Implementation of Nursing Care for Clients with Stadium IIA Cervic Cancer in Anxiety Disorders with Benson's Relaxation in The Pavilion of Faith Sudjudi Floor II Gatot Soebroto Army

Cervical cancer is a malignant process that occurs in the cervix, so that the surrounding tissue cannot carry out its functions as it should. The high incidence of cervical cancer in Indonesia has made cervical cancer a major health problem and one of the highest causes of death. It is noted that the incidence of cervical cancer in Indonesia is 36,000 cases or 9.2% of the total cancer cases and ranks second after breast cancer. Cervical cancer is a disease that causes psychological disturbances in the form of anxiety. One therapy that can reduce anxiety is benson relaxation. The purpose of this writing study is to describe nursing care for cervical cancer patients in anxiety disorders with Benson relaxation. The method used is descriptive research in the form of a case study. The characteristics of the subjects of this study were patients who experienced postoperative anxiety about cervical cancer with the HARS scale rating, with a score of 39 with a severe level of anxiety decreasing to 19 with mild anxiety. The results of this study found that in cervical cancer patients. after applying the Benson Relaxation technique can reduce the anxiety experienced by patients. The conclusion from this case study is that Benson's Relaxation Therapy is effective for reducing anxiety, from a score of 39 with a severe level of anxiety there is a decrease to 19 with mild anxiety.


Introduction
Cancer is a group of diseases characterized by uncontrolled and abnormal growth and development of cells.Cancer can be triggered by external and internal factors that trigger carcinogenesis (the process of forming cancer).External factors can also be infection, radiation, certain chemicals, and also consuming tobacco.Internal factors that can cause cancer are gene mutations (either inherited or due to metabolism), hormones and the condition of a person's immune system.(Riksani, 2016) The cervix or often called the cervix is a part of the uterus or uterus.Cervical cancer is cancer that grows from cervical cells, cervical cancer can originate from cells in the cervix but can also grow from cervical cells or both.Cervical cancer is caused by infection with the Human Papilloma Virus (HPV).More than 90% of squamous cervical cancers contain HPV viral DNA and 50% of cervical cancers are associated with HPV type 16.
Cervical cancer is one of the leading causes of death from cancer in women in western, eastern, central and South African countries, China and India contribute to more than a third of cases in the world, with 106,000 cases in China and 97,000 cases in India in 2018.According to Data from the Global Burden of Cancer Study (Globucan) released by the World Health Organization (WHO), the total cases of cervical cancer in the world in 2020 reached 604,127 cases with a total death of 341,831 cases.The incidence of cervical cancer in the world is around 13.1 per 100,000 women.(Setianingsih et al., 2022) Based on data obtained from nurse registration records in the Nursing Room Floor II of the Iman Sudjudi Pavilion, the Gatot Soebroto Hospital Presidential Hospital in the last 3 months, from March to May 2022, there were 326 patients and 43 (13.2%) of them admitted with a diagnosis of cervical cancer Cervical cancer is a disease that causes psychological disturbances in the form of anxiety.Safaria & Saputra, (2012) explains that the factors that cause anxiety, such as the knowledge a person has about the situation he is feeling, whether the situation is threatening or not threatening, as well as about his own ability to control himself (such as emotional states and focus on the problem).Anxiety is a disorder of feelings characterized by deep and ongoing feelings of fear or worry, no disturbance in assessing reality, personality intact, and disturbed behavior but still within normal limits.(Fatmalasari & Ekacahningtyas, 2019;Nevid et al., 2019 ) Anxiety experienced by patients with cervical cancer can cause loss of appetite.So there is a significant weight loss.Hysterectomy is the removal of the uterus by surgery, undergoing a hysterectomy is not something that is easily accepted by women even in the context of medical action.Some women removing the uterus can improve their quality of life, but hysterectomy is often a concern for women.Apart from the impact of not being able to have children anymore, loss of sexual desire and pleasure and not being able to satisfy their partner is a psychological burden for them, which causes this anxiety, which is associated with emotional burden and significant physical changes, as well as a wide range of symptomatology including pain, fatigue, changes in function, low acceptance of body image, marital relationship difficulties, stress and distress.Perception of anxiety can be measured using an anxiety measuring device in the form of an anxiety scale, namely the Hamilton Anxiety Rating Scale For Anxiety (HARS) scale (Sofyanty, 2017) One of the therapies that can reduce anxiety is benson relaxation.Benson relaxation is a relaxation technique combined with the patient's beliefs.Benson relaxation will inhibit the activity of the sympathetic nerves which can reduce oxygen consumption in the body and then the muscles will relax, causing a feeling of calm and comfort.(Fatmalasari & Ekacahningtyas, 2019) Based on the data and information above, the authors are interested in knowing how the implementation of nursing care for Cervical Cancer patients fulfills the need for a sense of security and comfort: anxiety through the preparation of a case study entitled

