EFFECT OF PICTURE-BOOK BIBLIOTHERAPY ON ANXIETY REDUCTION
IN HOSPITALIZED CHILDREN AT ANWAR MEDIKA HOSPITAL
Tri Peni.
Tri Ratnaningsih.
Siti Indatul Laili Universitas Bina Sehat PPNI Mojokerto Corresponding Email: peni.
ners@gmail.
ABSTRACT
Keywords Hospitalization is a process that requires a person to be hospitalized for treatment, until they are allowed to go home.
This process often causes stress and anxiety, especially for children, because they have to adapt to a foreign environment, be separated from their families, and undergo medical treatment.
The purpose of this study was to determine the effect of bibliotherapy with picture storybooks on reducing children's anxiety levels in the Lily Room of Anwar Medika Hospital.
Sidoarjo.
The research design used a Quasiexperiment with a one-group pre-testAepost-test design.
The population in this study were all children treated in the Lily Room of Anwar Medika Hospital.
The sample was taken using an accidental sampling technique, obtaining 37 The research instrument used a questionnaire.
Data were analyzed using the Wilcoxon Signed Rank Test.
The results of the Wilcoxon test obtained a p-value of 0.
000 <0.
05, which means bibliotherapy significantly reduced anxiety.
Bibliotherapy with picture books is highly effective in reducing anxiety in children because the text and illustrations in books are engaging and provide a distraction that can reduce anxiety.
INTRODUCTION
According to the World Health Organization (WHO), a child is an individual under the age of 18.
WHO views children as vulnerable individuals who need special protection and care.
Children are still in a period of physical, mental, and emotional development.
In the context of a family, children are the responsibility of their parents who need to be cared for and Child.
Bibliotherap .
Anxiety.
Hospitalizati raised properly.
If a child is sick, it will hinder their growth and development.
According to (Supartini, 2.
, a sick child who must be hospitalized will experience a difficult time because they cannot carry out their usual habits.
Children during hospitalization must undergo a series of painful and repetitive The treatment process forces children to be separated from their parents.
International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 3.
December 2025 causing them to feel excessive fear, worry, and anxiety (Lufianti et al.
, 2.
Hospitalization has impacts on children, such as separation, loss of control, pain, and Some of these impacts include (Nurlaila.
Utami and Cahyani, 2.
The environment and the various procedures children undergo are major sources of stress, disappointment, and anxiety.
Children who are hospitalized may react with sadness and fear because they are facing something they have never experienced before.
They may discomfort, loss of familiar experiences, and If the impacts of hospitalization are not addressed promptly, they will affect psychosocial development, especially in children (Supartini, 2.
The results of research (Nurlaila.
Noviyanti and Iswati.
Ning, 2.
at PKU Muhammadiyah Gombong Hospital found that of 34 children who were hospitalized, 9% experienced mild anxiety, 14.
moderate anxiety and 79.
4% severe anxiety.
Research (Harsismanto.
Yanti Alfathona, 2.
in the Edelweiys Pediatric Ward at Dr.
Yunus Bengkulu Regional Hospital stated that of 32 children who were hospitalized on the first day, the majority of children experienced severe anxiety, namely 8% and moderate anxiety 6.
Bangkinang Regional Hospital, of 19 preschool-aged hospitalized, 10.
5% experienced very severe anxiety, 21.
1% severe anxiety, 21.
moderate anxiety and 21.
15 mild anxiety (Apriza, 2.
At RA Basoeni Regional Hospital, of the 27 children who were hospitalized on day 1 to day 2, 22.
experienced mild anxiety, 44.
4% moderate anxiety, 25.
9% severe anxiety and 7.
severe anxiety (Peni.
Ratnaningsih and Laili, 2.
Responses to hospitalization are influenced by several factors, including the hospital environment, separation from significant others, lack of information, loss of freedom and independence, previous experiences with healthcare services, and interactions with hospital staff (Rahayu et , 2.
Hospitalization is essentially a treatment method aimed at assisting children in their recovery from illness and monitoring the condition of children experiencing health However, maladaptive responses resulting from hospitalization can create more complex problems for children (Fazrin, 2.
Hospitalized children who experience stress will experience increased cortisol, which will inhibit antibody formation, reduce white blood cells and the body's This suppression of the immune system appears to result in inhibition of the healing process, requiring a fairly long treatment time and even accelerating the occurrence of complications during treatment (Hale and Tjahjono, 2.
Children in preschool .
-6 year.
react to hospitalization by refusing to eat, frequently asking questions, crying softly, and being uncooperative with health workers.
Hospitalization is often perceived by children as punishment, resulting in feelings of shame and fear that lead to aggressive unwillingness to cooperate with nurses (Wong et al.
, 2.
Anxiety in children will disrupt the child's healing process, making it difficult for children to cooperate with all actions taken during treatment in the ward.
(Wong et al.
, 2.
revealed several ways to reduce anxiety in children during hospitalization, one of which is through language .
Bibliotherapy with picture books is a fun play activity for It creates a relaxed and comfortable environment for children.
Children feel happy and there is a distraction International Journal of Nursing and Midwifery Science (IJNMS).
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Based on this background, researchers are interested in conducting research on the effect of picture story bibliotherapy on reducing levels of anxiety during hospitalization in children in the Lily Ward of Anwar Medika Hospital.
METHOD
This study used a quasi-experimental design with a one-group pre-test-post-test The population in this study were all families with children treated in the Lily Room of Anwar Medika Hospital.
The sampling technique used accidental sampling, obtaining 37 respondents.
Data analysis used the Wilcoxon Signed Rank Test with a 95% confidence level and a significance level of p-value O 0.
