Hrev_master Healthcare in Low-resource Settings 2024; volume 12:12621 Enhancing mental well-being in coronary heart disease patients: the impact of integrated spiritual care and murottal auditory therapy on reducing anxiety and depression Aris Citra Wisuda,1,2 Tukimin Bin Sansuwito,2 Citra Suraya,1 Rusmarita,1 Dian Emiliasari1 1Faculty of Nursing, Sekolah Tinggi Ilmu Kesehatan Bina Husada, Palembang, Indonesia; 2Faculty of Nursing, Lincoln University College, Petaling Jaya, Malaysia Abstract Coronary heart disease, the most prevalent non-communicable disease, poses both physical and psychological challenges, includ- ing anxiety and depression. Addressing these issues requires a holistic approach that integrates biological, psychological, social, and spiritual dimensions. Spiritual care interventions can alleviate psychological distress and enhance patient satisfaction in nursing care. This study explored the impact of combining spiritual care with murottal auditory therapy to reduce anxiety and depression in patients with coronary heart disease. In this quasi-experimental study, 110 participants were divided into intervention and control groups, each with 55 participants selected based on specific crite- ria. Anxiety and depression levels were assessed using the validat- ed Depression Anxiety Stress Scale (DASS). The intervention group received daily murottal therapy sessions lasting 15 to 20 minutes for three days at Siti Khadijah Islamic Hospital in Palembang from March to July 2023. Pre-test and post-test assess- ments were conducted. The results indicated that a significant pro- portion of patients in the intervention group experienced mild anx- iety (52.7%) and reduced depression (65.5%) after murottal ther- apy. Significant differences in anxiety and depression levels were observed between the intervention and control groups, with p-val- ues of 0.000 for both. murottal auditory therapy, mainly using Surah Ar-Rahman, effectively reduces anxiety and depression in patients with coronary heart disease, offering a promising comple- mentary treatment approach. Introduction Global disease patterns have shifted with the increasing preva- lence of non-communicable diseases, among which cardiovascu- lar disease is a significant concern and remains the leading cause of death worldwide.2 In 2013, the World Health Organization reported that 17.3 million people died from cardiovascular disease globally, with projections indicating an increase to 23.3 million by 2020.3 According to the 2019 Global Burden of Disease Report, cardiovascular disease was Indonesia’s fourth leading cause of mortality.4 This condition results in both physiological and psy- chological changes, including social isolation, anger, anxiety, stress, and depression.5 Approximately 70-80% of individuals with heart disease experience anxiety.6 Patients often experience changes in response to threatening and unexpected situations.7 For many, anxiety and depression arise from facing uncertainty, concerns about treatment effects, fear of disease progression and death, feelings of guilt, and spiri- tual doubts.8 If not managed properly, anxiety can worsen a patient’s condition, leading to additional issues such as depres- sion, sleep disturbances, an increased risk of suicide, and a decreased quality of life for those with coronary heart disease. High levels of anxiety about the disease often indicate dissatisfac- tion with the healthcare services received. Therefore, further treat- ment and support are necessary.9 Correspondence: Aris Citra Wisuda, Faculty of Nursing, Sekolah Tinggi Ilmu Kesehatan Bina Husada, 30131 Palembang, South Sumatera, Indonesia. E-mail: ariscitrawisuda.edu@gmail.com Key words: anxiety, complementary therapy, coronary heart disease, depression, murottal, spiritual care. Contributions: ISW, conceptualization, data curation, formal analysis, methodology, validation, visualization, writing the original draft, and review and editing. TS contributed to conceptualization, investigation, methodology, validation, writing the original draft, and review and edit- ing. YSD handled conceptualization, methodology, formal analysis, val- idation, writing the original draft, and review and editing. AIA was involved in methods, visualization, and writing review and editing. MLK provided resources, conducted investigations, and participated in writing reviews and editing. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest. Funding: none. Ethics approval and consent to participate: the research received ethical approval from the Medical and Health Research Ethics Commission at the Faculty of Medicine, Sriwijaya University, under ethical certificate 024-2023. During the research process, the researcher followed the prin- ciples of information ethics, such as obtaining informed consent, respect- ing human rights, and ensuring beneficence and non-maleficence. Patient consent for publication: written informed consent was obtained to allow the publication of anonymized patient information in this article. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Acknowledgements: I thank my supervisor for their invaluable insights and contributions to this study. Received: 30 April 2024. Accepted: 14 July 2024. Early access: 8 August 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:12621 doi:10.4081/hls.2024.12621 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [ [Healthcare in Low-resource Settings 2024;12:12621] Non -co mmerc ial us e o nly In times of crisis, individuals with coronary heart disease may experience heightened levels of anxiety and depression, which can significantly affect their overall health and disease progression.10 Research by Nuraeni et al.11 supports this, indicating that patients with coronary heart disease have anxiety levels at 74.25% and depression levels at 66.75%. Similarly, a study by Febriana et al.12 reports that anxiety levels among these patients are very high, reaching up to 71.12%. According to Lestari et al.,13 nurses play a crucial role in crises by providing optimal, holistic nursing care that emphasizes the spiritual aspect. Spirituality is a critical com- ponent of comprehensive care and maintenance. A holistic approach to healthcare that addresses spiritual needs can strength- en an individual’s faith and connection with the Creator, helping those dealing with illness or weakness develop greater confidence and acceptance during the healing process. Music therapy serves as a form of distraction therapy, providing an alternative method for addressing psychological, psychiatric, and physical disorders. Numerous studies have shown its safety and effectiveness in improving mood and reducing anxiety, depression, and other men- tal health issues. Music is well-regarded for its ability to redirect attention and promote relaxation.14 One genre with notable thera- peutic benefits is spiritual or murottal music, which involves the recitation of holy Quranic verses with precise pronunciation (tajwid) and rhythmic delivery. Listening to these sacred recita- tions, known as murottal, has been found to induce a sense of calm.15 Among the frequently used verses in therapy is Surah Ar- Rahman, a chapter of the Quran that emphasizes Allah SWT’s blessings to His servants. Its simple yet eloquent language, with a recurring question, repeated 30 times, contributes to its therapeutic effects. Research by Kismana16 supports this, indicating that repe- tition in Surah Ar-Rahman can positively influence brain function due to its straightforward and consistent nature. Additionally, Surah Ar-Rahman provides valuable lessons in gratitude for Allah’s blessings, acceptance of His divine will, and the under- standing that healing from all ailments is within Allah’s control.17 Islamic spiritual care, which involves listening to holy Quranic verses at a volume below 60 decibels, can influence brain waves to promote relaxation and calmness. Research by Asrul18 supports this, comparing the effects of listening to Quranic verses with clas- sical music. The study found that listening to Quranic verses resulted in a 12.67% increase in the correlation between left and right brain alpha waves, compared to a 9.96% increase with clas- sical music. These results suggest that Quranic verses more effec- tively enhance alpha wave activity, which is associated with a relaxed state, compared to classical music.19 Additionally, Harisa et al.20 discovered that the therapeutic effects of Quranic verses are amplified when accompanied by translations, outperforming the impact of listening to the verses alone. murottal hearing therapy can improve comfort levels in patients with heart disease. However, those with cardiovascular conditions often require ongo- ing treatment and an extended recovery period if their needs are not adequately addressed. Therefore, this study aimed to evaluate the impact of murottal hearing therapy on anxiety and depression levels in hospitalized patients with cardiovascular disease. Materials and Methods Research design This study utilized a quasi-experimental pre-post design with a control group to evaluate the impact of murottal auditory therapy on anxiety and depression levels in patients with cardiovascular disease. The design involved measuring mental health indicators before and after the intervention, allowing for comparisons between patients who received the therapy and those who did not. This approach aims to provide strong evidence of the effectiveness of murottal auditory treatment in alleviating psychological dis- tress, such as anxiety and depression, in this patient population. Study participants Data were collected from March to July 2023 at Siti Khadijah Islamic Hospital in Palembang, South Sumatra, Indonesia. The sample size of 110 patients was determined using the Lameshow formula, with participants evenly divided into 55 individuals in the control group and 55 in the intervention group. Patients were selected through purposive sampling based on specific criteria, including a diagnosis of coronary heart