Preschool children undergoing hospitalization are vulnerable to anxiety due to separation from family, unfamiliar environments, and frightening medical procedures. Puzzle play therapy can provide support in children's psychosocial development. This case study aims to describe the application of puzzle play therapy in reducing hospitalization anxiety in children aged 3–6 years at 'Aisyiyah General Hospital, Ponorogo. The method used is a descriptive case study of one child patient with nursing anxiety problems. The intervention in the form of puzzle play therapy was carried out for 3 consecutive days with a duration of 15 minutes per session. Anxiety levels were measured using the Child Anxiety Scales and Preschool Anxiety Scale before and after the intervention. The results showed a significant decrease in anxiety levels, indicated by a decrease in the Child Anxiety Scales score from 4 to 1 in three days of intervention and a decrease in the Preschool Anxiety Scale score from 44 to 27. Puzzle play therapy has been proven effective in helping children divert attention, express emotions, and reduce anxiety during hospitalization. This intervention is recommended for implementation in pediatric nursing care to create a more friendly and comfortable care environment for pediatric patients.

Keywords: Play Therapy, Puzzle, Anxiety, Hospitalization, Preschool Children