RESULTS
Table 1.
Respondents' Frequency Distribution Based on Age, gender and history of hospitalization Characteristics of Respondents Category history of 1-3 years 4-6 years 7-12 years Man Women Never Ever Last education Diploma Age Gender Based on Table 1, data shows that almost half of the respondents were aged 4-6 years .
6%).
The majority of respondents were male .
1%) and more than half of the respondents had no history of hospitalization .
5%).
Table 2.
Frequency distribution of hospitalization anxiety levels in children before and after bibliotherapy in the Lily Room of Anwar Medika Hospital.
Category Before Normal Mild Moderate Severe Very Severe/Panic Normal Mild Moderate Severe Very Severe/Panic After Based on Table 2, data shows that more than half of the respondents experienced very severe anxiety/panic before bibliotherapy .
5%) and the most respondents .
experienced no anxiety .
after The Wilcoxon test results obtained a pvalue of 0.
000 < 0.
05, indicating that bibliotherapy with picture books had an effect on hospitalization anxiety in children in the Lily Ward.
Anwar Medika Hospital.
DISCUSSION
The results of the study showed that all hospitalized children experienced anxiety, ranging from mild to severe.
Univariate analysis of anxiety levels in hospitalized children revealed that more than half of the respondents .
5%) experienced very severe anxiety/panic before bibliotherapy.
Hospitalization is a crisis condition in children, whether planned or emergency, which requires the child to be hospitalized for treatment for several days until the child recovers and can return home (Mariani.
In children, hospitalization can cause regression due to separation from parents, unfamiliar environments, and medical According to (Muflih, 2.
, anxiety is a phenomenon we often encounter in everyday life.
Anxiety is an emotional reaction to the assessment of stimuli.
Basically, excessive anxiety will cause International Journal of Nursing and Midwifery Science (IJNMS).
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December 2025 problems.
Possible problems caused by anxiety include difficulty concentrating, feeling less cared for over small things or having difficulty focusing, and disturbed sleep quality.
Anxiety is an unpleasant emotion, characterized by terms such as worry, concern, and fear that we sometimes experience at varying levels (Lestari, 2.
Anxiety responses shown by children include difficulty sleeping, children refusing to communicate or interact, children appearing sad, and often crying and asking to go home.
This is because the child feels like he is living in a foreign environment and is afraid of medical procedures during his The analysis of anxiety levels after bibliotherapy with picture story books showed a decrease in anxiety levels.
The results showed that most respondents after bibliotherapy did not experience anxiety .
, namely .
2%), mild anxiety 0, moderate anxiety 21.
6%, severe 2%, and no children were found experiencing very severe anxiety/panic.
The results of the Wilcoxon Signed rank test obtained a p-value of 0.
000 <0.
05, which means there is an effect of picture story bibliotherapy on reducing hospitalization anxiety in children in the Lily Room of Anwar Medika Hospital.
The results of this study are supported by research (Trupti et al.
, 2.
on Bibliotherapy in Stress Reduction in Hospitalized Children in Western India.
The findings of this study indicate that bibliotherapy is statistically significant (P < 0.
in reducing stress in hospitalized Bibliotherapy is an effective intervention in reducing stress in hospitalized children.
The results of research (Sivasubramanian et al.
, 2.
on the Effect of bibliotherapy on reducing anxiety in preoperative patients in Gujarat.
India showed that the average anxiety percentage score of the experimental group in the pre- test was 80.
10 percent, while the average anxiety percentage score of the control group was 85.
66 percent.
After the trial, the average anxiety score of the experimental group was 50.
66 percent, while the average anxiety score of the control group was 83.
Bibliotherapy has been proven to be successful in reducing the level of anxiety in pre-operative patients.
The results of the study (Apriza, 2.
showed that the average level of anxiety before bibliotherapy with picture story books was 23.
3, while after bibliotherapy with picture story books With the T-test, p = 0.
<0.
was obtained, meaning that there was an effect of bibliotherapy with picture story books on the level of anxiety due to hospitalization in preschool children in the children's room at Bangkinang Regional Hospital.
According to (Wong et al.
, 2.
illness and hospitalization are crises for children, primarily due to the stress caused by environmental changes and changes in condition from healthy to ill, and children have limited coping mechanisms in dealing with stressors.
If a child has had an unpleasant experience being hospitalized before, it will cause fear and trauma.
Conversely, if a child is hospitalized and receives good and pleasant care, the child will be more cooperative with nurses and (Komang Bibliotherapy can help children overcome Bibliotherapy with picture stories helps someone process emotions and overcome problems through discussions about the story and its characters.
This therapy utilizes a combination of text and illustrations in books to convey messages, helping children .
specially younger childre.
understand and explore anxiety or When reading, children can identify with the characters in the story who face similar conflicts or problems.
This allows International Journal of Nursing and Midwifery Science (IJNMS).
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Illustrated bibliotherapy is a highly effective visual medium because images help children understand stories more easily and This method is particularly effective in reducing anxiety in children because engaging picture books can help them feel more comfortable and receptive to the therapeutic message.
CONCLUSIONS
The results of this study indicate that bibliotherapy using picture books has an effect on reducing anxiety levels in children at Anwar Medika Hospital.
Bibliotherapy can help children cope with anxiety.
Bibliotherapy using picture books helps individuals process emotions and resolve problems through discussions about the story and its characters.
This therapy utilizes a combination of text and illustrations in books to convey messages, helping children understand and explore feelings of anxiety and sadness.
Bibliotherapy using picture books is a highly effective visual medium because the images help children understand the story more easily and engagingly.
REFERENCES