The Effect of Chromotherapy on Decreased Blood Pressure during Sleep in Hypertension Patients in Kupang, Indonesia

*Serly Sani Mahoklory and Ferdinandus Suban Hoda*

#### **Abstract**

Various efforts to prevent the increasing prevalence of deaths due to hypertension continue to be developed, including alternative medicine systems (CAMS). One of the alternative treatment methods recommended by the world, easy, cheap, and efficient is chromotherapy or light therapy. The purpose of this study was to look at the influence of chromotherapy in lowering blood pressure during sleep in hypertension sufferers. The research method used is quasy experiment with the design of one group pre- and posttest with a control group design. Sampling techniques are carried out using purposive sampling with the number of 120 respondents. The results of this study have proven that chromotherapy has a tremendous effect in lowering blood pressure by 10–30 mmHg during sleep 15–35 minutes by utilizing the blue and green spectrum that affects the work of the sympathetic and parasympathetic nerves so as to provide elements of relaxation and lower blood pressure. The pretest result of the treatment group obtained a mean from 172/96 to 158/93 mmHg, which showed a decrease while in the control group, there was no significant change with mean values of 166/96 and 166/97 mmHg.

**Keywords:** chromotherapy, electromagnetic radiation, hypertension, blood pressure, Indonesia

#### **1. Introduction**

The prevalence of hypertension is increasing every year and is a leading cause of 13% global mortality. This condition is projected to increase by up to 30% of global mortality in 2025 [1]. Most of the hypertension-related-death in the world occurs in low- and-middle-income countries (31,5%) compared to high-income countries (28.5%) [2]. Indonesia is one of the middle-income countries whose prevalence of hypertension has increased from 25.8% in 2013 to 34.1% in 2018 [3]. The national prevalence for coronary heart disease is 1.5%, and the highest prevalence is in the East Nusa Tenggara (NTT) province at 4.4%.

Pharmacological treatment is the main choice for lowering blood pressure. However, along with the development of technology, non-pharmacological treatment has become one of the recommended alternative treatments for hypertension treatment based on evidence-based practice. The use of complementary therapies and alternative medicine (CAM) continues to grow and the majority of people with hypertension. This is because the side effects produced are lower than that of pharmacological treatment. The relatively cheaper cost and the same effectiveness are indicators of the use of complementary and alternative therapies in the treatment of hypertension. One of the therapies that can be used to lower blood pressure in people with hypertension is chromotherapy [4–6].

Chromotherapy or color therapy is a complementary alternative treatment recommended globally, utilizing electromagnetic radiation and several color frequencies to affect human neurohormonal pathways. With this mechanism, chromotherapy can cure various diseases [7–9]. The color effects work by intervening in the action of the sympathetic and parasympathetic nerves. Color therapy provides a relaxation element, reducing an individual's anxiety level [10]. The use of green and blue lights in chromotherapy help reduce stress levels and lower blood pressure in patients with hypertension *via* epinephrine hormone stimulation. This study aimed to determine the effectiveness of chromotherapy in blood pressure in hypertension patients in Oesapa Primary Health Care Center (Puskesmas). It can be hypothesized that chromotherapy can significantly reduce lower blood pressure in patients with hypertension.

#### **2. Methods**

This is a quasi-experimental study with one group pre and posttest with one control group design. The treatment group was given chromotherapy treatment, while the control group was not. The blood pressure was measured at baseline (pretest) and after the treatment was performed (posttest) for both groups [11, 12]. A total of 120 hypertension patients participated in this study. The participants were divided equally into two groups; 60 participants in the treatment group and another 60 participants in the control group. Data were analyzed using Mann–Whitney U test to determine any difference between the pre and posttest scores for each group. The level of significance was determined at *p*-value <0.05. Statistical analysis was performed using IBM SPSS™ software.

This study incorporates a combination of green and blue LED lights. The intervention was conducted in a closed room using a 50 cm light transmission device, and then hung or placed 210 cm above the participant's body and left for 15–35 minutes. Participants were requested to relax and close their eyes during the intervention. After the intervention, the respondent's blood pressure was measured again.

