The effect of play puzzle therapy on anxiety of children on preschooler in Kota Kendari hospital
Islaeli Islaeli
, Mimi Yati, Islamiyah, Fitri Rachmillah Fadmi
Corresponding author
Mandala Waluya Health Science College, Kendari, Kendari City, Southeast Sulawesi, Indonesia
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Children are individuals who are still dependent on adults and their environment, meaning that they need an environment that can facilitate the fulfillment of children's needs for their growth and development.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hospitalization is a stressful and threatening experience and can emotionally destroy children. Hospital play therapy has been widely used in preparing children for invasive medical procedures and inpatient care. However, it requires close supervision while playing in the hospital, in particular, using play activities to relieve the psychological burden of children who are hospitalized.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> When preschoolers are hospitalized, this condition forces children to being separated from the home environment they feel safe, full of love, and fun and loss of playing time with friends in the game.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Play therapy is a therapy for children undergoing hospitalization. When treated in a hospital, children will experience various unpleasant feelings, such as anger, fear, anxiety and pain. By playing the game the child will be free from the tension and stress they experience because by playing the game, the child will be able to divert the pain in the game and relaxation through the fun of playing the game. Along with its growth and development, preschoolers are more active, creative and imaginative. So, they can engage in puzzle games as one of the games that allows the children to freely hone their motor skills. Arranging puzzles can also be used as a healing game. Children can relieve their anxiety by arranging puzzles.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of this study was to see the effect of giving play therapy by arranging puzzles to relieve anxiety in preschoolers in the hospital's childcare room in Kendari City.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">Design quasi experiment with the design of the pre-test and post-test. This design is used to see the effect of giving play therapy to arrange puzzles on the level of anxiety of preschoolers.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Population and study settings</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was conducted from October to December 2017. The population in this study were pre-school pediatric patients who underwent treatment at the Kendari City Children's Hospital. Sampling in this study was carried out by accidental sampling technique which amounted to 33 children.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">Independent variables in this study play therapy compose puzzles. Variable dependent in this study is the level of anxiety of preschoolers who undergo treatment in the hospital. This study did not use a control group.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">The instrument used to measure the level of anxiety of preschool children is the Faces Anxiety Scale For Children, in which there are 5 expressions of child anxiety. Data was collected by researchers by measuring children's anxiety first, after which intervention was given by inviting children to play puzzles. The researchers gave puzzle which has been randomized to the child, then the child will play composing the puzzle. After the child has finished compiling the puzzle, the researcher praises the child for completing the game. After that, the researchers measured the level of anxiety of preschoolers after playing activities were completed.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Data analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Data were analyzed to determine the effect of play therapy on preschool children's anxiety. Furthermore, an analysis is carried out through computerized data analysis programs.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The results of the analysis are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The first column presents the level of child anxiety before play therapy. The second column presents the level of child anxiety after play therapy.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The results of the One-Sample Kolmogorov–Smirnov Test statistical test produced significance (<span class="elsevierStyleItalic">p</span>-value) of 0.002 before and 0.014 after the intervention was given, so that play therapy affected the level of anxiety of preschoolers. The value before giving the intervention averaged 1.73 and decreased to 0.91 after being given an intervention. Furthermore, from the positive ones (0.322) patients who experience anxiety decrease to 0.274 and those that are negative, the patients who do not experience anxiety show improvement.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Anova One way test in preschool children before and after therapy of puzzle play can be seen in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The significance value of <span class="elsevierStyleItalic">p</span> value from the One Way Anova test is below 0.05 which indicates there is a difference or a significant decrease in the level of anxiety of preschool children after being given puzzle play therapy at Kendari City Hospital.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Hospitalization is considered by the child as something that robs the freedom and autonomy of the child to be with family and must obey invasive procedures that are painful to produce fear and anxiety. This condition allows the right game strategy to be given to children so that it can minimize trauma.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Most children before being given play therapy experience mild levels of anxiety which include: anxiety, tension, fear and behavior during interviews. Some anxiety levels are moderate and some are severe and most patients who experience anxiety are girls. After being given play therapy to preschool children it was proven from the results of the analysis of the influence that there was a decrease in the level of anxiety in children.</p><p id="par0080" class="elsevierStylePara elsevierViewall">This is indicated as female patient numbering 19 people (57, 6%) there were 9 people who experienced mild anxiety levels, 3 moderate anxiety people and 7 people with severe anxiety levels and after play therapy experienced a decrease in anxiety levels where there was no anxiety among 8 people, mild anxiety level in 8 people, moderate anxiety in 3 people and there was no severe anxiety. While male patient was 14 people (42, 4%) before playing therapy there were 8 people with mild anxiety level, 4 people with moderate anxiety level and 1 person severe anxiety level, after playing therapy there is no anxiety 6, mild anxiety level 5, anxiety level is 3 people. Statistical analysis using the <span class="elsevierStyleItalic">T</span>-Test One-Sample test obtained the highest number of patients before play therapy was obtained, namely the level of mild anxiety amounted to 17 people (51.5%). While the level of moderate anxiety and weight amounted to 8 people (24.2%). After doing the most therapy, there was no anxiety, there were 14 people (42.5%) and moderate anxiety levels were 11 people (33.3%) and mild anxiety levels were 8 people (24.2%).