disease, awareness, practi- cal communication skills, Muslim identity, and no hearing impair- ments. Patients with unstable hemodynamics or cognitive impair- ments were excluded from the study. Before data collection, informed consent was obtained from all participants and their fam- ilies, ensuring they were fully informed about the study’s objec- tives and procedures. Variable, instrument, and data collection The independent variable in this study is murottal auditory therapy, while the dependent variables are levels of anxiety and depression. Additionally, participant characteristics such as age, gender, education, occupation, medical diagnosis, and illness dura- tion were recorded to understand the study population comprehen- sively. The participants, all cardiovascular patients receiving treat- ment at the hospital, were randomly assigned to either a control group or an intervention group. A pre-test was conducted before the intervention to establish baseline levels of anxiety and depres- sion in both groups, ensuring that any observed changes could be attributed to the therapy. This design allowed for a thorough com- parison of the effects of murottal auditory therapy on the partici- pants’ psychological well-being. Anxiety and depression levels were assessed using the Depression Anxiety Stress Scale (DASS), a self-report tool designed to evaluate emotional states, including anxiety and depression. The DASS includes 14 items for each scale, with ten items measuring somatic symptoms and four assess- ing anxiety-related affective symptoms. Validated by previous research in Indonesia, the DASS has demonstrated effectiveness and reliability, with the anxiety scale achieving a Receiver Operating Characteristic (ROC) value of 0.51. Participants rated their anxiety symptoms on a 4-point Likert scale, ranging from “Does not apply at all to me” to “Very often or frequently applies to me.” For patients with coronary heart disease, the DASS helps determine the severity of anxiety and depression and identifies those requiring psychological support. Depression levels were assessed using the same DASS instrument, which measures aspects such as hopelessness, life devaluation, self-deprecation, and lack of interest in activities. The Indonesian version of the DASS has a Cronbach’s alpha of 0.677, reflecting moderate relia- bility. Overall, the DASS is a valuable tool for both clinical and research settings, providing a standardized and culturally appropri- ate method for assessing and monitoring anxiety and depression among coronary heart disease patients in Indonesia. Murottal hearing therapy is an Islamic-based intervention designed to alleviate spiritual distress, including symptoms of anx- iety and depression, in patients. This study implemented the thera- py for 15-20 minutes daily over three consecutive days to address the increasing prevalence of anxiety and depression among coro- Article [Healthcare in Low-resource Settings 2024;12:12621] [page 689] Non -co mmerc ial us e o nly nary heart disease patients undergoing treatment. Conducted at Siti Khadijah Islamic Hospital in Palembang from March to July 2023, the research involved 55 participants divided into intervention and control groups. A quantitative quasi-experimental design was used to assess anxiety and depression levels in both groups before the intervention (pre-test). The intervention group received murottal hearing therapy from the first to the third day, followed by a post- test assessment on the fourth day. In contrast, the control group received standard treatment without murottal therapy and under- went a post-test evaluation on the fourth day. Participants in the intervention group were provided with MP3 players and earphones to listen to Surah Ar-Rahman recited by Muzamil Hasballah. The murottal recordings were played at 50 decibels to ensure listener comfort and maximize the therapy’s positive effects. The ear- phones allowed patients to hear the murottal audio within a fre- quency range of 5 Hz to 22,000 Hz, aiming to influence brain wave patterns and effectively reduce anxiety and depression. Results Demographic and clinical characteristics of partic- ipants Table 1 provides a comprehensive overview of the demograph- ic and clinical characteristics of the participants. The average age of participants was 56 years in the control group and 58 years in the intervention group. The average duration of illness was ten months for the control group and nine months for the intervention group. In both groups, most participants were male, with 67.3% in the control group and 74.5% in the intervention group. Additionally, over half of the participants in both groups had low education levels, with 65.4% in the control group and 69.1% in the intervention group. A considerable proportion of respondents in both groups were unemployed, comprising 43.6% of the control group and 47.3% of the intervention group. Anxiety and depression levels in control and inter- vention groups Table 2 illustrates the anxiety and depression