#### **3. Results**

#### **3.1 General data**

See **Table 1**

*The Effect of Chromotherapy on Decreased Blood Pressure during Sleep in Hypertension Patients… DOI: http://dx.doi.org/10.5772/intechopen.109819*


#### **Table 1.**

*Characteristics of participants based on gender, age, and education level of the working area of Oesapa primary health care Center Kupang.*


#### **Table 2.**

*Distribution blood pressure of hypertension of the working area of Oesapa primary health care Center Kupang.*



*The Effect of Chromotherapy on Decreased Blood Pressure during Sleep in Hypertension Patients… DOI: http://dx.doi.org/10.5772/intechopen.109819*

#### **Table 3.**

*Distribution of blood pressure pre and post intervention and control groups of working area of Oesapa primary health care Center Kupang.*

#### **3.2 Specific data**

The pretest was performed at baseline to understand the respondent's initial blood pressure before chromotherapy treatment was given.

**Table 2** shows that chromotherapy treatment can reduce blood pressure. After receiving chromotherapy treatment and the blood pressure was reevaluated, the blood pressure had improved to a level I hypertension (63.3%). On the contrary, there was no significant decrease in blood pressure for the control group; level I hypertension (48.3%) at the pretest and increased to level II hypertension (65%) at posttest.

**Table 3** shows the results of the blood pressure of the intervention and control groups before participating in chromotherapy did not experience a


#### **Table 4.**

*Analisis Beda mean tingkat Stres kelompok perlakuan dan kontrol.*

significant difference, namely the mean blood pressure of the treatment group was 172/96 mmHg and the group 166/96 mmHg. Meanwhile, after participating in chromotherapy, there was a decrease in the average blood pressure of the intervention group, namely 168/93 mmHg and the control group did not experience a decrease in blood pressure, namely 166/97 mmHg. So the average decrease in blood pressure after following chromotherapy is 10–14 mmHg.

**Table 4** shows the mean blood pressure in the treatment group before the intervention was 69.81, while the blood pressure in the control group was 51.19. The results of further tests using the Mann–Whitney U Test showed no significant difference in blood pressure scores of hypertensive patients between the treatment and control groups before being given chromotherapy. After treatment, blood pressure in the treatment group decreased significantly compared to the control group (p = 0.000) and the mean blood pressure score in the treatment group decreased to 49.99, while the control group did not experience a decrease in blood pressure and tended to experience an increase in blood pressure, namely 71.01.

#### **4. Discussion**

This quasi-experimental study is one of the initial studies exploring the effects of color therapy on the stress levels of hypertension patients. In chromotherapy, a color is a form of electromagnetic energy and visible light. When it enters the retina's photoreceptors, it will be translated as a color that stimulates the pituitary and pineal glands to produce hormones, such as serotonin and endorphin. These hormones are secreted as a response to light to maintain psychological health, balancing mood, feelings, and behavior [13, 14]. This study uses a green and blue light that specifically has been proven to reduce blood pressure by utilizing reflected green and blue light. Combining these colors with light could selectively repair damaged cells and provide the healing energy needed [15–17].

A report by Gul et al. (2016) reinforced the result of this study, which exhibits both mild and severe stress in both groups during pretest. After the treatment group received chromotherapy treatment, there was a reduction in blood pressure score up to 10–14 mmHg with a p-value of 0.000. This means that there was a change in the initial blood pressure. Results indicated a decline of the mean blood pressure in the treatment group from 172/96 mmHg during pretest, to 158/93 during posttest. It suggests a drop of 10–14 mmHg. In the meantime, the control group did not record

#### *The Effect of Chromotherapy on Decreased Blood Pressure during Sleep in Hypertension Patients… DOI: http://dx.doi.org/10.5772/intechopen.109819*

any significant change with a mean blood pressure of 166/96 mmHg during pretest and 166/97 during posttest. Still, a reduction in blood pressure can also be explained by categories of hypertension. Before the treatment, most of the participants in the treatment group were at level II hypertension (75%). Posttest measurement after the chromotherapy treatment displayed an improvement with 63.3% of the participants recording level I hypertension. On the other hand, no significant change was found. Most of the participants in the control group recorded level I hypertension during pretest (48.3%) and level II hypertension in posttest (65%).

