Medical Clowns Research Articles

Clowns in Paediatric Surgery: Less Anxiety and More Oxytocin? A Pilot Study.

Background Hospital stays and medical interventions are accompanied by worries and anxiety in children and parents. Recent studies show that hospital clowns may reduce anxiety and enhance well-being. However, so far studies are based solely on subjective measures and clowns are usually not integrated in medical routine. With this pilot study, we aim to provide both psychological and physiological evidence of positive effects of clowns' interventions in hospitalized children. Patients/Method In a consecutive randomized intervention-control group design with 31 children aged 4 to 13 years, 17 patients were accompanied by a clown prior to surgery or during ward round (intervention group) and 14 were not (control group). Saliva samples for oxytocin measurement were taken from all patients before hospitalization (T1) and prior to surgery or after ward round (T2). Self- and parents-reports were obtained at T1, T2 as well as at time of discharge from hospital (T3) regarding children's anxiety (STAI), worries and well-being. Clowns evaluated their success in cheering up the child. Health professionals were asked for their acceptance of clowns in hospitals. Results Children in the intervention group had lower anxiety ratings and a higher oxytocin concentration at T2 as compared with T1; the control group showed no changes. Parents rated the well-being of their children higher if their child had clown's contact and were more willing to recommend the hospital. The staff judged the clowns as helpful for patients. Discussion Consistent psychological and physiological results suggest the positive impact of a clown's intervention in hospitalized children.

The Role of Humor on Turnover Rates: The Case of Medical Clowns

The impact of humor on workplace outcomes is an increasing area of research. This study examined the contribution of humor styles to job satisfaction and turnover behaviors among medical clowns for whom humor is part of their job definition. Questionnaires assessing humor styles were distributed to 111 medical clowns at the start of their training. Of this group, about a third indicated that traumatic stressors in the past served as a significant motivator for pursuing a career as a clown. Job satisfaction and actual turnover were examined after six-months on the job. Results indicated that humor appreciation significantly predicted job satisfaction while humor creation significantly predicted job satisfaction among individuals who did not experience any previous traumas. In addition, traumatic stressors were found to moderate the association between humor and turnover behaviors. For those who had experienced traumatic stress, humor appreciation was negatively associated with turnover. In contrast, among those who had not experienced traumatic stress previously, humor creation and turnover were negatively correlated. The discussion highlights the contribution of humor styles to workplace outcomes and the potential healing effect of humor both to the individual and the organization.

The effect of a clown model implemented in hospital on the anxiety and depression level of ill children and their mothers

Background: This study aims to investigate the effect of hospital clowns on the anxiety and depression level of child patients and their mothers during hospital stay.Methods: 99 children (7–13 years old) and their mothers were randomly divided into clown and control groups. Anxiety and depression levels of the groups were measured with the State-Trait Anxiety Inventory and the Beck Depression Inventory.Results: 96% of the children stated that they had enjoyed the clowns, 84% said the clowns had been entertaining and relieving, 60% reported the clowns had reduced their fear and excitement, 94% wished the clowns would visit them again and 80% said the first thing they would remember when they were hospitalized again would be the clowns. The presence of clowns during hospital stay was found useful for managing children’s anxiety and depression (p < .05), but it was not efficient for their mothers (p > .05).Conclusion: Clown intervention is effective in reducing anxiety and depression levels in children during hospitalization.

Perceptions on Medical Clowns in the Israeli Field Hospital after the Nepal Earthquake

Perceptions on Medical Clowns in the Israeli Field Hospital after the Nepal Earthquake

Erratum to: Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials.

Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I2 statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was −0.83 [−1.16, −0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] −0.46 [−0.7, −0.21]} in the state anxiety was observed amongst parents. Conclusion: We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents.

Hospital clowning: a paediatrician\u2019s view

This study investigates the current position of hospital clowns from the perspective of paediatricians and paediatric residents. A total of 14 attending paediatricians and paediatric residents participated in two focus group sessions. Data were analysed using Atlas.ti 5.0. In general, physicians reported positive experiences regarding the interaction between hospital clowns and paediatric patients on the ward. Physicians were more interested in research on children’s perception of hospital clowns than in research on the clinical efficacy of hospital clowning. No direct collaboration between physicians and hospital clowns was reported. However, physicians proposed conditions which may streamline their encounters with hospital clowns such as clear communication prior to hospital clown visits, and the condition that visits do not impede medical interventions.Conclusion: Overall, paediatricians and paediatric residents view the positive impact on paediatric patients as the most important aspect of hospital clown visits, rather than the clinical efficacy of hospital clowning. In light of the growing number of hospital clowns worldwide, this article provides recommendations for arranging their encounters with paediatricians and paediatric residents to maintain optimal health care.What is known:• Previous studies show a clinically significant pain- and anxiety-reducing effect of hospital clowning in paediatric patients admitted to hospitals or undergoing (invasive) medical procedures.• In general, paediatricians have positive ideas about hospital clowns, aside from personal prejudices.What is new:• This novel study gives deeper insight into day-to-day interaction between paediatricians and hospital clowns on the ward.• This study provides recommendations for clinical practice to arrange encounters between physicians and hospital clowns during hospital clown visits.

