The Effect of Storytelling Using Finger Puppets on Anxiety in Hospitalized Preschool Children

Article history: Received: 27 September 2021 Accepted: 27 November 202


INTRODUCTION
Prevalence of child disease in Indonesia, according to the age group of 0-2 years by 15.14%, ages 3-5 years by 25.8%, ages [6][7][8][9][10][11][12] years as much as 13.91% when compared to the overall population, the prevalence of preschool-age disease is higher at 25.8% [1]. This condition allows the child to be treated in a hospital (Hospitalization). Hospitalization causes traumatic events and stress in an uncertain environment for the child and family, whether it is an effective procedure that has been planned in advance or of an emergency that occurs due to trauma [2].
According to researchers [3], the incidence of anxiety in 30 preschool-aged children admitted to Buton hospital 70% experienced moderate anxiety, and 23.3% experienced severe anxiety and 6.6% experienced mild anxiety. Stressors that occur in children associated with hospitalization can cause various impacts. Short-term impacts, such as regression, namely loss of control, displacement, aggression (denial), withdrawing, protest behavior, and more among them experiencing fear when health workers will do the treatment [4].
The long-term impact of anxiety on children has a significant influence on their life function if not addressed early, which will be comorbid with other mental disorders and developmental disorders in children [5].
There needs to be quick action so that children become more comfortable and cooperative to medical treatment measures, one of which is an intervention with play therapy [6].
Play therapy is a fun activity for children and is the most effective activity in reducing anxiety, fear, and coping in the face of stress [7]. Play therapy can help lower anxiety and negative emotions in hospitalized children [8]. Research [9] suggests play therapy with storytelling can decrease anxiety and behavioral disorders in children with surgical preparations. It is also supported by research conducted [10], fairy tale therapy can provide happiness and smiles to hospitalized children, to reduce anxiety. Based on the background, we chose play therapy with storytelling modified using finger puppets as an intervention to reduce anxiety in preschoolaged children treated at Jombang Hospital.
The research aims to examine the effect of storytelling using finger puppets on anxiety in hospitalized preschool children.

METHODS
This study is a quasi-experiment with the      developmental disorders in children [5].
There needs to be immediate intervention in overcoming anxiety in children. Otherwise, it will cause fear and apathy, so that the child refuses to perform treatment procedures, treatments to extend the hospitalization period. All this will worsen the child's health condition and cause severity [12].
Play is a fun activity for children, overcoming various kinds of unpleasant feelings in child. By playing, children can feel happy and satisfied [7]. In-play therapy activities researchers also involve the role of parents because the involvement of parents in play therapy, in addition to improving social skills and abilities, can also provide positive emotional support and the child's ability to care for others.
The results of research that has been done showed that the modified storytelling of the use of finger puppets decreased anxiety in children who were hospitalized with a value of p = 0.000. Storytelling can provide a pleasant effect for children, so the brain will stimulate endorphins that can inhibit anxious stimulus sent to the BISA brain's [15].
Research conducted [3] also showed a significant influence of storytelling in play therapy in lowering anxiety levels in preschool children with hospitalization. Another study conducted [16] showed lower anxiety levels in preschool-age children hospitalized after getting storytelling therapy.
Researchers performed a storytelling modification strategy by using a finger puppet effectively to reduce anxiety. The results showed the effectiveness of finger puppet games against decreased fear in children before surgery, during, and postoperative [17]. Other studies have shown finger puppets may lower anxiety in children with leukemia in hospitals [18]. Finger puppets also showed significant differences in reducing anxiety in children with thalassemia [19]. sensitivity/concern for others, thus developing the ability of the right brain and left brain. It is also necessary for the parents or families' involvement in providing emotional support to children so that the results are more effective.
Storytelling play therapy activities using finger puppets can be applied to reduce anxiety in children during hospitalization, and better parents and families are involved. It is expected that in the future, it can be used as an alternative method to reduce anxiety.