Medical Clowning Research Articles

Send in the Clowns: A Special Tribute to Medical Clowning and Clown Eponyms in Dermatology

Clowns have long delighted circus crowds and are celebrated not only in popular culture but also in the dermatology literature as medical eponyms. This contribution discusses four such eponyms: 1) clown nose-like lesion, 2) clown eczema (perioral dermatitis) 3) clown alopecia pattern in frontal fibrosing alopecia and 4) clown's face of Brachman de Lange syndrome (Cornelia de Lange syndrome). This contribution also highlights the role of medical clowning in patient care by paying tribute to Cobo the Clown, also known as Barbara Joyce Cohen, who has served as a dedicated caring clown for over thirty years.

The Effects of Medical Clowning on the Quality of Life (QoL)on the Patients in on Co-Pediatric Daycare Wards

This study investigate the effects of Medical Clowning on the quality of life (QoL)on the patients in onco-pediatric daycare wards. A total of 35 participants aged 8-15 years were recruited from an onco-pediatric ward. Validated tools, including the Pediatric Quality of Life Inventory (PedsQL) and thematic coding, were utilized to assess QOL respectively. Statistical analysis, including frequency distribution for quantitatively analyzing the scores of quality of life and further using thematic coding to form respective codes done conducting semi structured interviews on the patients and their guardians were employed to analyze the data. The findings revealed significant improvements in the pediatric quality of life following medical clowning therapy. The frequency distribution for scoring quantitative data for quality of life, thematic coding for qualitatively analysis and forming 8 different themes, to assess the effectiveness of medical clowning therapy was used. The findings indicated a significant positive impact of medical clowning on improving pediatric quality of life. These results highlight the therapeutic benefits of medical clowning interventions in pediatric oncology care, emphasizing their role in enhancing patient well-being and promoting a supportive treatment environment. Furthermore, the findings underscore the importance of interdisciplinary collaboration and policy support in integrating medical clowning into comprehensive pediatric oncology care protocols. Overall, this study contributes valuable insights into the effectiveness of medical clowning as a psychosocial intervention in pediatric oncology settings, providing evidence to support its integration into standard care protocols. Moving forward, further research is needed to explore the long-term effects of medical clowning interventions and optimize their implementation in clinical practice.

Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator.

To investigate the potential effectiveness of "medical clowns" on preoperative, intraoperative, and postoperative anxiety of children undergoing various dental treatments and also its effect on the operator's stress levels in a dental setup. A total of 170 pediatric patients, aged 4-8 years, indicated for preventive therapy, extractions, restorative, and endodontics were included and divided into two groups [group I-audiovisual (A-V) aids; group II-medical clowns], group of 85 patients each after recording Modified yale preoperative scale. Both pre- and postoperatively, Frankl's behavior score was recorded for each patient. During treatment, the face, legs, activity, cry, consolability (FLACC) pain scale, and dental operator's stress level were recorded. Intervention of medical clowns positively influenced children during dental treatment by increasing their pain threshold. The majority of children showed positive Frankl rating scales after dental treatment. Also, the operator's stress was significantly reduced, which led to enhanced treatment outcomes. Humor yields the power of healing, distracts pediatric patients, reduces their anxiety, and alleviates their pain, conferring the patients with a sense of laughter, creativity, and care.Therefore, medical clowns in pediatric dentistry can prove to be serviceable and valuable as a nonpharmacological approach to behavior management. Aggarwal P, Mathur S, Chopra R. Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator. Int J Clin Pediatr Dent 2024;17(1):59-66.

Medical clowning in hospitals: practices, training and perception

Previous studies on medical clowning focused on patients, while research remains inadequate concerning clowning itself: training programmes and prerequisite requirements, clowning methods, deontology and accepted practices. Diverse approaches and paradigms...