The mechanism of chromotherapy in the body utilize electromagnetic radiation and different color frequency by affecting the human neurohormonal system from the sympathetic and parasympathetic nerves, thus giving it a relaxation effect, which can reduce anxiety [10]. Also, chromotherapy can heal various illnesses by utilizing seven color lights, for example, yellow for gastric ulcer, a combination of red and blue for skin infections, etc. [15]. The effect of color and light from chromotherapy can be used as an easy, inexpensive alternative nonpharmacologic treatment with minimum risk of side effects.

This study has several limitations, including a relatively small sample size (120 participants) with a short time span to measure stress level and blood pressure, which was within the three times intervention. However, this study has shown the efficacy of chromotherapy using green and blue lights after accounting for several biases during the study.

#### **5. Nursing implication**

Nurses can implement chromotherapy in their environment as an alternative treatment aside from pharmacologic medication, which is a new innovation in complementary therapy. Also, this study adds to the nursing reference regarding the efficacy of color therapy in reducing stress and lowering blood pressure in hypertension patients. It is recommended for forthcoming studies to increase the sample size and lengthen the timespan of the measurement by also including other color lights.

#### **6. Conclusion**

Chromotherapy with a combination of green and blue lights is proven to be effective to stimulate the pituitary and pineal glands to produce hormones such as serotonin and endorphin, thus maintaining psychological health, balancing mood, feelings, repairing impaired cells, and providing healing energy that the body needs. Therefore, this study recommends the use of chromotherapy to reduce stress and lower blood pressure for hypertension patients.

*New Research in Nursing – Education and Practice*

### **Author details**

Serly Sani Mahoklory\* and Ferdinandus Suban Hoda STIKes Maranatha Kupang, Indonesia

\*Address all correspondence to: sani.mahoklory04@gmail.com

© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*The Effect of Chromotherapy on Decreased Blood Pressure during Sleep in Hypertension Patients… DOI: http://dx.doi.org/10.5772/intechopen.109819*

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[2] Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control. Circulation. 2016;**134**(6):441-450. DOI: 10.1161/ CIRCULATIONAHA.115.018912

[3] Basic Health Survey. RISKESDAS MAIN RESULT. 2018

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[12] Nursalam. Nursing Research Methodology: A Practical Approach. Ed 3 ed. Jakarta: Salemba Medika; 2013

[13] Hermida RC, Ayala DE, Fernández JR, Mojón A. Hypertension: New perspective on its definition and clinical management by bedtime therapy substantially reduces cardiovascular disease risk. 2017. DOI: 10.1111/eci.12909

[14] Of AB, Dults OLA, Xperimental AQU, et al. Effects of chromotherapy on the cognitive age study explore. 2019;**15**(3):191-197. DOI: 10.1016/j.explore.2019.01.002

[15] National Center for Complementary and Alternative Medicine. Complementary, Alternative, or Integrative Health: What's In a Name? [Internet]. [Updated 2008; cited 2015 November 3]. Available from: http:// nccam.nih.gov/health/whatiscam

[16] Yousuf ST, Rafiq HM, Ismail I, Rabab S. Complementary therapies in medicine the mechanistic basis of chromotherapy: Current

knowledge and future perspectives. Complementary Therapies in Medicine. 2019;**46**(August):217-222. DOI: 10.1016/j. ctim.2019.08.025

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#### **Chapter 13**

## Nurses Work System Optimization: Macroergonomics Perspective

*Ehsan Garosi*

#### **Abstract**

The hospital work system as a complex sociotechnical system has been an interesting research environment for human factor/ergonomic researchers. In this chapter dimensions of nurses' work system elements were presented and Macroergonomics approaches were pointed out to optimize the interaction between nurses and other system elements. From Macroergonomics perspectives, human factor researchers would be able to identify and categorize health and performance issues through a systematic approach. Researchers are believed that this approach was not shown positive results initially, therefore a low-hanging fruit strategy is recommended. Decomposing work system elements is a potential opportunity to track the balance in the hospital nurse work system by considering these elements for redesigning work systems and applying appropriate interventions.

**Keywords:** nurses, ergonomics, human factor, design, performance

#### **1. Introduction**

*To reap what we sowed, "we should start with the low-hanging fruits" (Michael Porter in 1980).*

Hospital work system as a complex sociotechnical system has been an interesting research environment for the human factor/ergonomic researchers. Among health care workers, nurses have always been considered to be a special group because of the significant physical and mental demands they face at work. Nursing is a physically and psychologically demanding profession with a high prevalence of musculoskeletal disorders (MSDs) as indicated in several studies [1–5]. MSDs are also often cited as the reason for sickness-related absences and the high turnover of nurses [6, 7].