Fear of clowns in hospitalized children: prospective experience.

The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known: • Fear of clowns is a phenomenon known for more than several decades and related to the increased use of clowns as negative characters in horror movies and TV shows. • The increased use of medical clowns in hospital wards and corridors increases the significance of defining and characterizing this phenomenon in hospital wards. What is New: • The study is novel by giving new data related to the extent of fear of clowns in pediatrics wards and giving demographic characteristic of children experiencing fear of clowns.

Children’s experience of the encounter with a hospital clown

Children’s experience of the encounter with a hospital clown

Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials.

Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I(2) statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95% CI] for child anxiety score was -0.83 [-1.16, -0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95% CI] -0.46 [-0.7, -0.21]} in the state anxiety was observed amongst parents. We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents. • Trials with clown doctors in pediatric population have shown conflicting results in allaying anxiety amongst children undergoing either hospitalization or invasive procedures What is new: • This is the first systematic review and meta-analysis on hospital clowns • We found out that hospital clowns reduce anxiety amongst children before undergoing either hospitalization or invasive procedures.

Clowning in Health Care Settings: The Point of View of Adults.

Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.

Strategies for diversity: medical clowns in dementia care - an ethnographic study.

BackgroundAs nursing homes become increasingly diverse, dementia care needs a wider range of culturally responsive strategies for individual and collective social interactions. While previous studies conclude that medical clowns have positive effects on verbal and non verbal social interactions, research is lacking from the perspective of residents' cultural background. The aim of this study was to identify interaction strategies employed by medical clowns in culturally diverse dementia care settings.MethodAn ethnographic approach was used and data were collected through observation of interactions between medical clowns and residents with dementia in two nursing homes during a ten week period.ResultsThe observations showed that the medical clowns interacted with residents by being tuned in and attentive to the residents as individuals with a unique life-history, confirming each person´s sense of self. The clowns used sensory triggers, encouragement and confirmation in culturally responsive ways to bond socially with the residents in their personal spaces. The clowns involved objects in the daily environment that were meaningful for the residents, and paid attention to significant places and habits in the past. The clowns further contributed to joint interaction in the common spaces in the nursing homes, using music and drama.ConclusionThe strategies employed by medical clowns in activities with older people with dementia appear to support social interaction. The medical clowns used the social and material environment in culturally responsive ways to strengthen individuals’ sense of self, while contributing to a sense of togetherness and interaction among residents in the common spaces. Findings suggest that both verbal and non-verbal cultural content affected social interaction. The non-demanding encouraging way the clowns tuned in to the residents as individuals could help nurses and staff members improve ways of communication in social activities inside the nursing home.

Patients' Evaluation of Intervention by a Medical Clown Visit or by Viewing a Humorous Film Following In Vitro Fertilization and Embryo Transfer.

This study compared responses to an in-person clown visit and a humorous film following in vitro fertilization and embryo transfer. Intervention was a 10-minute clown visit (n = 101) or 10-minute humorous video clip (n = 99). Demographic and fertility-related data and preintervention anxiety scores were collected. Participants completed an Evaluation of Intervention form postintervention. There were no group differences on demographic or fertility-related data or anxiety scores. Findings indicate while participants viewed the intervention positively, the clown visit offered a higher degree of satisfaction in more patients than did the film. Median evaluation scores were significantly higher for the clown visit, specifically reducing anxiety level and being more distracting. Both groups reported that the exposure made the clinic experience more pleasant and did not bother them, and most would recommend incorporating the intervention in routine treatment. However, free-text comments clearly expressed greater enthusiasm to the in-person clown intervention than to the film.

Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: A randomised controlled trial.