Medical clowning influences the emotions of parents of children undergoing cancer treatment: A quasi-experimental study

BackgroundMedical clowning for children has been found to be effective at enhancing parents' psychological well-being during preoperative preparation, but has not been found during cancer treatment. This study aimed to examine whether and how medical clowning influenced the emotions of parents of children undergoing cancer treatment. MethodsIn this quasi-experimental study, 96 parents of children receiving inpatient cancer treatment were recruited, from June 2018 through April 2020. A demographic questionnaire measuring characteristics of parent and dyadic child, Brief Symptom Rating Scale measuring psychological distress of the parent, and Mood Assessment Scale measuring emotional status of parent and child were administered 1 day before a clowning service. The day after the clowning service, the Mood Assessment Scale again collected emotional status for parent and child. Descriptive analysis, bivariate analysis, and structural equation modeling to fit the actor-partner, cross-lagged model were used. FindingsParents experienced a low degree of psychological distress that called for emotional management. The indirect effect of medical clowning on parents' emotions through children's emotions was significant, as were the direct effect and total effect of medical clowning on parents' emotions. DiscussionParents experienced psychological distress during their child's inpatient cancer treatment. Medical clowning can directly improve children's emotions and through this pathway indirectly improve their parents' emotions. Application to practiceThere is need to monitor psychological distress and provide interventions for parents of children undergoing cancer treatment. Medical clowns should continue to serve parent-child dyads in pediatric oncology practice and become members of multidisciplinary health care teams.

A Lifetime of Play: Group Medical Clowning with Older Adults

Play is fundamental to a person’s well-being. However, cultural norms and ageism have negatively impacted this practice among older adults. This study explored to what extent medical clowning promotes play among older adults. Qualitative data were collected in weekly group sessions of medical clowning in an Israeli retirement home. Group medical clowning offered participants a new sort of playground, which combined body play, cognitive play, and role-play. The clown created an ambience that legitimized older adults’ loosening-up, expanding their space, feeling happy, and developing new creative interactions. He enabled participants to get involved in free play, thus freeing them of social constructions regarding older adults. The medical clown created a community of play and legitimized play among older adults, thereby breaking rules based on social stereotypes, the convention that older adults should not behave nonsensically and challenging the accepted social norms of the retirement home.

Medical clowns in Coronavirus wards: A milestone in further integration into Israeli hospitals

BackgroundDuring Covid-19, medical clowns disappeared from hospitals worldwide, ending their in-person visits. However, Israeli ‘Dream Doctors’ continued in children's wards and gained entrance to the Coronavirus wards. MethodsUsing qualitative data from interviews and digital ethnography, the involvement of medical clowns in Coronavirus wards and their challenges were studied. ResultsMedical clowns integrated mandatory protective gear and adapted their art: altering outfits, body language and interactivity. Spreading laughter and joy improved wards' ambience by uplifting patients', families' and staff's mood. Staff joined the clowns and loosened up in front of them. Reported need for this interaction was great and the clowns' intervention was crucial, leading to a successful trial in general wards, funded by one hospital. ConclusionsAdditional working hours and direct payment increased medical clowning's integration in Israeli hospitals. Entering the general wards evolved from the clowns' involvement in the Coronavirus wards.

From Laughter to Medicine, from Clowning to Therapy

“Laughter is the best medicine,” was just a saying up until, therapeutic clowning started using humour and play to bring about emotional healing and psychological recovery. This article attempts to review 27research based articles in a thematic fashion, to develop a comprehensive understanding about therapeutic clowning, its effects across different conditions and specific populations, and how it could be established as a profession. The review not only adds to the existing literature on medical clowning, but also tries to highlight the therapeutic nature of it, and how it lends itself in maintaining the holistic well-being of the diseased or disabled. After close examination, it was found out that therapeutic clowning has positive and sustainable consequences for community well-being. This also expands further scope for future researches to measure the effects of therapeutic clowning so that it could be accepted as an intervention model or a psycho-socio-emotional rehabilitation model.

Medical clowning’s contribution to the well-being of older adults in a residential home

ABSTRACT Medical clowning is a familiar practice in residential homes worldwide. While previous studies focused on medical clowning interventions with individual dementia patients, this study explores medical clowning group sessions with independent older adults in a residential home in Israel. Data were collected through observations in 10 weekly sessions in two groups and 28 semi-structured interviews. Combining medical clowning and psychodrama techniques, sessions included three phases: (1) warm-up where participants move their bodies using funny items, (2) action where they play group games and do role-play, and (3) sharing, in which one participant in each session is invited to tell a personal story, followed by a medal ceremony. Participants stated that medical clowning supported them physically, emotionally and socially, and should become part of the culture in residential homes. The unique contributions of medical clowning sessions for the well-being of older adults are the result of having the legitimacy to play and laugh, gaining empowerment by sharing stories from the past, and the creation of a sense of belonging to the group. In addition, older adults experienced medical clowning as a process of becoming visible and active.