Nurses' working conditions usually differ across countries, regions, and hospitals [8, 9]. These differences are attributed mainly to the provision of instruments and the quality of process management in hospitals. For instance, nurses whom working in intensive care units may experiences higher stress levels and more health disorders compared with other wards [10].

There are many factors that can influence on nurses working conditions [11]. Therefore, seeking and attenuating these risk factors (risk factors that affect on nurses' health and working performance) requires a systematic and comprehensive



#### *Nurses Work System Optimization: Macroergonomics Perspective DOI: http://dx.doi.org/10.5772/intechopen.110400*


**Table 1.**

*Published articles concern to macroergonomic approaches.*

**168**

approach. To deal with and overcome on such ergonomic issues in the complex sociotechnical system, macro ergonomic approaches always have been shown positive and applicable [11].

#### **1.1 Macroergonomic approaches as a solution**

As the new millennium unfolds, there is significant evidence that the complexity of organizations is increasing and with this consistent growth comes new considerations for designing, implementing and maintaining work systems. In order to manage this growing complexity and to achieve desired outcomes, in these contexts, numerous approaches have been proposed [12]. Macroergonomics, a sub-discipline of ergonomics, has been a practical response to this growing need and with embracing this innate complexity it aims to improve performance and well-being in work systems [13].

Viewing under the Macroergonomics glasses, enables human factor researchers to identify and categorize health and performance issues through a systematic approach. In this vein, it would be helpful for identifying such factors by taking into account all components of the work system [14]. For instance, Garosi et al., used this approaches to identify influencing factors on nurses workability [15].

Lets back on Michael Porter in 1980 quotation about "piking low hanging fruits" as indicated by H. W. Hendrick and B. Kleiner [14]. This quotation is indicates on doing micro accessible intervention and then performing the macro intervention. Macroergonomics approaches help researcher to find, which work system elements are accessible and can be manipulate at first.

During this book chapter, we do a review on some studies affirmed macroergonomics approaches in similar health scope system and then we decomposed nurses work system elements with focus on their workability using the Systems Engineering Initiative for Patient Safety (SEIPS). Next, relative recommendations were provided to optimize interaction between nurses and work system element.

#### **1.2 Published articles in domain of Macroergonomics**

Studies on the level of Macroergonomics were searched over Google Scholar, PubMed, and Science Direct from 2013-2018. The search was conducted using such keywords including: "(Macroergonomics OR Macro-ergonomics)" The inclusion criteria were the article published in English, and all type of study (interventional or questionnaire). The database search showed 72 articles, out of which 40 were excluded because of duplication, repetition and article publication date. Among the remaining articles, a further 7 were removed due to the irrelevant subject. Finally,25 articles were left and selected for extracting the kay-pints. **Table 1** shows the article in order of publication date.

#### **2. Decomposing nurses work system elements**

According to the Systems Engineering Initiative for Patient Safety (SEIPS) elements of a work system comprises five components including environment, person, tools and technology, task, and organization, and their interplay determines (the processes), how care is managed and provided to patients leading to desired or undesired outcomes [39]. Following, partial results of a study [15] is presented to emphasize

on SEIPS model as a framework for decomposing influencing factors on the nurse's workability.

#### **2.1 Environmental elements**


Environmental conditions may interfere with nurse's task. Due to lack of space, people may work in inappropriate postures and poor lighting conditions, which can increase the risk of musculoskeletal disorders [29].

For better perception in work space, applying ornamental artificial flowers and color variations as features for motivating are recommended. However optimal design of the work environment increases the satisfaction of nurses and consequently lead to positive performance results [40].

#### **2.2 Person- related factors (nurses)**


Many studies have examined the relationship between demographic characteristics, ethnicity, and diseases to the nurses work ability. For instance, high body mass index had an inverse relationship with work ability [41]. Generally, as BMI crosses over 25, the working ability of nurses decreased by 2.2 points [42]. Moreover, many studies have showed the relationship between age and work ability. Second job or worked simultaneously in two or more hospitals put nurses under more physical and mental stress, fatigue [43, 44].

