Implementation of Puzzle Play Therapy to Reduce Hospitalization Anxiety in Preschool Children with Febrile Seizures: A Case Study

Abstract

Hospitalization is an experience that can cause anxiety in preschool children due to changes in their environment, invasive medical procedures, and the children’s limited ability to understand their illness. Anxiety that is not properly managed can hinder the treatment process and worsen the child’s condition. One nonpharmacological nursing intervention that can be used to reduce anxiety in preschool children is puzzle play therapy as a form of distraction and developmental stimulation. This study aims to describe the application of puzzle play therapy in reducing hospitalization anxiety levels in preschool children diagnosed with febrile seizures in the pediatric ward of Prof. Dr. H. Aloei Saboe General Hospital in Gorontalo City. The method used was a case study with a nursing care approach that included assessment, nursing diagnosis, planning, implementation, and evaluation. The interventions carried out were anxiety reduction and puzzle play therapy, conducted over three days. Anxiety levels were assessed through observation of the children’s behavior using the Modified Yale Preoperative Anxiety Scale (m-YPAS). The results of the intervention showed a decrease in the anxiety score from 86.6 (severe anxiety) to 31.6 (mild anxiety), as well as changes in the child’s emotional responses and behavior, marked by a reduction in crying and restlessness; the child appeared calmer, more cooperative, and able to interact with the nurses. The conclusion of this case study indicates that the application of puzzle play therapy as part of nursing care, along with therapeutic communication and parental involvement, can support children’s adaptation process during hospitalization.