The aim of this paper is to investigate prospectively the potential benefits of the participation of the medical clowns in the outpatient paediatric penile surgery programme. Eighty children undergoing meatotomy, age 2 to 16 years, were randomised into two groups (40 each). In the first group, the medical clown was an integral part of the medical team, and in the second group, the treatment was given without participation of the medical clown. The following parameters were measured: the level of pre-operative anxiety, the level of the post-operative pain, the amount of pain medication use in the first 24 h after surgery and the time needed to return to normal activities. The operating room time and hospital costs were calculated. The patients from the first group demonstrated a lower pre-operative anxiety index upon (P = 0.0319) and after surgery (P = 0.0042), required less induction time for anaesthesia (P < 0.001), spent overall less time in the operating room (P < 0.0001) and required less time to recover from the surgery and to be discharged (P = 0.0172). The overall OR time and post-operative unit care savings of 20 and 155 min, respectively, led to the cost savings of $467. Our data demonstrated that the use of the medical clown functioning as an integral part of the operating team reduces children pre-operative anxiety and leads to a shortening of the overall time in the hospital thereby reducing the overall medical cost justifying the participation of medical clown as an integral part of the health team in a paediatric urology outpatient surgical unit.

Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals

ABSTRACTThis qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children’s perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

The funny world of medical clowns

The funny world of medical clowns

Salivary Cortisol Levels: The Importance of Clown Doctors to Reduce Stress.

This study was designed to correlate entertainment of clown-doctors (CD) activities on hospitalized children and aphysiological bio-marker. For this purpose we collected saliva samples and verified children satisfaction with these activities by using a visual analog scale (VAS). Children from 6 to 7 years-old, with diagnosis of any acute pathology, interned in the Pediatric Ward of the Botucatu Medical School Hospital (São Paulo, Brazil) were interviewed. Two groups were taken into consideration: lunchCD and dinnerCD. The following protocol was applied in each group (lunch and dinner): collection of the first saliva sample and presentation of VAS prior to CD activities, followed by collection of a second saliva sample and another VAS assessment after CD activities. The salivary cortisol was reduced in both groups comparing the first saliva sample. The satisfaction of the intervention was evident for lunchCD. The CD intervention is effective in decreasing an important physiological biomarker of stress factor, cortisol, in hospitalized children, been effective for the healing process.

Dream Doctor Intervention Instead of Sedation: Performing Radionuclide Scanning Without Sedation in Young Children: A Study in 142 Patients.

Dream Doctors (DDs; professional medical clowns) are expanding their activities in pediatric wards. DDs were introduced as an alternative to sedation among children undergoing kidney imaging after urinary infection. The imaging requires that the patient lie completely still under the camera during the scan; otherwise the image cannot be interpreted. It is extremely difficult to get these children to cooperate, and pediatricians have to provide sedation to get good results. Giving sedation requires medical observation, and it can take hours until the child can be safely released from the hospital. A DD intervention was introduced in an attempt to avoid sedation in these young children. The DD tried to gain the child's cooperation during the procedure. Each study was subsequently scored by a radionuclide physician to assess study quality and interpretation. A total of 142 patients were studied over a 14-month period. The mean age was 2 ± 1.6 years. During the study, in the presence of the DD, only five (3.2%) patients required pharmacologic sedation compared with 100% before the study. The introduction of DDs proved to be a good alternative to sedation in cases where the procedure does not involve pain and only requires the child's cooperation.