The effectiveness of a medical clowning program on improving emotional status among hospitalized children undergoing cancer treatment: A quasi-experimental study.

To examine the effectiveness of one-time medical clowning on improving short-term positive emotions among hospitalized children undergoing cancer treatment, and to analyze whether age moderates this effect. In this quasi-experimental research study, we recruited a pooled sample of 96 children who were undergoing cancer treatment in pediatric oncology/hematology wards at three university-affiliated medical centers in Taiwan from June 2018 through April 2020. Children's demographic characteristics, symptom distress, quality of life, and pretest emotional status were collected at T1. At T2, we collected only posttest emotional status. We adapted generalized estimating equation models to evaluate the effectiveness of medical clowning on enhancing positive emotions. Changes in the probabilities of positive emotion were significantly different across groups (51.84% for the experimental group, 15.76% for the control group; Δ = 36.08, p = 0.001), and the change was more than two times larger for the experimental group (effect ratio = 3.28, p < 0.05) than for the control group. When evaluating the moderating effect of age on the intervention, none of the coefficients reached the significant (p < 0.05) levels, suggesting that age may not moderate the intervention effect. This study demonstrates the core value of medical clowning in child-friendly health care. Our findings clearly support the benefit of the one-time medical clowning program on enhancing short-term emotional well-being across age groups of children. Medical clowning programs should be strongly encouraged and supported in pediatric oncology wards. Medical clowning programs should be widely and continuously implemented in pediatric oncology wards as a routine clinical practice for enhancing emotional well-being among children receiving cancer treatment. Nurses need to be aware of medical clowning's equal effectiveness across age groups, not only or better for younger children.

Medical Clowning: A Cost-Effective Way to Reduce Stress Among Children Undergoing Invasive Procedures.

BackgroundDistraction techniques like medical clowning and the use of soap bubbles can aid in reducing children’s stress levels while undergoing invasive medical procedures. Such complementary therapies are not a common practice in Pakistan, and data exploring the potential benefits of complementary therapies are sparse. This study aimed to determine whether distractions like medical clowns and soap bubbles could reduce anxiety and pain perceived by children undergoing invasive medical procedures in a hospital in Pakistan.Material and methodsWe conducted a randomized controlled trial of 76 pediatric patients (aged six to 12 years) whose treatment required a peripheral intravenous (IV) catheter insertion at the pediatric ward of the Fauji Foundation Hospital in Rawalpindi, Pakistan, from March 2016 to June 2016. Peripheral IV catheter insertion was required for all patients as part of their treatments (no participants received IV catheter placement solely for this study). Our sample size was selected via random sampling, and we excluded patients whose parents or legal guardians did not consent for their inclusion. Study participants were randomly assigned to either a clown group (n=38) or a control group (n=38). The patients in the clown group underwent IV catheter placement while interacting with the medical student clown and soap bubbles in the presence of a parent. Patients in the control group underwent IV catheter placement with support provided only by the parent. We assessed the patient’s distress and anxiety before, during, and after the procedure. We used the Observation Scale of Behavioral Distress (OSBD), before and after the procedure with the short version of self-reported Spielberger’s State-Trait Anxiety Inventory-Children (STAI-C), the visual analog anxiety scale (VAS), and pain experienced with the Wong-Baker Faces pain scale (FPS) only after the procedure. Additionally, we collected demographic information. The hospital's ethical review committee approved our study design.ResultsOf the 76 study participants, 53.9% were male and 46.1% were female. Most patients lived in a rural setting (67%). Mean values of the FPS, OSBD, and STAI-C for the clown group (3.21, 6.23, and 8.52, respectively) were all lower than those for the control group (8.00, 18.02, and 15.29, respectively; p<.001); however, the difference was not statistically significant for children older than 10 years. After IV catheter placement, the mean VAS score for the clown group was also significantly lower than that for the control group (2.84 vs. 8.92, respectively; p<.001).ConclusionThe use of distractions via medical clowns and soap bubbles was an effective nonpharmacological method of reducing anxiety and perceived pain in children undergoing invasive medical procedures. Therefore, proceduralists could use such techniques as powerful, noninvasive, and cost-effective complementary and alternative medicine tools in pediatric treatment settings in Pakistan. Further studies on the potential benefits of the aforementioned techniques are warranted.