levels among par- ticipants. In the pre-test, severe anxiety was observed in 61.8% of the control group and 69.1% of the intervention group. After the post-test, severe anxiety persisted in most of the control group, at 54.5%. However, the intervention group experienced a significant anxiety reduction, with 52.7% of participants reporting only mild anxiety. Regarding depression levels, the pre-test revealed that more than half of the participants in both groups experienced severe depression, with 52.7% in the control group and 63.6% in the intervention group. After the intervention, most participants in the control group experienced moderate depression, at 69.1%. In contrast, the intervention group showed a substantial decrease in depression levels, with 65.5% of participants reporting only mild depression after the post-test. Differences in anxiety and depression between the control and intervention groups This study demonstrates a significant difference in anxiety lev- els between the control and intervention groups, with a p-value of 0.000 (p < 0.05). The Mann-Whitney test revealed that the average anxiety score was 80.76 in the control group, compared to 30.24 in the intervention group, indicating a substantial difference. Similarly, there was a significant difference in depression levels between the two groups, also with a p-value of 0.000 (p < 0.05). According to the Mann-Whitney test results, the average post-test depression score was 77.75 in the control group, while the inter- vention group scored 33.25 (see Table 3). Article Table 1. Demographic and clinical characteristics of participants in each group (N=55). Characteristics Control Group Intervention group Mean (SD) n (%) Mean (SD) n (%) Age (years) 56±8.967 58±9.211 Illness duration 10±8.328 9±7.854 Gender Male 37 (67.3) 41 (74.5) Female 18 (32.7) 14 (25.5) Education High 19 (34.6) 17 (30.9) Low 36 (65.4) 38 (69.1) Occupation Self-Employed 8 (14.6) 9 (16.4) Employee 11 (20.0) 2 (3.6) Trader 6 (10.9) 14 (25.4) Teacher 6 (10.9) 4 (7.3) Unemployed 24 (43.6) 26 (47.3) Table 2. Frequency distribution of anxiety and depression levels of pre-test and post-test in the control and intervention groups. Variable Control Group Intervention group n (%) n (%) Anxiety level Pre-test Moderate 21 (38.2) 17 (30.9) Severe 34 (61.8) 38 (69.1) Post-test Normal 0 (0) 12 (21.8) Mild 0 (0) 29 (52.7) Moderate 25 (45.5) 14 (25.5) Severe 30 (54.5) 0 (0) Depression level Pre-test Moderate 26 (47.3) 20 (36.4) Severe 29 (52.7) 35 (63.6) Post-test Normal 0 (0) 5 (9.0) Mild 2 (3.6) 36 (65.5) Moderate 38 (69.1) 14 (25.5) Severe 15 (27.3) 0 (0) Total 55 (100) 55(100) Table 3. Differences in anxiety and depression between the con- trol and intervention groups. Variable Group Mean post-test p-value Anxiety Control 80.76 0.000 Intervention 30.24 Depression Control 77.75 0.000 Intervention 33.25 [page 690] [Healthcare in Low-resource Settings 2024;12:12621] Non -co mmerc ial us e o nly Discussion Patients with cardiovascular conditions, such as coronary heart disease, often experience significant spiritual distress that pro- foundly impacts their psycho-spiritual well-being. This distress is frequently driven by intense worry and fear, particularly related to the prospect of death, and can trigger a crisis manifesting as anxi- ety and depression.21 The presence of anxiety and depression resulting from spiritual distress can increase the risk of complica- tions. These emotional states can activate involuntary physiologi- cal responses, part of the body’s self-defence mechanisms. This activation can worsen existing health issues and lead to additional complications, highlighting the need to address both spiritual and emotional needs in the management of cardiovascular diseases.22 Anxiety is a prevalent issue among patients with Coronary Heart Disease (CHD). This anxiety is often characterized by per- sistent worry and fear about the disease, along with physical symp- toms such as trembling, unexplained sweating, respiratory issues, and weakness.23 Research by Soylu et al.24 reveals that a CHD diagnosis frequently triggers intense fear of a fatal heart attack or sudden death. Uncontrolled anxiety can severely affect a patient’s quality of life by disrupting sleep patterns and worsening physical symptoms such as chest pain and shortness of breath. Furthermore, excessive anxiety can exacerbate the patient’s physical condition by elevating blood pressure, causing unstable blood sugar levels, and reducing stress tolerance. Borji and Mousavimoghadam25 also note that anxiety in heart patients often stems from a lack of under- standing about the disease, which leads to increased worry and impaired coping skills. Excessive and unresolved anxiety can lead to depressive responses.26 Depression is a common issue among patients with CHD. Those suffering from depression related to their condition often feel they have lost their previous capabilities, experience sad- ness, lack motivation, and become pessimistic about their future. They may also feel