children after being given religious music and
a decrease in the level of pain in children after being
given digital storytelling. There are differences in the
effectiveness of religious music and digital
storytelling in regard to the cooperative level of
preschool children when given invasive measures
whereby religious music is more effective in
increasing children's cooperation. There is a
difference in the effectiveness of religious music and
digital storytelling on the pain level of preschool
children when given invasive measures whereby
religious music is slightly more effective in reducing
children’s pain.

CONFLICT OF INTEREST
The authors declare that there is no conflict of
interest.

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