Book Review: Pratiquer l'ACT par le Clown [ACT through Clown

“Let it go…Let it go” is one of the key message of the Acceptance and Commitment Therapy (ACT), as well as the Frozen movie. My 2 years old daughter Elise is very good at both: singing and let it go. She is also a great clown, such as another Elise Ouvrier-Buffet, a professional clown and co-author with Jean-Christophe Seznec of the book reviewed here (Seznec and Ouvrier-Buffet, 2014). Putting ACT and clown together is unusual and can be surprising…except if you are already familiar with both ACT and clown. Contact with the present moment, committed action, acceptance, self as context, values and defusion are some core characteristics of the clown, and the six psychological processes ACT seeks to strengthen (Hayes et al., 2006; Hacker et al., 2016). The clown is listening to his body, sensations and emotions, instead of focusing on distracting parasite thoughts. Therefore he is a great example for patients, as well as for therapists. The first author wrote his clown skills enhanced his psychiatrist job. Now he wants to play, laugh and have fun during sessions. If life includes pain and death, clown and therapist have to deal with it and, likewise, help other people to do so. Because of these similarities, ACT and clown can learn from each other; this was obviously the authors' guidelines for this eight chapters book. Chapter 1 introduces us to the clown, using open questions. We learn the history of the white clown and Auguste, the role of fun and playing, his relationships with laugh (no need to be funny) and most importantly, other human being. Psychologists already familiar with ACT will enjoy the end of its chapter, dealing with clown values, very helpful to develop ACT skills. Chapters 2 and 3 are respectively dedicated to ACT presentation and its models. Chapter 2 is a good reminder (or discover) of ACT and its roots: from meditation to Cognitive and Behavioral Therapies (CBT). To help the reader through the book, the authors quote famous or original quotes, including the Forrest Gump's chocolate box one to exemplify ACT principles. Hexaflex, matrix, C-ABC model and four squale tool are described in Chapter 3. Chapter 4 is the ACT toolbox presentation, starting with metaphors. Specific tools for observation (including mindfulness), action, defusion (apples sorting), and emotions regulation. At this point, we can fully understand how ACT and clown overlap each other with psychological flexibility. Chapter 5 starts with the classical ACT ocean metaphor and the surf spirit to set us up before exercises. Beyond classic ACT values, the focus is on playing, having fun and let our clown go. We also learn to say “yes” to anything, just like the Auguste. This is a very powerful skill also developed in improvization theater with the famous “yes, and…” (Bermant, 2013; Bernstein, 2014). Chapter 6 is dedicated to practice. The first part contains illustrations for warm up and body expression exercises. We also learn clown skills to explore space, focus, voice, facial expressions, unlocking imagination, working with others and psychotherapeutic exercises from clown practice, as the “ask and no answer” game. In this exercise, people have to ask eccentric questions, so the answer can be no. The two last chapters are the perspective sections. Chapter 7 introduces us to ACT and clown practice in different contexts, mostly at work, nonprofit organization and in hospital. Hospital clown associations grew up in the last 30 years on both side of the Atlantic: Big apple clown care in the USA or Le Rire Medecin in France. A French clown says how much her clown, being a third actor, changes the relationship between child in hospital and his parents. The clown makes parents laugh and the children enjoying the clown and their parents laughing. While clinical teams often want to comply with their supposed serious role, the clown helps them to improve their flexibility. While more studies need to confirm, clowns seem to have an impact in hospital, especially in pediatric practice (Fernandes and Arriaga, 2010; Finlay et al., 2014). Chapter 8 is more personal. Authors let their thoughts go and explain how and why they wrote this book after a professional and personal journey. They became clown or psychiatrist because they love freedom, goodwill and humanism. Overall, this book can be used as a toolkit for psychologists and psychiatrists, already familiar with ACT (or not), for their everyday practice. Anyone without particular psychological knowledge could benefit from this book, thanks to its exercises and clinical illustrations. The main concern about this book is that it is, for now, only available in French. I hope non-French speaking people reading this article will translate it to spread the ideas. Just say “yes.”

Positive emotions elicited by clowns and nurses: An experimental study in a hospital setting.

The present research is first to investigate the unique effect of a humorous clown intervention on patients’ emotional state in comparison with a different kind of intervention in a hospital setting using a controlled experimental method. Forty-four adult patients of a physical rehabilitation center were randomly assigned to either participate or observe 2 interventions: a hospital clown and a nurse intervention. Compared with baseline and the nurse intervention, the clown intervention elicited a higher level of amusement in patients. Both interventions elicited arousal, and neither intervention led to a change in negative emotions. No difference was found between the emotional states of participants and observers of the interventions at any level. A combination of general funniness of clown performances and felt transcendence during the hospital clown intervention best predicted the total amount of positive affect experienced during the intervention, which supports and extends results from previous studies. The results clearly support the benefit of hospital clown interventions for the elicitation of a positive emotional state in patients. Clowns working in hospitals should be encouraged to continue their work with patients in need of care.

O humor e o riso na promoção de saúde: uma experiência de inserção do palhaço na estratégia de saúde da família

Working with different forms of artistic and cultural expressions has been considered a form of health intervention to enhance the understanding and thinking about the needs in this field. A group of clown doctors conducted home visits for eight months to ten families located in micro areas of two family health teams. The practice aimed at expanding the solvability of the care given to people and to communities through the intense proximity established by the art of clownery. The idea consisted of making interventions in the homes of socially vulnerable families indicated by the family health teams using joy, humor, and laughter to stimulate reflections on the daily problems. The presence of "clown doctors" in the houses built strong and free bonds with the families and enhanced the humanized and comprehensive care within the context of family health strategy. Clowns and families found a special way to find possible solutions to the difficulties faced on a daily basis. Male and female clowns were able to manage new subjective constructions for each family to deal with everyday situations.