powerless to return to their usual activities.27 This is consistent with Najafi et al.,28 who observes that a diagnosis of CHD can trigger feelings of sadness, hopelessness, loss of inter- est in daily activities, and worthlessness. Depressed CHD patients face a higher risk of severe health complications, including increased mortality and reduced overall quality of life. Additionally, depression can decrease a patient’s motivation to adhere to treatment and make necessary lifestyle changes for man- aging heart disease. Thus, anxiety and depression are psychologi- cal factors that indirectly contribute to a decline in health quality. When addressing patients’ psychological issues, interventions often extend beyond pharmacological treatments to include non- drug approaches that address their holistic needs.29 Non-pharmaco- logical strategies may encompass relaxation techniques, distrac- tion methods, and other therapeutic practices designed to provide comprehensive care. These approaches aim to alleviate psycholog- ical distress by addressing both mental and emotional aspects of well-being. By integrating these methods, healthcare providers can offer a more comprehensive and effective treatment plan that sup- ports overall patient health and improves their quality of life.30 In holistic care, nurses are crucial as primary facilitators in delivering and coordinating conventional and complementary patient therapies. They act as critical supporters throughout the recovery process, providing essential information about available treatment options and helping patients choose the approaches that best meet their needs and preferences.31 Additionally, nurses create a supportive environment, manage therapy sessions, and offer emotional support during treatment. Their active involvement in holistic therapy ensures that patients receive comprehensive care, which enhances the effectiveness of recovery and optimizes the overall therapeutic experience.32 Spiritual care is a crucial component of holistic support, focus- ing on recognizing and respecting the spiritual dimensions of patients. It involves offering emotional support, helping patients find meaning and purpose, and maintaining spiritual balance while facing health challenges.33 This form of care often includes conver- sations about the patient’s beliefs and values, allowing them to voice their concerns and reflect on their spiritual growth.34 Spiritual well-being can significantly influence how patients cope with coronary heart disease and manage anxiety and depression. Thus, incorporating spiritual care into holistic treatment is essen- tial, as it helps patients find calm and hope throughout their healing journey.35 Spiritual care in Islam is a critical component of Islamic spiri- tual care interventions in nursing practice, emphasizing the vital role of spirituality in a patient’s recovery and well-being. This approach is deeply grounded in religious teachings, highlighting the individual’s relationship with Allah as a source of strength and peace. Practices such as worship, dhikr (remembrance of Allah), prayer, and reflection are central to this approach, aiming to strengthen faith, cultivate inner peace, and offer a profound under- standing of life’s purpose.36 In healthcare, Islamic spiritual care extends beyond religious aspects to include moral values, ethics, and healthy social interactions, providing a comprehensive foun- dation for holistic patient care. By understanding and applying Islamic spiritual care principles, nurse practitioners can offer more effective and integrated support, enhancing patients’ recovery experiences.37 Islamic spiritual nursing practices, such as prayer and Quranic recitation (dhikr), are essential for enhancing patients’ spiritual well-being. These practices help strengthen their connection with faith, provide emotional comfort, and promote inner peace, sup- porting emotional and spiritual recovery. Incorporating these prac- tices into nursing care addresses the holistic needs of patients, improving their sense of purpose and tranquillity during the heal- ing process.9 This study highlights significant differences in anxi- ety and depression levels among participants who received murot- tal auditory therapy, with p-values of 0.000 for both measures, indicating vital statistical significance. Similarly, other research has shown that music therapy can effectively reduce stress, anxi- ety, and depression in intensive care patients, emphasizing its value as a complementary treatment approach. These findings rein- force the effectiveness of integrating spiritual and therapeutic modalities into patient care to enhance emotional and psychologi- cal health. Murottal refers to reciting Quranic verses with precise pronun- ciation (tajwid) and rhythmic delivery. Listening to murottal can bring a sense of tranquillity to the listener.38 Ar-Rahman is a fre- quently used Surah in therapy, underscoring Allah SWT’s bless- ings to His servants. This Surah is characterized by its straightfor- ward