Application of Puzzle Play Therapy to Reduce Pain Levels in Children After Appendectomy
Keywords:
Appendectomy, Distraction Therapy, Pediatric Nursing, Postoperative Pain, Puzzle Play Therapy.Abstract
Appendectomy can cause acute postoperative pain that restricts movement, disrupts rest, and increases distress in children. This study described changes in pain levels following puzzle play therapy among pediatric appendectomy patients at Citra Sari Husada Hospital, Karawang. A descriptive case study with a one-group pretest–posttest design included five children aged 7–10 years. Puzzle play therapy was provided twice daily, in morning and afternoon sessions lasting 30 minutes each, for three consecutive days. Pain intensity was assessed using the Wong-Baker FACES Pain Rating Scale before and after the intervention, and scores were compared descriptively. Initial scores ranged from 6 to 8, indicating moderate to severe pain. Final scores ranged from 3 to 4, corresponding to mild pain. Individual score reductions were 3, 4, 3, 4, and 4 points, yielding a calculated mean reduction of 3.6 points. Participants also exhibited less crying, greater cooperation during nursing care, improved rest, and increased willingness to move. These observations suggest that puzzle play may be a feasible supportive activity for children recovering from appendectomy. However, the small sample, lack of a comparison group, and undocumented concurrent analgesic use prevent attributing the changes solely to the intervention. Controlled studies are needed to evaluate effectiveness more rigorously
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