Method
The research design used by researchers is descriptive research in the form of case studies.This study uses a case study design that describes and describes Nursing Care that risks occur in the Sudjudi Faith Pavilion room of the Gatot Soerbroto Army Hospital which are analyzed in depth and reported narratively.

a. Subjective data
The patient complains of pain in the postoperative wound, the pain increases when moving, the pain is like being stabbed, the pain scale is 5 and the pain comes and goes, the patient complains of worry and anxiety about his condition, and does not feel comfortable with his current condition, the patient says it is difficult to move because of the pain , the patient said his activities were assisted by his family and nurses.

a. Objektive Data
The patient grimaces when pain arises, a surgical wound appears on the patient's lower abdomen, the patient looks restless, the patient looks anxious, the patient often daydreams, score 36 According to nursing care in theory on the nutritional pattern of patients with postoperative patients, decreased appetite.Meanwhile, the results of the field authors did not find a decrease in appetite on the grounds that the patient's appetite was good.
According to nursing care in theory on supporting examinations there are several examinations namely Acetic Acid Visual Inspection (IVA Test), pap smear, thin prep, coloscopic, and Schiller's test.Meanwhile, in the field, the authors only found a pap smear examination on the grounds that the results of the pap smear had shown cervical cancer.

Nursing diagnoses
a. Acute Pain Associated with Physical Injury Agents (post hysterectomy surgery) b.Anxiety related to Situational Crisis.c. Risk of infection related to invasive procedures (postoperative hysterectomy) d.Impaired physical mobility related to reluctance to move

Nursing intervention
Setting goals found a gap between theory and writers in the field where theory has no time limit.While the writer in the field set the time.For reasons of time to reach the goal, a time of 3 x 24 hours is set as a reference in measuring the achievement of the final goal and makes it easier to evaluate the nursing care that has been made.
Theory does not refer to SMART (Specific, Measurable, Achievable, Reality and Time), while writers in the field refer to SMART (Specific, Measurable, Achievable, Reality and Time).For reasons of planning in the field writers in accordance with the conditions and situations that existed at that time.

Implementation
The results in the field, theory and related journals found no gaps in the implementation section because the implementation in the field was carried out based on plans based on the theory of Indonesian nursing intervention standards.

Evaluation
After nursing actions have been taken, the last step is evaluating the nursing diagnoses found either by conducting formative evaluations or summative evaluations.

Summary
The conclusion obtained from this case study is the management of nursing care from the case study that Benson's relaxation therapy is effective for reducing anxiety, from a score of 33 with a level of severe anxiety, it decreases to 20 with mild anxiety.The recommendation is that nurses need patience for Benson relaxation therapy by doing it for at least 6x doing Benson relaxation in 1x24 hours or a day in order to get the effectiveness of actions that can reduce anxiety.In conclusion, the authors in the field and previous case studies (related journals) have similarities, namely the Benson Relaxation Technique can reduce anxiety in Cervical Cancer patients., dini. (2017).CARA BIJAK menghadapi dan mencegah KANKER LEHER RAHIM (SERVIKS).KDT. Aspiani, Y. (2017)

Aminati
Implementation of Nursing Care for Mrs.A With Stage IIA Cervical Cancer In Troubled Feelings Of Safety And Comfort: Anxiety With Benson Relaxation In The Faith Sudjudi Pavilion Room, Floor II RSPAD Gatot Soebroto.