The effect of play puzzle therapy on anxiety of children on preschooler in Kota Kendari hospital

Abstract

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.

Quantitative research was done with the design of quasi experiments among preschool children as samples treated in hospitals.

The results showed that the level of anxiety of preschoolers experienced a significant decrease after being given puzzle play therapy.

The conclusion in this study showed that puzzle play therapy effected anxiety levels in preschoolers.

Introduction

Child health determines the quality of the child in the future, because the success of the child in the future, will depend on how the child goes through the early stages of life, namely the age of the baby, toddler, preschool and school. 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.¹

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.² 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.³

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.⁴

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.

Method

Design

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.

Population and study settings

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.

Variables

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.

Data collection

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.

Data analysis

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.

Results

The results of the analysis are presented in Table 1. The first column presents the level of child anxiety before play therapy. The second column presents the level of child anxiety after play therapy.

Table 1.

Results of one-sample Kolmogorov–Smirnov test analysis.

Variable	Mean	Std. deviation (SD)	Most extreme differences	p value
Pre-play therapy	1.73	0.839	0.322	0.002
Post-play therapy	0.91	0.879	0.274	0.014

The results of the One-Sample Kolmogorov–Smirnov Test statistical test produced significance (p-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.

Anova One way test in preschool children before and after therapy of puzzle play can be seen in Table 2.

Table 2.

Results of anova one way sample test analysis.

Groups	Sum of squares	df	Mean square	F	Sig.(p)
Between groups	12.229	2	6.114	17.780	0.000
Within groups	10.317	30	0.344
Total	22.545	32	6.458	17.780	0.000

The significance value of p 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.

Discussion

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.⁵

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.

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 T-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%).

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.⁶

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.

Conflict of interest

The authors declare no conflict of interest.