language and elegant literary style, including a repetitive question asked 30 times. Surah Ar-Rahman fosters gratitude for Allah’s blessings and acceptance of His will, emphasizing that ulti- mate healing from illness lies within Allah’s power.39 Murottal therapy, which involves listening to Qur’anic recita- tions with precise tajwid and soothing rhythms, significantly affects brain function, leading to reductions in anxiety and depres- sion.40 This therapy activates the brain’s auditory system, especial- ly the auditory cortex, and engages the parasympathetic nervous system to promote relaxation. By enhancing alpha wave activity, Murottal therapy fosters a state of calm that lowers cortisol levels, Article [Healthcare in Low-resource Settings 2024;12:12621] [page 691] Non -co mmerc ial us e o nly the primary stress hormone associated with anxiety and depres- sion.41 Additionally, the spiritual aspect of murottal therapy con- tributes to emotional well-being by instilling a sense of peace and purpose. This combined physiological and spiritual effect helps alleviate symptoms of anxiety and depression, promoting overall relaxation and a heightened sense of well-being.42 Research by Ruby43 indicates that Islamic spiritual care thera- py using murottal significantly reduces anxiety and depression lev- els in coronary heart disease (CHD) patients, with reductions of 76.45% in anxiety and 81.5% in depression. This finding is sup- ported by Hajiri et al.,44 who reported up to an 84% decrease in depressive symptoms and an 87% reduction in anxiety among CHD patients receiving murottal therapy. Husna45 further corrobo- rates these results, noting that the mean depression score in the treatment group dropped to 11.09 (±8.47) following the spiritual program, with statistical significance (P < 0.001). Additionally, Indrika46 found that patients undergoing cardiac catheterization who listened to murottal had significantly lower anxiety scores compared to a control group. Studies by Moulaei et al.47 and Che Wan Mohd Rozali et al.48 also support the effectiveness of listening to Quranic verses in alleviating mental disorders such as anxiety and depression. These findings suggest that a comprehensive, per- sonalized approach to spiritual care with murottal, enhanced by supplementary modules, improves patients’ understanding and engagement, thereby more effectively reducing anxiety and depression. Overall, Islamic spiritual care therapy with murottal appears to be a promising holistic approach for treating CHD patients and addressing their spiritual and emotional needs. Listening attentively to murottal therapy has been shown to have a beneficial impact on individuals with cardiovascular disor- ders, such as CHD. This therapy promotes mental calmness, which helps reduce anxiety and depression in patients, ultimately influ- encing blood pressure, heart rate, heart rhythm, and respiratory rate. These results are consistent with the findings observed in the intervention group of this study, where murottal therapy led to sig- nificant reductions in anxiety and depression levels. The study confirms that murottal therapy is effective in alleviating anxiety and depression among patients undergoing CHD treatment. Given that anxiety and depression present significant challenges through- out the treatment journey for cardiovascular patients, murottal therapy is emerging as a valuable adjunct to pharmacological treat- ments. Nurses play a vital role in mitigating patient anxiety and depression, which can accelerate recovery. However, this study has several limitations. First, the therapy is limited to patients diagnosed with coronary heart disease, which restricts its applicability to other conditions. Although murottal therapy helps calm individuals experiencing psychological stress, its benefits are not fully understood due to the limited duration of treatment, leading some patients to continue experiencing anxiety and depression. Second, the absence of randomization in the sam- pling process affects the generalizability of the findings to a broad- er population. Future research should investigate additional factors influencing the application of murottal therapy and explore its inte- gration with various relaxation techniques to enhance spiritual connection, increase peace of mind, and improve overall recovery outcomes. Conclusions This study demonstrates a significant reduction in anxiety and depression scores among patients undergoing treatment for coro- nary heart disease after receiving murottal therapy. The notable differences in scores between the control and intervention groups suggest that murottal therapy can be an effective complementary therapy when integrated into spiritual care approaches to alleviate these symptoms. In addition to reducing anxiety and depression, this non-invasive and cost-effective therapy enhances overall patient care by promoting a holistic approach and fostering deeper nurse-patient relationships. 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