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Child patients when admitted to the hospital before being given therapy often experience anxiety. This anxiety is not only experienced by patients but also by families. This is caused by the perception of children who consider hospital treatment as a punishment so children feel embarrassed, guilty, anxious and frightened. This excessive anxiety can have a negative impact on patients where patients can show hostility, the response to the environment may decreases totally, making it difficult for the nurses to work with them. Patients with mild anxiety levels are often addressed without serious examination, preferably moderate anxiety levels can lead to two types of coping mechanisms including task-oriented reactions (adaptive) and ego (maladaptive) defense mechanisms.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">So there was significant decrease in the post test level of anxiety among hospitalized children preschool children. Therefore therapeutic play can be introduced as a safe and effective mechanism to help in the reduction of anxiety among hospitalized preschool children.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1365998" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1255744" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Population and study settings" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Variables" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Data collection" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Data analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-09-25" "fechaAceptado" => "2019-11-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1255744" "palabras" => array:4 [ 0 => "Play therapy" 1 => "Anxiety" 2 => "Puzzle" 3 => "Preschooler" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anxiety is an internal response that gives danger signals to individuals. An anxiety reaction in preschool children arises from the effect of hospitalization where the child loses control of himself. This study aims to determine the effect of giving play therapy to arrange puzzles for anxiety in preschoolers in the Kendari City childcare room.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Quantitative research was done with the design of quasi experiments among preschool children as samples treated in hospitals.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results showed that the level of anxiety of preschoolers experienced a significant decrease after being given puzzle play therapy.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The conclusion in this study showed that puzzle play therapy effected anxiety levels in preschoolers.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Conference on Healthcare and Allied Sciences (2019). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Std. deviation (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Most extreme differences \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-play therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.839 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.322 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-play therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.879 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.274 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2346168.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Results of one-sample Kolmogorov–Smirnov test analysis.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Groups \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sum of squares \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">df \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean square \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">F</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sig.(<span class="elsevierStyleItalic">p</span>) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Between groups \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.229 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.780 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.000</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Within groups \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.317 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.344 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">22.545</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">32</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">6.458</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">17.780</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.000</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2346169.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Results of anova one way sample test analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Textbook on basic nursing concepts for children. Prints 1" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y. Supartini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2004" "editorial" => "EGC" "editorialLocalizacion" => "Jakarta" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Li WHC, Chung JOK, Ho KY, BMC Kwok. Play interventions to reduce negative emotions in hospitalized children. BMC Paediatric [Internet]. 2016. Available from: <a target="_blank" href="http://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-016-0570-5">http://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-016-0570-5</a> [accessed 25.10.19]." ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between family role and anxiety level of school-age children (6–12 years) who experienced hospitalization in room III Dr. General Hospital Pirngadi Medan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Aidar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2011" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Textbook for pediatric nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Wong Donna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "editorial" => "EGC" "editorialLocalizacion" => "Jakarta" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "da Silva SGT, Santos MA, Floriano CM de F, Damião EBC, Campos FV de, Rossato LM. Influence of therapeutic play on the anxiety of hospitalized school-age children: clinical trial. Rev Bras Enferm. 2017;70:1244–9." ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pocket book counseling in nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Baradero" 1 => "M.W. Dayrit" 2 => "Siswadi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2006" "editorial" => "EGC" "editorialLocalizacion" => "Jakarta" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/11308621/00000030000000S5/v1_202007240748/S1130862120300644/v1_202007240748/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/11308621/00000030000000S5/v1_202007240748/S1130862120300644/v1_202007240748/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862120300644?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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| 2024 November | 18 | 8 | 26 |
| 2024 October | 40 | 29 | 69 |
| 2024 September | 55 | 31 | 86 |
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| 2024 July | 72 | 27 | 99 |
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| 2024 January | 136 | 56 | 192 |
| 2023 December | 80 | 36 | 116 |
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| 2023 October | 96 | 19 | 115 |
| 2023 September | 75 | 13 | 88 |
| 2023 August | 66 | 17 | 83 |
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| 2022 December | 82 | 10 | 92 |
| 2022 November | 73 | 12 | 85 |
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| 2022 September | 76 | 19 | 95 |
| 2022 August | 88 | 28 | 116 |
| 2022 July | 70 | 24 | 94 |
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| 2022 May | 74 | 27 | 101 |
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| 2021 December | 65 | 19 | 84 |
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