Turnover among medical clowns early in their career

In recent years, several investigations of the medical clowning profession have appeared in the literature. However, few studies have focused on factors associated with turnover among medical clowns early in their careers. The current study examined whether individual differences in humor disposition predicted turnover behavior. Participants were 111 medical clowns in a three-phase longitudinal study. Humor disposition was measured in the first week of their training, clowns' job satisfaction two months later, and turnover six months after that. Results showed that humor appreciation decreased actual turnover through the mediating role of job satisfaction, whereas individual differences in humor creation directly decreased turnover. In addition, previous traumatic experiences moderated the associations between humor appreciation and turnover. Overall, our research findings support the notion that humor disposition can help predict which clowns remain in the hospital.

Clowning during COVID-19 – A survey of European Healthcare Clowning Organisations highlights the role of humour and art in the healthcare system

ObjectivesThis paper presents the findings of a Europe-wide survey that investigates the impact of COVID-19 on Healthcare Clowning Organisations and encourages the healthcare community to reflect on the role of medical clowning within the healthcare system. Study designOnline survey. MethodsThe survey was conducted in June 2020. Forty organisations from 21 countries across Europe responded through a mix of closed and open-ended answers. ResultsDuring the pandemic, 36 out of 39 of the surveyed organisations (with one non-response) had to postpone or cancel their artistic activities. As the crisis continued, 34 out of 40 of them managed to adapt their in-person activities, but the impact of virtual and distanced interactions with the beneficiaries was generally perceived as lower than that of in-person activities. In open responses, many Healthcare Clowning Organisations criticised the exclusion of medical clowns from healthcare institutions in times when the need for psychosocial support was particularly acute. ConclusionsThe healthcare sector should reconsider the important role the medical clowns play within healthcare settings, and allow for more inclusive and flexible safety regulations that take into consideration the holistic well-being of vulnerable groups, especially children, the elderly, and medical staff.

Medical clown support is associated with better quality of life of children with food allergy starting oral immunotherapy.

The start of oral immunotherapy (OIT) for food allergy is a critical period in the treatment process, with a potential to influence patient quality of life (QOL) and subsequently treatment outcome. The association of medical clowning with QOL at OIT initiation was examined. Children aged 4-12years supported by a medical clown (MC) during the induction week of OIT for food allergy were studied. Children in the same age range starting OIT without the support of a MC served as controls. Parents of all children completed the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF), and children aged 8-12years completed the Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF). QOL scores of parents and children with and without a MC support were compared. Children with (n=88) and without (n=212) the support of a MC were comparable in demographics and clinical characteristics. The study group had a significantly lower single highest tolerated dose compared to controls (57±83 vs 162±274mg protein, respectively, P<.001). Parental perception of the QOL of children was not associated with a MC support (P=.81) but rather with previous reaction severity (P<.01). In contrast, the QOL of children aged 8-12years (n=119) was positively associated primarily with a MC support, total score 3.7±1.1 vs 4.6±1.3 (P<.001). While the perception of QOL of parents of children with food allergy at OIT initiation is mainly associated with previous reaction severity, the QOL of the children themselves is primarily positively associated with MC support.

Humanizing Healthcare through Humor: Or How Medical Clowning Came to Be

Increasing numbers of hospitalized children, institutionalized elderly, and other vulnerable populations around the world are receiving special treatments from “clownical” members of clinical teams. Integrating humor into healthcare is flourishing and for good reason; feeling good is good for us.