#### **2.3 Factors related to tools and technology**

Usability of the tools and technology are reported as an important factor, which could increase satisfaction and work ability. In addition, some other factors *Nurses Work System Optimization: Macroergonomics Perspective DOI: http://dx.doi.org/10.5772/intechopen.110400*

such as equipment precision (calibration), applicability, equipment safety, computerization are reported important contributors to the nurses work ability [15]. Correspondingly, availability of equipment, proper functioning and effectiveness of tools were identified as measures to prevent nursing fatigue. Moreover, it is reported that electronic reporting and high level technology based tools may prevents nurses fatigue [29]. In this way Samadi and Golmohammadi, showed that there was a negative relationship between work ability and fatigue [45]. It is quit clear that usability of devises are important in every similar sociotechnical systems. Therefore, Lacking usability leading to fatigue and increases the risk of musculoskeletal disorders in nursing job [46]. For instance, a nurses quotation from a qualitative study is considerable "although computers and technology are much quicker and more comfortable to use, in some cases these computers and automation software are so problematic and time wasting, that we decide to do tasks manually" [15].

#### **2.4 Task-related factors**

Task-related factors are factors related to the nature of nursing tasks. The most important factors Identified included:


Nursing job stressors such as inappropriate expectations from co-workers, time constraints, response to patient families are reported as other nurses job related factors that have negative effect on nursing work ability [45].

#### **2.5 Organization elements**

Danesh et al., 2020 reported that are more effective factor on the nurses work ability [15]. These factors included:


Quality supervisors support was reported among the most important predictors of nurses work ability. In a study by Gharibi et al. [47], which was conducted among a number of employees of different sectors, including industry, bank, and hospital, there was a straight relationship between supervisors support and work ability. Moreover, a strong correlation between supervisor support and work ability was reported [48]. Teamwork and support of colleagues are among other effective factors that influence on nurses work ability. Working under the supervision and in an efficient team and fairly performing tasks, there will be lower fatigue and team performance will be increase [49]. Shift work schedule is a factor that can affect circadian rhythm as, Safari et al. Safari et al. showed a significant relationship between work ability and work shift [50]. Other studies emphasized the role of shift work on nursing work ability, with nurses who had more than 8 hours of work shift were more likely to suffer burnout [51].

Salary and wage are factors that directly related to motivation and work ability. Under Herzberg's two-factor model, incomes and paybacks are "health" factors, which, if not sufficient, result in dissatisfaction and eventually stress and adverse outcomes [52].

#### **3. Conclusions**

Optimizing nurses' work system requires a holistic approach and the Macroergonomics approach could be helpful in this way. Under Macroergonomics perspectives, human factor researchers would be able to identify and categorize health and performance issues through a systematic approach. Researchers are believed that this approach was not shown positive results initially, therefore a low-hanging fruit strategy is recommended. Decomposing work system elements is a potential opportunity to track the balance in the hospital nurse work system by considering these elements for redesigning work systems and applying appropriate interventions.

#### **Author details**

Ehsan Garosi Department of Ergonomics, School of Public Health, Iran University of Medical Sciences, Iran

\*Address all correspondence to: eh.garosi@gmail.com

© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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## *Edited by Victor Chaban*

Discover cutting-edge research and novel approaches in nursing education and practice in this comprehensive collection. This book offers an overview of the latest advancements in nursing. All authors received global acclaim for the relevance of their research for clinical interventions and the discovery of the transformative potential of the integration of new technology in clinical practice. This book explores the challenges and opportunities faced by healthcare professionals in today's complex global healthcare environment. The authors clearly emphasize the role of education in shaping nursing practice for developing the next generation of nursing providers since the quality of clinical competences has a powerful impact on therapeutic progression and recovery from illness. This book presents a comprehensive overview of clinical research and education that aims to help healthcare providers give their patients the best treatments for different metabolic and psychiatric diseases. Whether you are a patient, student, or experienced professional seeking to expand your knowledge, this volume is a valuable resource. It provides a state-of-the-art review of different aspects of nursing research and education and is recommended for everyone who is focused on the care of patients, their families, and their communities.

Published in London, UK © 2023 IntechOpen © Derek Finch / unsplash

New Research in Nursing - Education and Practice

New Research in Nursing

Education and Practice

*Edited by Victor Chaban*