Measuring patient experiences in a Children\u2019s hospital with a medical clowning intervention: a case-control study

BackgroundBecause the healthcare sector is shifting to a customer-oriented approach, it is important to understand experiences of children as users of healthcare services. So far, studies that measure the influence of medical clowning on patient experiences are scarce. This study aims to measure experiences of children and their parents during day-surgery in hospital setting.MethodsA case-control study was conducted in a large Finnish children’s hospital. Seventy children aged 4–17 years coming for a minor operative procedure including pre-operative cannula insertion prior to surgery were included. Thirty-eight children were exposed to the medical clowning intervention and 32 children (the reference group) did not receive exposure to medical clowning. A novel digital survey tool was used to measure patient experiences before and after the insertion of a venous cannula needed for anaesthesia. The children were asked about their emotions, anxiety levels, the pain from the cannula insertion and the best and worst things about the hospital. The parents were asked about their emotions, expectations and the fluency of the procedure and the hospital day.ResultsBefore the procedure, 32% or 36% of the children in the intervention group and 44% or 28% of those in the reference group expressed positive or neutral emotions, respectively. After the procedure, 76% or 63% of children in the intervention group or reference group, respectively, expressed positive emotions. The intervention group rated the medical clowns as the best aspect of the hospital day. Both groups reported that the best aspects of the hospital day were related to the nurses and food and the worst were related to waiting and pain. Most commonly the parents felt uncertainty, anxiety or calmness before the procedure and relief afterwards. Their expectations towards the procedure related to its success and the certainty of the diagnosis.ConclusionsThe results show a trend towards more positive emotions in children with exposure to medical clowning. The digital survey tool was suitable for gathering information about the experiences of children and their parents. Information on emotions and expectations of children and parents during a procedure is useful when improving the quality of healthcare services.Trial registrationCurrent Controlled Trials NCT04312217, date of registration 17.03.2020.Retrospectively registered.

Saving Costs for Hospitals Through Medical Clowning: A Study of Hospital Staff Perspectives on the Impact of the Medical Clown.

This study explores the perspectives of doctors, nurses, and technicians on the medical clown. A total of 35 subjects were interviewed one on one. Interviews were transcribed and analyzed for common themes. Medical staff outlined novel limitations and views of future directions for the field of medical clowning. Most importantly, many previously unpublished benefits of medical clowns were described. These reported benefits included cost-saving measures for the hospital, increases in staff efficiency, better patient outcomes, and lower stress in medical staff. Given that most of the limitations on medical clowning are financial in nature, these findings have substantial implications for the future of the field. As medical clowning continues to grow, this study outlines the potential for various future research projects within this field of study.

Medical Clowning: The Healing Performance by Amnon Raviv

Medical Clowning: The Healing Performance by Amnon Raviv

Intervention of Medical (Therapeutic) Clowns in a Kindergarten for Children with Intellectual Disability: A Case Study

ABSTRACTIn recent years, there is growing evidence for the efficacy of medical clowning as a para-medical profession. In the present study, we explored the possibility of expanding the work of medical clowns into the special education system, hypothesising that medical clowns can contribute to the development of socio-emotional abilities of children with intellectual disability (ID). Two medical clowns worked with 50 children in a kindergarten cluster for children aged 3–7 with ID for 6 months. All clowning sessions were videotaped and coded using the Test of Playfulness (ToP) observation instrument. Parents and the clowns were interviewed about the children’s participation. This preliminary report presents a case study of one of the children who participated in the study. The level of playfulness after the intervention increased compared to the baseline, including social skills, use of humour and pretend play, flexibility and engagement. The mother’s interview indicates the unique gains of the clown’s intervention. The preliminary results point to the importance of clowning and free-play for children with ID, and expand the possibilities for interacting with children with ID to enhance their socio-emotional abilities.

Disaster zones-should we be clowning around?

Medical teams in disaster areas may benefit from the presence of medical clowns. What is known about this topic: • Medical clowns are used for alleviation and distraction in painful and distressful medical procedures and treatments. Its positive effect on patients, and their families are well established. • This is the first description of medical clowning in a disaster area. In addition, the impact of medical clowning on the medical staff working in a disaster area is evaluated. No previous studies have explored the impact of medical clowns on the medical staff.